It’s great to have the opportunity to write for readers of Care Management Matters. As this is my first column, I’ll begin by telling you a little about my role. I’m CQC’s Deputy Chief Inspector of Adult Social Care for the North region. This means I lead the inspection teams working everywhere from the Wirral up to Berwick-upon-Tweed. I’m also the strategic lead for CQC’s enforcement work, a vital part of our role.
We register, monitor, inspect and rate all services that fall within our scope, so you will all be familiar with this part of our role. Although four out of five services in England are rated as Good or Outstanding, there is still too much poor care and where we find it we will use our enforcement powers to take action. I think of enforcement as a way of encouraging improvement – rather than a punishment – to make sure people receive safe, effective and high-quality care.
Since we began our new approach to regulation in 2014, we have matured in how we use and learn from our enforcement powers. Our civil powers ensure people remain safe and our criminal powers ensure we hold providers to account when there are serious failings. We’re taking more enforcement action and we know more about the risks that providers are least likely to act on. I want to share the issues we’re seeing regularly and talk about our plans to inform providers about them.
So, where have we been taking enforcement action in relation to the most serious incidents?
Issues with documentation have been a key theme. In one case, we found errors with anti-coagulant medication that linked to wide-ranging documentation failures including: medication dosages and strengths, allergy information, and medication administration times not being accurately recorded, plus poor systems of stock management leading to the service running out of essential medicines.
We’ve also seen problems with the quality and use of risk assessments. One care home was found to have no proper system for assessing the risks to the health and safety of people using the service, which shockingly included failing to prevent a person with visual impairments from repeatedly falling in their bedroom.
Failure relating to equipment has come up frequently. In one very upsetting case, a person living with dementia suffered burns after falling against a radiator where the provider had failed to ensure effective radiator covers were in place and pressure sensor mats were not used to alert staff to the person getting out of bed.
The final theme we’ve seen across a lot of our enforcement work is problems with staff training. One provider failed to bring to the attention of staff a national safety alert about the importance of safety/posture belts and to ensure that staff understood how to fit chair straps safely, which led to a person falling out of a shower commode chair.
Getting these things right are the basics of delivering good care; the impact when this doesn’t happen can have devastating consequences. It’s so important that we do all we can to protect people who use services from this type of harm. With this in mind, we are working to bring these issues to the attention of providers so that action can be taken to mitigate any risks they find within their own services.
How are we doing this? We’re currently developing a series of updates that will be shared via our newsletter and available on our website: Learning from safety incidents. We’ll share the risk, give an example of where we have taken enforcement action in this area, share how the provider has since taken steps to improve, and link this issue to our regulations and any relevant Medicines and Healthcare products Regulatory Agency safety alerts. The idea is to provide short, easy-to-digest summaries that providers can use to support their risk management, and stop other similar incidents happening in the future.
We’re testing these updates with providers on our Online Community to make sure that the information and format is useful. When we’ve completed this testing and made any changes, we’ll share them in our newsletter later this year.
I hope that gives you a taste of CQC’s enforcement work and how it enables us to encourage services to improve.
Debbie Westhead is Deputy Chief Inspector of Adult Social Care at the Care Quality Commission. Sign in to share your thoughts on Debbie’s column and suggest topics for future CQC columns on the CMM website www.caremanagementmatters.co.uk Not a member? Sign up today.