1. Trade Associations meeting
Adult social care
Trade Associations meeting
13 July 2016 1 1

2. Agenda Welcome and introductions Deborah Ivanova 10.00
Agenda item
Lead
Time
Welcome and introductions
Deborah Ivanova
10.00
Minutes and actions from last meeting
10.05
Ratings and updates
Learning disabilities services
Inadequate services
DCA registration changes (correction)
Care home closure document publication
Factual accuracy update
10.15
Issues raised by Trade Associations
10.45
Next phase: Safe and Caring
Ronald Morton
11.00
AOB
11.25
Implementation meeting
11.30 2

3. Welcome and introductions

4. Minutes and actions from last meeting

5. Ratings and updates

6. Current ratings overall and by key question for active locations
Current ratings up to
30 June 2016
Note: Figures in chart are percentages
Source: CQC ratings data

7. Current overall ratings by service type
Source: CQC ratings data

8. Current overall ratings by size of care home
Note: One inadequate rated residential home has been omitted due to data quality issue
Small = 1-10 beds, Medium = 11-49, Large = 50+
Source: CQC ratings data

9. Current overall ratings by size of domiciliary care agency
The chart to the right presents data we have for DCA locations that have been rated and the number of people using the service.
There is a trend suggesting that locations providing care to a smaller number of people are performing better than larger services.
This analysis is only based upon 1,682 rated DCA locations.
The chart to the left provides an overview of 3,418 DCA locations, around 40% of the services registered with CQC, and the number of people using the service.
Note: The grouping on the x axis is as follows; 25 is 1 to 25 people, 50 is 26 to 50 people and so on.
Source: CQC ratings data and CQC community PIR data from May 2016

10. Overall ratings by publication quarter
Residential social care ratings, by publication quarter
Calendar quarter
Inadequate
Requires improvement
Good
Outstanding
2015 Q1
186
666
1,048 7
2015 Q2
192
896
1,304 4
2015 Q3
174
927
1,277 15
2015 Q4
164
878
1,514 13
2016 Q1
190
979
1,816 18
2016 Q2
127
678
1,254
Residential social care ratings, by publication quarter
Calendar quarter
Inadequate
Requires improvement
Good
Outstanding
2015 Q1 27
153
313
2015 Q2 19
387 3
2015 Q3 28
183
470 2
2015 Q4 29
225
728 13
2016 Q1 41
284
869
2016 Q2 93
Source: CQC ratings data

11. Overall ratings by region (rated locations)
Figures in chart are percentages of rated locations
Source: CQC ratings data

12. Learning disability ratings analysis – current ratings up to 30 June 2016

13. Current ratings for services learning disability services
Source: CQC ratings data

14. Current ratings by type of learning disability service
Source: CQC ratings data

15. Ratings maps: Inadequate adult social care services – current ratings up to
28 June 2016

16. Nursing Homes rated inadequate
CQC current ratings at 28/06/16. Percentage of care homes with nursing rated inadequate

17. Residential Homes rated inadequate
CQC current ratings at 28/06/16. Percentage of care homes without nursing rated inadequate

18. Domiciliary care agencies rated inadequate
CQC current ratings at 28/06/16. Percentage of domiciliary care agencies rated inadequate

19. All adult social care rated inadequate
CQC current ratings at 28/06/16. Percentage of all ASC locations rated inadequate

20. Update: Domiciliary Care Agency change of address
From 11 May, single location domiciliary care agency providers that change address will not be treated as a new application and they will keep their rating.
Previously shared that this would be applied retrospectively, however, we have been notified that this is something that is being explored opposed to having already been implemented. 20

21. Update: Care home closures document publication
Hoping to launch the care home closures document next week – date to be confirmed.
This is the piece of work that we are joint producing with NHS England, and other signatories, including ADASS, Local Government Association, Department of Health and Care Providers Alliance.
A lot of wider engagement activities will be happening to raise awareness, and from a media perspective, we’ll be focussing on opinion pieces on behalf of Andrea:
Local Government Chronicle
Guardian Social Care Network
bi-annual column in the Caring Times. 21

22. Update: Factual accuracy
From our Provider handbook:
The Factual Accuracy process gives Providers the opportunity to challenge the accuracy and completeness of the evidence on which the ratings are based.
Any factual accuracy comments that are accepted may result in a change to one or more ratings.
Registered persons have 10 working days to review draft reports for factual accuracy and submit their comments to CQC. 22

23. Quality assurance and factual accuracy
Our Quality Assurance Programme identified some improvement areas these include:
Consistency
Design of the Form
Sign posting non Factual Accuracy responses
Variations in format
Guidance 23

24. Factual accuracy: phase 1 (1)
Phase 1 of the project is underway.
Initial improvements – an updated form, including:
Cover sheet with guide on raising comments:
Before publication – via Factual Accuracy Form
After publication – as outlined in Final report letter
Conduct of Inspection
Representations 24

25. Factual accuracy: phase 1 (2)
Sections for
Typographical/numerical errors
Accuracy of existing evidence
Additional evidence for completeness
Coming soon:
Updated Guidance
Note: Providers are encouraged to submit comments via the form provided to facilitate a timely response. 25

26. Issues raised by trade associations

27. Issues raised by the trade associations
Delays in re-inspection especially of requires improvement services (Ann Mackay)
Complaints handling by CQC (Duncan White)

28. Safe and Caring key lines of enquiry, prompts and characteristics

29. Safe and Caring: The questions
We are considering prompts around use of the finances of people who use services i.e. protection from financial abuse. What sources of evidence should we look at?
What are your views about including restraint and duty of candour in Safe?
Caring
The majority of services are Good or Outstanding for Caring. What evidence should we focus on to get to the heart of the caring question?
How do we understand domiciliary care services are caring when we cannot see care being given?

30. Co-production feedback
Key lines of enquiry and Characteristics should be simplified in both presentation and content.
Safe:
How well a service protects people from abuse and avoidable harm
Personal outcomes – feeling and being safe
Caring
How well a service involves people and treats them with compassion, kindness, dignity and respect
Personal outcomes – treated well and respected

31. Key changes for Safe Learning from our inspections
Service user finances – no key lines of enquiry or prompts around this.
Is the question “do you feel safe” the best question to ask people using services?

32. Key changes for Safe Cross sector alignment (proposals)
Restraint and Duty of Candour included in Safe
Key learning from internal and national reports
Services rated Good had business continuity plans and e.g. seasonal risk assessments
Merge key lines of enquiry and reduce overall number:
S4 How are people’s medicines managed so that they receive them safely?
S5 How well are people protected by the prevention and control of infection?
‘Are there reliable systems, processes and practices in place to keep people safe and safeguarded from abuse’

33. Key changes for Caring Learning from our inspections
Specific prompts for individual personalised care
Evidence currently reported under Care is quite limited
Current key topic areas:
Staff approach/kindness
Confidentiality
Involving people
Privacy and dignity
Wellbeing
End of life care
Advocacy
Equality and diversity

34. Key changes for Caring Cross sector alignment
Suggestion from other sectors that Advance Decisions should be moved from Caring to Effective.
Key findings from internal and national reports
Services rated as good accommodated the spiritual and cultural needs of people at the end of their life:
Adapted the service provided.
Care plans included people’s preferred place of care at the end of their life.

35. Key timelines – what happens next
Share initial findings
May 2016
Internal and external engagement
April- July 2016
Proposals and drafting
Summer 2016
Jan–Mar
Sign off for new handbook
March 2017
Publish revised inspection framework and handbooks
November 2016
Field test/consultation

36. AOBs

37. Implementation meeting