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Compliance is a buzz-word right now, with many enquiries coming in on how we can support providers to maintain compliance within their service. This is great news, as it shows that providers are really working hard to ensure a high quality service is delivered and they want to be able to have evidence to back it up.

Compliance was one of our most popular enquiries when we visited the Home Care & Residential Show at the Excel Centre last month. Whilst there, we were able to see many different types of services supporting not just care delivery but how to maintain compliance in difference ways, whether it be from the CareTech that is branching out and how Data Protection comes into this, to how to support Nutrition and Hydration to promote service user health and wellbeing. Compliance is not just about following the rules and regulations, although exceptionally important, but also includes being creative and thinking of ways to promote the health and wellbeing of your service users so that they can reach their full potential and have a better quality of life. The vast range of equipment, technology and services now available can be a mine field, but there is one common denominator – compliance. It can be hard to know which way to turn if you are struggling in any aspect of maintaining compliance but to be forward thinking and seeking advice when you need it is a great place to start.

As you all know, the Care Quality Commission (CQC) have a duty to monitor and inspect care services to ensure they are providing services that are in line with Fundamental Standards, Industry Regulations and UK Law.

CQC have set out five areas on which they currently assess care providers and these are:

Is the service safe? – asking whether staff and service users are protected from harm and live and work in safe environments.

Is the service effective? – asking whether the care, support and treatment achieves good outcomes, based on the service user’s needs? Are the service users encouraged and supported to reach their full potential? Are staff well trained?

Is the service well-led? ­– asking whether the management of the organisation is competent, promoting a culture of openness and honesty, striving for the highest quality of care and support, encourages learning and development amongst staff, etc.

Is the service responsive? – asking whether the service is responsive to service user’s needs. Is the service organised and adaptive? Do management encourage and listen to feedback, compliments and complaints and make changes in response?

Is the service caring? ­– Do the staff treat service users with kindness and compassion? Are they showing respect and protecting the dignity of those they support?

These are known as the 5 Key Lines of Enquiry (KLOEs). They form the basis of CQC’s current inspection regime and they will not only look at the documents you can provide and what you tell them, but also seek feedback from the service users you support, their family members and your staff team.

Every provider wants to ensure the best care is delivered to their service users but maintaining a happy and committed staff team is crucial in facilitating great care. Juggling the vast aspects of a care service is tricky and we admire all our providers who work hard and strive towards the coveted ‘outstanding’ rating. Thinking outside of the box and going beyond supporting daily living tasks when it comes to care delivery can help to achieve this.

Compliance really starts from the ground up. We are finding that smaller organisations who are just starting out are focusing heavily on compliance before they accept any care packages and this helps to ensure all aspects of compliance are being followed from the start. 

It is much easier to maintain in this way as you can highlight ways to improve and this often allows a better relationship to be formed between management and care staff, management and service users & care staff and service users. It creates an open and honest work culture because providers want to be made aware of any aspect of care delivery or service management that needs improving as soon as possible, so it can be put right. Care staff appear to be happier when their managers are approachable and encouraging them to develop and this ultimately leads to better outcomes for the service users. If staff are not supported or feel they are over worked and/or not appreciated, this can create friction and dips in performance. It can lead to increased absences which can be costly to the service and affect how the service users view those responsible for their care delivery. Following the COVID-19 pandemic it became all too obvious how much we need our care staff and how much work is needed to show how much we respect and appreciate the work that they do. It can be argued that your care staff are the most important part of a well-run service and must be supported accordingly if you want to maintain compliance.

If a service is not well managed or organised then it will be difficult to stay compliant because it needs consistent monitoring. A provider can work towards compliance by having the following:

• Robust recruitment checks to ensure the staff you select are appropriate for the role. Ongoing, your staff need to be well trained and have regular supervisions/competency checks.
• Risk assessments and well developed policies and procedures to ensure safety in all areas.
• Quality assurance practices such as auditing, service user & staff feedback/compliments/complaints to inform and improve your practice.
• Safe systems for storing/using/disposing of waste, hazardous substances and medications; with evidence to prove it.
• Good record keeping systems that are secure and consistent.

Provider Information Return (PIR) forms are requested by CQC each year to maintain compliance. The PIR forms the basis of your CQC inspection of your service as it details how your service runs, including any changes made and how you ensure you meet the 5 Key Lines of Enquiry. CQC recently changed their approach to inspections, and there are now a few different ways your service could be inspected:

Comprehensive inspections are holistic and in-depth, looking at the service as a whole. You may be contacted in advance for a comprehensive inspection or it may be unannounced. Usually, a comprehensive inspection will be required where there are concerns and risks to the safety or wellbeing of service users, or where the service has deteriorated in the quality of the service provided. Where a service might have received a rating of ‘inadequate’ or ‘requires improvement’ in the past, a comprehensive inspection could be carried out to see if there have been any significant improvements.

Focused inspections are looking at specific key lines of enquiry that may have required improvement or been inadequate in the past. This type of inspection will not be looking at all 5 key lines of enquiry, but may for example, focus on whether the service has improved in terms of being ‘safe’ and ‘well-led’. These inspections are more targeted and may be to follow up on a previous inspection or in response to specific information and concerns that have been raised. They are smaller than a comprehensive inspection but often follow the same process. This type of inspection can contribute to a change in your rating, and are normally unannounced.

Targeted inspections are smaller still, and are carried out to assess a particular risk or concern that has been raised. They do not look at a key question in its entirety, more so they are looking at the enquiries within a key question that raises concerns. These inspections are also usually unannounced and can take place before a focused or comprehensive inspection. Further concerns or significant improvements during a targeted inspection can lead to a focused or comprehensive inspection taking place.

Combined inspections are for services who may deliver services across both health care and social care. As these services are inspected in different ways, CQC aim to combine their inspection process to alleviate the burden on providers. Each service will be inspected by a specialist and the reports and ratings from each service combined to give an overall rating.

CQC’s website contains a wealth of material and resources to support compliance and providers should be familiar with the KLOE’s and associated guidance to help them stay ‘on the ball’ when it comes to compliance.

How can CQC Experts help?

Our team are friendly and knowledgeable. Visit our website if you need any support or advice on how you can maintain compliance within your service. We may be able to help you by providing high quality policies and procedures, helping you with your Provider Information Return form, if you have received enforcement actions from your last inspection or want to work towards increasing your rating. We have staff development and performance related documents to support the growth and development of your care team and we also have toolkits to support you to carry out your own mock inspection and where necessary, highlight any areas for improvement within the key lines of enquiry.

For further information about our compliance services visit our website.

We are always available if you want some friendly advice from experts who have been through inspection and compliance processes themselves.