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Emergency support framework: discussion questions for adult social care services

  • Organisations we regulate

The conversation with your inspector will focus on four areas. The questions are for the inspector to answer, helped by the discussion prompts. This helps us to understand how you are managing currently and whether you need support with anything. Your inspector may not need to cover all the questions as things may already be clear, so you don’t need to spend time preparing for them.

1. Safe care and treatment

1.1 Are infection risks to people using the service being thoroughly assessed and managed?
  • How do you keep up to date with current Infection Prevention and Control (IPC) guidance/practices?
  • Have you needed to review and develop your IPC arrangements in response to the pandemic – have you needed to make any changes?
  • How are changes in IPC and other guidance and processes being communicated to staff?
  • How is COVID-19 and other IPC-related training and support being provided?
  • How are the particular IPC risks to BAME (Black, Asian and Minority Ethnic) people being assessed and managed?
1.2 Does the service have the resources to obtain, and have reliable access to, all supplies, personal protective equipment and COVID-19 testing it needs, for both staff and people who use the service?
  • Are you able to get hold of supplies of the right PPE and equipment?
    • Are you confident that you understand what standard of PPE is required for your service?
    • Are your stocks of PPE of an appropriate standard and suitable for use in a care setting?
    • Are you able to reliably get hold of enough of the right PPE to meet your needs?
    • if no, what needs to be improved?
  • Do you know where to get PPE supplies and information?
  • Have you been able to arrange accessible testing for staff and users when needed?
  • Have results been received in a timely way?
1.3 Does the location’s environment and layout support preventing and containing transmission of infection?

For care homes/houses in multi-occupation being used as supported living schemes:

  • What changes have you made to your premises to reduce cross-infection risks?
  • Can your premises enable/provide:
    • The 14-day isolation period for people moving in from hospital or another social care facility?
    • Isolation for people who have tested positive/are being treated for COVID-19?
    • Secure walking and exploring for people who like to be active?
    • Outside socially distanced visiting for friends and relatives?

      For homecare (DCAs) and other locations:

      • Socially distanced working arrangements for staff and visitors?

        For all locations:

        • Access to hand gel / hand washing facilities?
        • Facilities for staff to safely put on and remove PPE before, during and after work?
1.4 Are working arrangements and procedures clear and accessible to staff, people who use the service, their supporters, and visitors to the service?
  • Where changes were made so that the service could provide care to both people with and without COVID-19 symptoms or confirmed diagnoses:
    • how do you share information about health and safety risks with staff, people using your service and any visitors?
    • how do you ensure staff, people using your service and visitors understand the arrangements (for example signage, accessible information, information on your website)?
    • how have you supported vulnerable people and those with communication requirements i.e. accessible information needs?
  • Have you made any changes to your arrangements for supporting people at the end of their lives?
    • In particular in relation to contact with family and friends?
  • What arrangements have you made in relation to visits from contractors and essential visitors such as maintenance providers and healthcare workers?
1.5 Are medicines being managed safely and effectively?
  • Have you been able to ensure that:
    • The right medicines in the right doses and quantities are available to people at all times?
    • Medicines are stored and transported safely?
    • Any errors are noted, addressed and learned from?
    • People who administer their own medicines can continue to do so?
  • Have you had any challenges when working with your local healthcare professionals, including community pharmacies?
1.6 Are risks to the health and wellbeing of people using the service being properly assessed, monitored and managed?
  • Are your risk management arrangements coping with assessing, managing and continuously reviewing:
    • COVID-19 risks
    • Other new and existing risks?
  • Have you taken any new action in response to new and emerging risks, including but not limited to those posed by COVID-19?
  • Have there been any significant events related to COVID-19 or other new risks? If yes, how is learning from these being identified and shared?

2. Staffing arrangements

2.1 Are there sufficient numbers of suitable staff to provide safe care and treatment in a dignified and respectful way?
  • If the pandemic has affected your ability to staff the service, what action have you taken to manage this?
  • Have you been able to make sure that people get care and support from workers with the right knowledge and skills?
  • How are you making sure that new staff and any volunteers have been safely recruited and appropriately inducted?
  • How are you ensuring that staff are working in a way that respects and maintains people’s dignity?
  • How are you proactively supporting staff who may be at increased risk of getting COVID-19 (including: Black, Asian and Minority Ethnic (BAME) colleagues, older colleagues, pregnant women, returnees, people with underlying health conditions)?
  • Have you had to ask for staffing-related support from any system partners?
2.2 Are there realistic and workable plans for managing staffing levels if the pandemic or other causes lead to shortfalls and emergencies?
  • Do you have plans for responding to unforeseen and critical staff shortages?
    • Have you had to put those plans to use? If so:
    • Did they prove effective?
    • Are they financially sustainable?
  • How would you escalate concerns if you were unable to provide a safe service?
  • Have you engaged with local system arrangements and agreements for staff sharing and other contingencies?
    • do you have confidence in the arrangements?
    • if you’ve used them, did/are they proving effective?

