How to fix an “inadequate” or “needs improvement” CQC rating

In an ideal world, all care homes would receive “good” or “outstanding” Care Quality Commission (CQC ratings). Unfortunately, we’re not there yet.

If your care home receives a disappointing CQC rating, it’s important to tackle the issues found at inspection as quickly as possible. Here, we’ll go over what happens when you receive a poor CQC rating, and how you can bring it up, fast.

‍What’s involved in a CQC inspection?

CQC inspections happen every one to five years depending on your current care home rating. They’re meant to make sure residents are looked after to a high standard, and that care homes are run properly.

After inspection, you’ll receive one of four CQC ratings:

• Outstanding. Your care home is performing exceptionally well.
• Good. Your care home is performing well and meeting CQC expectations.
• Requires improvement. Your care home isn’t performing as well as it should, and your inspector has told you what you need to do to improve.
• Inadequate. Your care home is performing badly, and the CQC has taken action against the person or organisation that runs it.

You’ll be assessed on the answers to five key questions (known as key lines of enquiry, or KLOEs) during an inspection.

1. Is your care home safe? 

“The service is provided in a way that ensures the safety and welfare of people who use the service. This includes protecting them from abuse and avoiding the transmission of infection.”

Do you protect service users, residents and staff at your care home from avoidable harm and abuse? You’ll need to prove you perform adequate, regular risk assessments, and show that your policies help keep residents safe.

We can break this KLOE into five parts:

• Protection from abuse and infection. Policies should help prevent incidents, reduce the transmission of illness and tackle adverse events properly if and when they do happen.
• Risk assessment. Your risk assessment and mitigation processes have to be robust and effective.
• Protection from avoidable harm. You need to prove that you protect residents from avoidable harm: falls, pressure sores and medication errors, for example.
• Incidents, accidents and complaints. Your incidents, accidents, complaints management and audit procedures must be clear and comprehensive. 
• Working in partnership. You need to work effectively with local authorities, safeguarding teams and other health and social care providers to ensure resident safety and welfare.

2. Is your service effective?

“Your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.”

Is the care, support and treatment you provide based on the latest evidence, and does it help improve quality of life for service users and residents? The CQC expects you to use the latest evidence and up-to-date guidance to make the best-possible decisions about resident care.

This KLOE has seven sections:

• Delivering evidence-based treatment. You need to assess residents’ physical health, mental health and social needs, and deliver care and treatment in line with legislation and guidance.
• Staff skills and knowledge. Your staff need to have the right qualifications, skills, training and experience to do their jobs properly. 
• Nutrition and hydration. You must offer residents the support they need to eat, drink and maintain a balanced diet.
• Working together. Members of your team should work together to deliver effective and consistent person-centred care and treatment.
• Providing support. You need to show that you meet residents’ day-to-day health and wellbeing needs, and refer them appropriately if and when necessary.
• Accessible premises. Residents should have access to meaningful activities, gardens and other outdoor spaces. They should also be able to spend time alone, or with visitors.
• Consent to care and treatment. You need to seek consent at every stage of the caregiving process, and make sure that residents know they have choices.

3. Do you treat residents with care?

“Staff involve and treat you with compassion, kindness, dignity and respect.”

Do the staff at your care home treat service users with empathy and give them emotional support if needed? Your inspector will look at the procedures you have in place to make sure you treat residents in a caring way.

There are three parts to this KLOE:

• Kindness, respect and compassion. You need to prove you treat staff and service users with care as they engage in normal daily activities and deal with sensitive situations.
• Care-focussed decisions. Residents need to be involved in decisions made about their care, support and treatment – and they need to feel they can express concerns and ask questions. 
• Privacy and dignity. You need to show that your staff can recognise when residents are uncomfortable or in physical or emotional pain, and that they know how to respond appropriately. 

4. Are you responsive?

“People's needs are met through the way services are organised and delivered.”

Do you tailor the care and support you provide to each resident’s individual needs? The CQC wants to see that you’re including residents in decisions about their care and that they have enough information to make informed decisions. 

We can split the responsive KLOE into three topics:

• People-focussed care. You need to demonstrate effective care planning and be sensitive to residents’ physical, emotional, mental and social needs, as well as any religious or cultural beliefs.
• Concerns and complaints. Residents and staff need to know that you’ll address their concerns. You need to have a robust complaints procedure in place and use incidents as opportunities for learning and growth.
• End-of-life care. You need to show how you explore and honour each person's end-of-life wishes.

5. Is there solid leadership?

“The leadership, management and governance of the organisation make sure it's providing high-quality care that's based on residents’ individual needs; that it encourages learning and innovation, and that it promotes an open and fair culture.”

Do leaders, managers and governors at your care home champion high-quality care, inspire staff, encourage innovation and promote an open, fair workplace culture? You need to perform risk assessments, look for ways to develop and have a clear strategy to improve standards of care.

