Staying One Step Ahead

Demystifying quality assurance and the CQC

In my experience, many providers and managers of residential or home care services associate the term ‘CQC’ with inspections (usually unannounced), panic and anxiety, unwarranted interference and disruption, anger and resentment, reports and ratings, and a range of other activities processes, thoughts and emotions (most of them negative). However, having worked as both a CQC inspector, and as a consultant supporting adult social care providers and managers over the last few years, I believe that such an attitude towards the CQC is both unhelpful and misplaced. It’s unhelpful because, like it or not (and many providers and managers definitely do not like it) the CQC is here to stay (for the time being at least), and getting angry, resentful, and so on, is simply going to make the whole inspection process more difficult.

But more importantly, in my view at least, such an attitude is misplaced because it misses the point of what the CQC is actually doing when it monitors and inspects services. Essentially, what the CQC does when it comes to inspect your service is to engage in what I would describe as ‘high-level quality assurance’; in other words, it is mapping-out quality across the whole of your service, and using the five domains and the twenty four key lines of enquiry (KLOEs) as a way to facilitate this mapping-out process. More importantly, perhaps, this process of mapping-out quality in a structured way is the essence of any quality assurance (QA) process, not just the one used by the CQC. Furthermore, there is a lot more to the work of the CQC than just inspections, report writing and giving ratings. In fact, these activities are only part of a much wider monitoring framework that is under constant development by the CQC.

It is with all these thoughts in mind that I have recently published a short book (in digital format) that aims to address these and many other related issues. I have entitled it Staying One Step Ahead firstly because I want to convey the idea of ‘staying ahead’ of the CQC in the sense of having a better understanding of how it operates, and why.  Secondly, and perhaps more importantly, ‘staying ahead’ is about being more proactive and in control when it comes to managing quality and the whole QA process across your service.

This book is not a ‘how-to’ step-by-step manual, but rather an attempt to demystify and clarify a number of key concepts within the field of quality assurance, culture and management. In my experience, many providers and managers seem to treat QA as if it’s a matter of audits and surveys, the results of which are then quickly filed away somewhere and forgotten. Furthermore, and as I suggested above, many providers and managers view the CQC’s role with suspicion and resentment, and as far as they are concerned the main thing is to get the inspection out of the way as soon as possible and then get back to the core business of running a care home or home care service. If they get a positive report with positive ratings that’s all well and good, and if they get a poor report and poor ratings then the focus is on addressing the specific issues highlighted in the report and then quickly moving on.

What is often noticeably absent in these situations is any clear understanding of why the CQC monitors and inspects the way it does, and how this relates to the broader quality assurance framework, and the wider questions of culture, management and leadership. There is also often little or no time devoted to examining and analysing the inspection reports in any real detail, beyond taking note of specific issues that need to be addressed before the next CQC inspection.

Summary of chapters

Chapter One is an introduction to the concept of quality assurance and how this relates to the wider question of organisational culture. The core argument here is that QA is a way to ‘map-out’ quality across a service or part of a service, in a formalised, structured way. At the same time, though, it is also a way to ‘map-out’ the culture of a service, which is why this chapter also explores the concept of ‘culture’ in some detail and how it can be changed.

Chapter Two looks at the role of the CQC in providing a framework of monitoring and inspection for registered services, and, as indicated earlier, argues that the CQC is essentially engaged in ‘high-level quality assurance’. It explains how the CQC ‘breaks down’ quality into five domains and 24 key lines of enquiry (KLOEs), and uses this to ‘map-out’ quality across services. It also highlights the importance of finding evidence to back up any claims made about quality in a particular service.

Chapter Three looks at CQC reports and how these need to be analysed in some detail, rather than simply looking at the ‘headline’ findings and ratings. Although there is often a temptation amongst providers and managers to focus on ‘fixing’ any problems highlighted in a report, I argue that it is important to ask more searching questions about such findings and what they say about the underlying culture of the service. I also look at the question of ratings, and what they mean; and linked to this, the question of challenging a report.

Chapter Four explores the question of leadership and management, and why this is so important when it comes to building a quality service. It also looks at how the CQC inspects leadership and management; and the role of leadership and management in defining and sustaining a particular service culture.

Chapter Five discusses the concept of self-assessment and how this can be a useful way for managers and providers to ‘stay one step ahead’, both in terms of preparing for a CQC inspection and, more importantly, being able to constantly monitor quality in their services. It recommends that providers and managers use the CQC’s own Provider Information Collection system, which is currently being rolled out, as the basis for self-assessment; but that they also use some form of self-assessment tool to gather evidence of quality, based on the CQC’s domains and KLOEs, in a systematic way.