3. Protection from abuse and protection of human rights

3.1 Are people using the service being protected from abuse, neglect, discrimination and loss of their human rights?
  • How are you managing restrictions that might deprive people of their liberty? (Note: not just relating to managing COVID-19)
  • How are you ensuring that Mental Capacity Act Code of Practice requirements are continuing to be met during the COVID-19 restrictions?
  • How do you ensure that people’s diversity and human rights are recognised and respected?
  • Has the pandemic affected your ability to protect people?
  • How have you enabled people to stay in contact with family and friends? (methods, frequency.)
  • Have you had to physically restrain or seclude anyone during the pandemic period?
3.2 Are the service’s safeguarding and other policies and practice, together with local systems, properly managing any concerns about abuse and protecting people’s human rights?
  • Have you or your staff had any safeguarding concerns since the pandemic began? If yes:
    • Were they escalated appropriately, referred to local safeguarding systems, and investigated properly?
    • Were they notified appropriately to CQC?
    • What was the outcome?
    • What was learned, and has this led to any changes to minimise the risk of recurrence?
  • Has safeguarding-related training and mentoring continued during the pandemic?
  • Have your local safeguarding arrangements and systems remained effective?
  • How have you identified and supported particularly vulnerable people during the pandemic? (for example, older isolated people, victims of domestic abuse, children who are at risk etc).

4. Assurance processes, quality monitoring and business risk management

4.1 Is the provider monitoring and protecting the health, safety and wellbeing of staff?
  • How are you supporting and protecting the health and safety of staff during the pandemic?
  • How have you managed challenges to staff wellbeing during the pandemic?
  • Have you taken steps to understand and respond to the particular needs of staff from BAME communities as a high-risk group during the pandemic?
  • Where staff have been asked to take on delegated healthcare tasks, how do you make sure that they are confident and competent to do so?
  • How do you make sure staff are getting the emotional support they need at this particularly difficult time (for example counselling)?
4.2 Does the provider have effective systems and methods for monitoring the overall quality of the service and for responding to business risks and issues as they arise?
  • How are ‘business as usual’ processes and systems being managed?
  • Has the pandemic affected your ability to monitor the overall quality of care?
  • Are there any unique pressures that are challenging your usual quality monitoring systems?
  • How are you keeping up to date with relevant standards and guidance relating to the delivery of care during the pandemic?
  • Have you been able to develop effective contingency plans relating to COVID-19?
  • Have any areas of improvement been identified and actioned?
  • Do you have any particular concerns about the financial viability of your service at this time?
  • Would you be ready for a second ‘spike’ in COVID-19 infection rates?
4.3 Is the provider supporting staff and people who use the service to raise any concerns and give feedback?
  • Have you put any extra measures in place to support and encourage speaking up and providing feedback?
  • How are you ensuring that leaders are accessible to staff and service users when needed?
  • How have you managed to promote team working, for example, team meetings?
  • Have any areas of improvement been identified and actioned?
4.4 Is care and treatment provided to people being properly recorded?
  • Has the impact of the pandemic affected the ability of staff to keep records?
  • Do staff get the information they need to provide care and support?
  • Has the impact of the pandemic led to changes in how records are kept and shared?
  • Are you experiencing any barriers to sharing or accessing information with other providers or commissioners?
4.5 Is the provider been able to work effectively with system partners when care and treatment is commissioned, shared or transferred?
  • How effectively is information being shared across the system?
  • Is planning and partnership working effective? For example:
    • effective hospital discharges?
    • coordinating care with other partners (for example GPs, district nurses, local authorities, etc.)
    • How often are care package reviews being carried out?

Indicators we will use to assess risk

Your inspector will use their knowledge of your service and will look at some specific indicators for the data that we hold to help decide what risk you are facing. These will evolve as the situation changes and we will update them as needed.

Residential care (predictive modelling):

  • Registration: regulated activities; location ownership type; location service user age; location max service user; provider size; provider registration change count; nursing vs residential homes.
  • Notifications and enquiries: safeguarding incidents; complaints; abuse; police callouts; DoLs notifications; injuries; deaths; unexpected deaths; whistleblowing.
  • Registered manager: registered manager needed/not needed; registered manager days absent in 12 months prior to inspection; registered manager yearly absent rate over lifetime of location.
  • Local Indicators: CCG complications with diabetes; local authority; region; unemployment (%); ASCOF indicators relating to adults with learning disabilities; total hospital admissions based on 5 conditions.
  • Demographic: Percentage of resident population over 85; postcode population size.
  • HES data: For example pressure sores; pneumonia; accidents/injury; dehydration; heart failure and the remaining diagnosis groups.
  • Other: history of inadequate/requires improvement rating; length of time location open in days; mean FSA rating over 24 months prior to inspection.

Community care (risk modelling):

  • Registered manager (Y/N)
  • Current overall rating
  • Months since rating published or months since registered (if a service has not been rated)
  • Rating change
  • Safe rating
  • Effective rating
  • Caring rating
  • Responsive rating
  • Well-led rating
  • Number of complaints in past 12 months
  • Number of whistleblowing reports in past 12 months
  • Regulatory status (In breach or compliant)
  • Count of red and amber ASC Insight flags
  • Count of notifications in past 12 months
  • Provider Information return data
Last updated:
01 July 2020