The leadership KLOE has five parts:

• Promoting a positive culture. You need to provide high-quality care and support and promote a positive, person-centred, open, inclusive and empowering culture.
• Clear governance. Your framework must make responsibilities clear and prioritise quality performance, risks and regulatory requirements.
• Engaging and involving service users. The CQC expects you to consider the opinions of staff, clients, families and other people when developing services.
• Continuous improvement. You need to show how you use IT, training, development and other tools to continually improve services.
• Partnering with agencies. Your inspector will want to see how you collaborate with local authorities, safeguarding teams and healthcare providers.

You can read more about KLOEs at the CQC website.

What happens if you get a bad CQC rating?

If you get an “inadequate” or “requires improvement” rating at inspection, the CQC will introduce special measures. If things are really bad, the inspector could take urgent enforcement action on the spot.

You’ll get six months to improve standards

If you get a poor CQC rating, you’ll have six months to make changes for the better. After that, the inspector will return to see how you’ve improved.

You may be given another six months to bring your service up to par if you don’t improve enough in the first six months. However, the CQC will likely take steps to stop you from operating in the meantime. For instance, they might issue an embargo, which will stop you taking on new residents or service users.

What happens if standards don’t improve?

If standards don’t improve over the next six months, your care home might get shut down by the CQC, so it’s vital to follow all the instructions you’re given by the inspector. 

Remember – the CQC is on the service user’s side. While they’re not looking to shut down care facilities, they may take drastic action if they’re concerned about resident health or safety.

‍Tips to pass a CQC inspection

It can be demoralising to fail a CQC inspection. If you’ve been rated poorly, these three tips can help you turn your service around.

1. ‍Empower your staff

Inspections can make frontline staff feel really nervous, even if they’re doing a good job. You can flip the script by framing your upcoming CQC inspection differently:

• Instead of using fear-based language (for example “if we fail, it’ll be a disaster”), make the inspection an opportunity to show off achievements and get helpful advice.
• Encourage staff to tell you how they feel about the inspection, listen carefully to any concerns and, if appropriate, create an action plan for change. 

2. ‍Hold mock inspections

Mock inspections can flag things that need improvement before the CQC inspector arrives. These two companies can help you prepare:

• ‍Care Improvement Association (CIA)
• Quality, Management and Development Services (QMADS)

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3. Make the most of technology

Technology doesn’t have to be expensive or complicated – and it can save you time and money.

Using technology can also improve your CQC rating because inspectors look favourably on organisations that embrace innovation and learning. The right tech can help improve your services and reduce the time you spend on admin tasks.

How Florence can help

We’ve already mentioned tech; now, let’s get more specific.

Florence combines tech with friendly, personalised round-the-clock support to make life easier for you. 

When you sign up with Florence, you wave goodbye to paper files and say hello to digital profiles. You can create schedules, track compliance documents, save Florence favourites and view training documents online.

The CQC looks favourably on good-quality digital records because:

• They provide real-time information about care and support, so you can be more responsive when people’s needs change.
• They make it easier to share data quickly and accurately.
• They help minimise risks, like medication errors and missed visits.

Traditional agencies don’t always tell you in advance who’ll work a shift, and they often supply patchy records afterwards. With Florence, you can access a full, digital record of everyone who has worked at your care home. When inspection time rolls around, you have a comprehensive paper trail at your fingertips.

Here are five ways we help you make the most of existing staff, cut agency costs and improve continuity of care so that you can focus on your CQC inspection.

1. You get total control

You get 24/7 access to your schedule, no matter where you are. If someone calls in sick, for instance, you can send a last-minute shift to your favourite Florence worker from your smartphone.

2. Better continuity of care

CQC inspectors look carefully at staffing and recruitment whenever they visit a care home. Florence can help you maintain better continuity of care because you get the option to invite favourite nurses, healthcare assistants and support workers back again and again.

3. Improved engagement

The health and social care professionals who use Florence, rather than an agency, to find flexible shifts benefit from a better work-life balance. As a result, they feel more in control and more engaged with staff and residents at your care home.

4. Full accountability

You can use our smart rating system to rate your Florence nurse, healthcare assistant or support worker on a scale of 1–5 after every shift. Florence professionals know how important it is to be professional, and how much ratings affect future work potential.

5. Easy hiring

Want to hire a Florence nurse, healthcare assistant or support worker? No problem. You can employ any Florence professional permanently without paying a finder’s fee – after all, we’re here to help solve the healthcare staffing crisis, not add to it.

Moving onward and upward

Only a small percentage of care homes in the UK achieve an “outstanding” CQC rating, but many more are rated “good” – and that’s a rating you can feel proud of, too.

If you receive an “inadequate” or “requires improvement” rating at inspection, it’s important to boost standards at your care home. First, read through the five key questions we mentioned earlier, then make changes based on the recommendations you receive from your inspector.

Finally, consider swapping your agency for Florence to improve continuity of care, cut costs and save precious time. We’re on your side.

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Florence can help you schedule existing staff, find flexible nurses, care assistants and support workers to fill gaps in your rota, and provide essential training. Find out more and get started today.

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You might also be interested in:

• A new, free way to fill shifts with your own staff first
• Florence becomes founding partner of Championing Social Care
• We’re now a Scottish Care Preferred Supplier

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