November 2022

Pre-inspection audits are crucial to your business in preparing for a CQC inspection. Understanding what the CQC expects from regulated providers will ensure that you are prepared and can demonstrate that you are delivering Good and Outstanding care.  In this article, ClouDoc offers you a range of criteria and guidance to help managers better understand how to prepare for an inspection. From the time between inspections to the CQC’s Five Key Questions, it’s essential to maintain consistent awareness of CQC expectations. The Care Quality Commission website offers further information about preparing for a CQC inspection.

Why Are Pre-inspection Audits Important?

Pre-inspection audits allow you to evaluate your service provision against actual standards. They are measured against the same standards the CQC use, including the Key Lines of Enquiry (KLOES) and their Five Key Questions – Safe, Effective, Caring, Responsive and Well-led. A pre-inspection audit will provide detailed feedback from a different perspective and allow you to take a step back, reflect and review your service. Post-inspection, you can formulate specific action plans for improvements and further support your team’s knowledge and confidence. A pre-inspection audit can highlight actions for specific team members that the inspector may talk to and can also allow you to prepare service users, as inspectors may also speak with them. By evaluating your service in the same way the CQC does, you can adapt and prepare to best secure your opportunity of a Good or Outstanding rating. The Skills for Care website offers further information on preparing for a CQC inspection. 

When Will the CQC Inspect Me? 

To attain Good and Outstanding ratings from the CQC, it’s crucial to understand what they expect from regulated providers. The CQC will use your previous practice rating to determine when to next inspect your service. Before an inspection, an inspector will contact you to announce the inspection, and a letter will be sent to confirm the date. You should be alerted of this with two weeks’ notice and display the comment cards and posters that are supplied in the letter.

The table below offers an overview of the duration between inspections, dependent on your previous rating:

The Five Key Questions

There are Five Key Questions that the CQC will ask your care service. These questions are central to how they regulate and help them make sure they focus on the things that matter to people.

• Are they safe? 

The CQC will investigate whether people are protected from abuse and avoidable harm.

• Are they effective?

They will want to ensure that your care, treatment, and support achieve good outcomes and helps you maintain a good quality of life. This is based on the best available evidence.

• Are they caring? 

Do staff involve and treat people with compassion, kindness, dignity, and respect?

• Are they responsive to people’s needs?

The CQC will investigate the responsiveness of your service to meet people’s needs.

• Are they well-led?

The CQC will investigate the organisation’s leadership, management and governance to ensure it provides high-quality care based on your individual needs, encourages learning and innovation, and promotes an open and fair culture.

How the CQC use the Five Key Questions

Each of the Five Key Questions is broken down into a further set of questions. The CQC call these their ‘Key Lines of Enquiry’. When they conduct inspections, they will use these to help them decide what they need to focus on. For example, the inspection team might analyse how risks are identified and managed to help them understand whether a service is safe. The CQC use Key Lines of Enquiry in different sectors. Using the KLOEs helps them ensure they’re consistent in what they look at under each of the Five Key Questions and then focus on the areas that matter most.

Common Compliance Factors Affecting Providers Agencies During Inspections

Common factors that can hinder your CQC rating include: 

• Good at providing care but poor at evidencing it.
• Lack of investment in quality protocols which demonstrate compliance.
• Policy in paper and not in practice,
• Quality protocols are in place, but the data is not used to improve services. Training, learning and mentoring are in place but not adequately evidenced. For example, only face-to-face training is evidenced, sometimes without specific learning outcomes/details relevant to the role.
• No clear audit trail linking strategic goals to deliverable actions.
• Poor systems in place for the recruitment and retention of staff.
• A disproportionate focus on profitability over client outcomes
• The staff team is unaware of KLOEs and how their day-to-day work is relevant to these. 

Recommendations From Good and Outstanding Providers

In 2017, the CQC reported that significant numbers of new care providers failed to meet the standards in their first inspection. This highlights the importance of new services being better prepared for inspection. Poor inspection ratings for a new service can be damaging, especially if they’re trying to raise their profile, attract new staff and win new contracts. A poor inspection rating for already established services can impact staff retention, reputation, and relationships with other services.  Providers who have received Good and Outstanding ratings have compiled a list of recommendations that can help prepare your service:

• Read the CQC key guidance around the fundamental standards. Ensure managers and leaders fully understand their responsibilities.
• Download and use the adult social care assessment framework with the sources of evidence for the key lines of enquiry from the CQC website.
• Maximise the opportunity presented by the CQC ‘provider information process’, ensuring you keep regularly updated and reflective of the latest practice.
• Where you’ve had a previous inspection, review the report and ensure that any areas for improvement have been successfully addressed.
• Review CQC inspection reports from other services to identify good and poor practices. Analyse how this insight can help your service to deliver better care.
• Engage with other services to see what they’re doing to deliver high standards of care. You can do this by arranging visits or via registered manager networks.
• Consider different ways to involve those who work and engage with your service to identify areas of good practice, for example, team meetings, appraisals, surveys, meeting with healthcare specialists etc.
• When recording good and best practice examples, always consider what the positive outcomes are for people who require care and support.
• Plan for mock inspections or robust quality assurance. Focus on all areas that may be considered part of the CQC inspection.
• Where areas of improvement are identified before the CQC inspection, prioritise these and invest time and resources in resolving any issues.
• Ensure that documenting, reviewing and reporting is standard practice for everyone working at the service. Be prepared to provide evidence and ensure this is a consistent priority.
• Ensure all those managing the service can access the evidence and documents at all times.
• Consider compiling good practice examples, positive feedback and other success stories into a file or resource to share with the CQC inspector.
• Regularly check that managers, leaders, staff and those that engage with your service are confident about the CQC inspection process.
• Ensure you’re open and honest in all your engagement with the CQC. 

Care Agency Media offer a team of expert CQC compliance consultants that maintain up-to-date knowledge and experience to support you and your staff. Their pre-inspection audits help you ensure that your services meet the fundamental standards and that you’re prepared for your inspection day. Their understanding CQC workshops offer an introduction to CQC training, covering all the key areas that need to be addressed to ensure compliance with the Fundamental Standards and Key lines of Enquiry.