Even though we have already met and exceeded our 2025/26 target of completed inspections, we know there is more to do. We have spent time this year looking at ways we can be more effective and visit services more quickly to help turn our performance around.
Our programme of returning to adult social care services with an older rating of good is an example of how we are increasing regulatory contact with providers while reducing unnecessary burden. Following a pilot where we tested and refined our approach, we rolled out the programme in the early summer, focusing on services with a rating that is six or more years old, to confirm whether the rating remains accurate.
Not all adult social care services with an aged rating of good will meet the eligibility criteria. We are returning to services that are rated as good overall and good in all five key questions, and where there has been no indication of a change in rating. The service must have a registered manager, have no ongoing enforcement activity and not have added the service user band of ‘people with a learning disability and autism’ since it was last rated as good.
The approach applies to all care homes, including services for autistic people and people with a learning disability (if the registered provider was delivering care and support to this service user group when they were last rated as good), residential care homes and those providing nursing care. We will also use this approach for supported living services and homecare services.
Assessments using the approach focus on the importance of people’s experiences and outcomes from care, supported by our observations. These are backed up with reviews of records and other relevant documentation. The approach is more streamlined and, rather than inspecting the full suite of quality statements, the inspection focuses on 18 quality statements across all five key questions.
The impact of the approach
Initial figures indicate that inspectors can complete inspections more quickly, meaning that reports are published almost four weeks earlier than usual.
In the first few months of the programme:
- 92% of services assessed retained their good rating.
- 7% dropped to ‘requires improvement’.
- Two services improved to ‘outstanding’.
One thing I heard when speaking with providers and their representative organisations is a concern that the programme will not allow room for services to demonstrate improvement. Please be reassured that is not the case. Although we are looking for evidence of good-quality care, we deal with poor care robustly when we see it or hear about it – and will celebrate where we find outstanding care, where appropriate.
One such celebration was of West Eaton Nursing Home. This service in Herefordshire provides care for up to 33 older people, including those living with dementia and physical disabilities. Upon arrival, it was clear there had been significant improvement since the last inspection.
Everyone shared positive feedback and, within a couple of hours, the inspection team found evidence of outstanding care and agreed it should extend to a full inspection. This meant more quality statements were examined to consider the different ways in which staff and leaders were supporting the people they cared for and the lengths they went to, which would allow the rating to be updated. The effects were clear, with a relative commenting that West Eaton had given their loved one a reason to keep living.
As this approach progresses, we will continue to review feedback – both from colleagues and providers. I have been pleased to hear positive reaction from providers and their representative organisations. We have now passed 200 inspections in this programme and, to continually improve, we are asking those who have been involved to respond to a survey about the process.
In the meantime, we will continue to deliver more inspections with less administrative burden and a stronger focus on people’s lived experience. This is one way we are creating a more collaborative regulatory relationship.
For more analysis of CQC’s return to good approach, read CMM’s latest Navigating CQC blog from Quality Compliance Systems (QCS). Then share your thoughts on this Inside CQC by leaving a comment.
Chris Badger is Chief Inspector of Adult Social Care and Integrated Care at CQC.
Email: [email protected]
LinkedIn: @Care-Quality-Commission