1 Changing the way CQC regulates, inspects and monitors care

2 Our purpose and role Our purpose We make sure health and social care services provide people with safe, effective, compassionate, high-quality care and we encourage care services to improve Our role We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety and we publish what we find, including performance ratings to help people choose care We will be a strong, independent and expert inspectorate that is always on the side of people who use services

3 Adult social care vision The Mum Test Is it safe? Is it caring? Is it effective? Is it responsive to people’s needs? Is it well-led? Is it good enough for my Mum?

4 Our new approach

5 Mental Capacity Act and Deprivation of Liberty Safeguards Duty to monitor the use of the Deprivation of Liberty Safeguards Inspect and report on services’ approach to meeting the Mental Capacity Act code of practice In particular, we look at how and when capacity is assessed and how decisions are recorded in compliance with the Mental Capacity Act Included in our prompts and descriptions of ratings for safety, effectiveness and caring

6 Making the Mum Test Real Communication

7 What will be different?

8 Timetable Co-production and development to shape consultation proposals Oct 2013 – March 2014 Consultation on regulatory approach, ratings and guidance April 2014 Wave 1 pilot inspectionsApril – May 2014 Evaluation; guidance and standards refined. July – Sept 2014 Wave 2 pilot inspections and initial ratings of some services June 2014 Oct 2014 New approach fully implemented and indicative ratings confirmed March 2016 Every adult social care service rated 4 June: Consultation closes

9 Inspection principles

10 What will be different? Intelligent monitoring Provider information return Questionnaires – community services Sharing information with external partners Inspections 6 months – 2 years Tailored inspection teams Increased use of experts Experts by Experience Specialist Advisors

Our key questions and key lines of enquiry We will no longer focus solely on whether providers are compliant or non-compliant with regulations Our focus is on the five key questions about services: Is it safe? Is it effective? Is it caring? Is it responsive? Is it well-led? 11

Principles for our key lines of enquiry For each of the five key questions there are mandatory key lines of enquiry There will be additional key lines of enquiry based on: An inspector’s knowledge of the service Information available The inspectors professional judgement They support consistency of what we examine under the five key questions and focus on those areas that matter most Key lines of enquiry are supported by guidance on the ‘key things to consider’ as part of the assessment – these are called prompts 12

Safe By safe, we mean that people are protected from abuse and avoidable harm. In adult social care, this means that people are supported to make choices and take risks and are protected from physical, psychological or emotional harm; abuse, discrimination and neglect. Key line of enquiry example: How are people protected from bullying, harassment, avoidable harm, abuse and breaches of their human rights? 13

Effective By effective, we mean that people’s care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence. In adult social care, this means that people are supported to live their lives in the way they choose and experience the best possible health and quality of life outcomes. Key line of enquiry example: How are people’s needs and choices for care, treatment and support met? 14

Caring By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect. In adult social care, this means that people, their families and carers experience care that is empowering and provided by staff who treat people with dignity, respect and compassion. Key line of enquiry example: How are positive, caring relationships developed with people using the service? 15

Responsive By responsive, we mean that services are organised so that they meet people’s needs. In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected. Key line of enquiry example: How do people receive personalised care that is responsive to their needs? 16

Well-led By well-led, we mean that the leadership, management and governance of the organisation assure the delivery of high-quality care, supports learning and innovation, and promotes an open and fair culture. In adult social care, this means that people get the care they need, are listened to and have their rights and diverse circumstances respected. Key line of enquiry example: How does the service promote a positive culture that is person centred, open, inclusive and empowering? 17

18 Ratings

19 Four point scale High level characteristics of each rating level Innovative, creative, constantly striving to improve, open and transparent Consistent level of service people have a right to expect, robust arrangements in place for when things do go wrong May have elements of good practice but inconsistent, potential or actual risk, inconsistent responses when things go wrong Severe harm has or is likely to occur, shortfalls in practice, ineffective or no action taken to put things right or improve

20 How key lines of enquiry and evidence build towards ratings Intelligent monitoring and local information Pre- inspection information gathering On-site inspection Speak to staff and people using the service Key lines of enquiry (mandatory plus additional KLOEs identified from information held) Gather and record evidence from all sources Define the questions to answer Write report and publish alongside ratings Outstanding Good Requires improvement Inadequate Apply consistent principles, build ratings from the recorded evidence Make judgements and build ratings

21 How do we decide a rating?

22 To what do we give ratings? Services will be rated at two levels: level one - we will use our rating methodology and professional judgement to produce separate ratings for each of the five key questions level two - we will aggregate these separate ratings up to an overall location rating using ‘ratings principles’

23 Principles The five key questions contribute equally to the overall location rating. Overall ratings are produced using the following principles: If two or more of the key questions are rated ‘inadequate’, then the overall rating will normally be ‘inadequate’ If one of the key questions is rated ‘inadequate’, then the overall rating will normally be ‘requires improvement’ If two or more of the key questions are rated ‘requires improvement’, then the overall rating will normally be ‘requires improvement’ At least two of the five key questions would normally need to be rated ‘outstanding’ before an overall rating of ‘outstanding’ can be awarded

24 Rating limiters

25 Other ways to share your views Consultation: 9 April to 4 June 2014 Get involved: Web form at Provider online community: join at

26 Thank you