CQC Inspection Methodology

Following on from the PIR article, this week I want to look at what CQC will actually do whilst they are on site with you; in other words, what is the “Inspection Methodology”?

This is taken directly from module 5 of Lead to Succeed, the Skills for Care leadership program that Grey Matter Learning is accredited to deliver. So let’s take a look at the methodology, as follows:

• Planning
• Gathering Feedback
• Talking to people
• Observation
• Talking to staff
• Reviewing records

Let’s look at each one in turn:

Planning. Firstly, CQC will plan their inspection before they arrive, using what you have put in the PIR. Using any feedback they have captured (notifications and alerts etc), they will also look at previous inspection reports and much more. This means that, by the time they arrive, they will already have formed opinions about your service and will have ideas about the kind of evidence they are expecting to see in order to form their judgement about your rating.

Therefore, it is vitally important to find ways of communicating with your inspector on a continuous basis so they have plenty of information available to them to support their planning process, but also so they have more than the “on paper” view of your service. For example, if you (or your team) came up with an idea that you felt would improve your service, why not share it with your inspector, who else has done this? Ask them if they think there are any obvious pitfalls or things you might have missed; alternatively, do they know anyone you could contact for advice?

Gathering feedback. This too will take place before the inspector arrives, in so much as they will talk to the people you support and sometimes your staff (using the information you put in the PIR) to collect objective feedback about your service and to contribute to the planning process. Bear in mind that they will not limit who they speak to, i.e. just to those people you include in the PIR; they are likely to include the Local Authority, commissioners, the safeguarding team, potentially the Fire Service or Environmental Health.

Talking to people. On the day, CQC will talk to the people you support (wherever possible) and so it would be prudent to discuss this with the people you support so that they know who the inspectors are, what might happen whilst they are there and what they are there to do. But rest assured, they will talk to as many people as possible to build a clear picture of your service, therefore this is going to include your staff. What can you do to prepare your staff? Have you seen the questions in the CQC document “Prompts and Characteristics”, because it contains lots of questions that might provide some clues:

Prompts and Characteristics

If we start to look at the order of the inspection methodology, we are halfway through and the manager(s) has not had a great deal of involvement. So if CQC are going to plan what they do before they arrive and gather feedback, as well as talk to the people you support, is there a way you can do the same? CQC have shared their “process”, their methodology, so let’s use it to prepare and make the actual day of inspection less scary for everyone.

I am sure you will have seen “How CQC regulate Adult Social Care”, but it has recently (at the time of writing) been updated and contains lots of useful information to support you to prepare.

How CQC Regulates Adult Social Care

We will share ideas on some of the tools you can use to do this in future posts, but the key here is preparation; like I said in our previous blog, don’t wait until two weeks before inspection to “get ready”, because there will be huge volumes of evidence available. All you need are methods for capturing it.

Observation. I am sure you are all aware of SOFI (Short Observation Framework for Inspection) which is “how” the CQC will carry out the observations. Some managers during the Lead to Succeed sessions have shared how they have had two (or sometimes more) inspectors and one “just sat in the lounge and watched what was going on” whilst the other inspector was with the manager or the staff.

For those of you who are familiar with Dementia Care Mapping, SOFI works in a similar way: recording observations every two minutes for a period of approximately 20 minutes to capture a holistic view of the service delivered and, most importantly, the reactions and interactions with the people you support.

So if CQC are going to “talk to people” and use “observation” as described above, can you do the same to get your staff ready for what is going to happen when the inspectors arrive? Many of the managers who have completed Lead to Succeed already use things like “spot checks” and “quality audits” to check performance. However, if during a team meeting you outlined to staff what is going to happen and how you’re preparing for it, then there is no need to worry when CQC are here – “just do what you normally do” should be the message. We are going to talk about “business as usual” in a future blog.

Talking to staff. This is the bit that most people find challenging. You know “that” member of staff that will say they have never had supervision, because you call them “one to ones” and CQC call it supervision (more about that in a future post too). Many managers have shared that one of the questions CQC are likely to ask is “what do you think of your manager?” I suspect this question is asked to find about “well led” and the KLOEs that support it, rather than whether or not people “like” their manager. Therefore, as we know that CQC are asking this kind of question, why not include it in supervision and support your staff with the answer?

However, there are a wealth of resources available from CQC that outline the questions the inspectors will ask. The five “key questions” are by their very nature questions and the CQC doc “sources of evidence” and the “KLOEs” all contain questions. So if we know that CQC are going to ask questions and we know what those questions look like, maybe we can start “practising confidence”. Confidence is key when staff are answering the questions that CQC ask. We therefore recommend, either in team meetings or during the spot checks we talked about earlier, ask your staff questions! In doing so, you can support your staff to be confident in their answers and you can coach them where appropriate, which is a great way to take the “nerves” out of the situation on the day.

Reviewing records. I always find it interesting that reviewing records is last in the list, but I also believe that it is last for good reason! CQC will do all of the above and build a picture of your service and THEN check that the paperwork matches up with what they have seen, heard and been told. This means there is a good chance that by the time they get to the paperwork they will already have a rating in mind and the paperwork is just an opportunity to find more evidence to support the rating they have in mind.

Follow the blog for future posts about each of the individual stages outlined here.