How to get the most out of inspection

How and why this was developed

The Adult Social Care Trade Association members, CQC inspection colleagues and members of the Outstanding Society came together to agree:

• What does a good inspection look like, for all parties?
• What are the common issues?
• If it goes wrong, why?
• Whether we could develop some agreed expectations and opportunities.

We wanted to work collaboratively to develop key principles and a shared understanding for providers and CQC inspectors that makes sure everyone can get the most out of inspection by:

• Clarifying common misunderstandings
• Removing any barriers to effective working
• Agreeing some mutual expectations

We saw we all wanted the same, so the following principles were easy to develop and agree.

What we heard

• There are key themes which run through each stage of an inspection for providers, inspectors and for both parties.
• Communication and consistency are vital to an inspection running smoothly and being valuable to all parties.

Key themes

There are some underpinning themes that apply throughout all stages of an inspection:

• Everyone is looking to achieve the same outcome; great quality care for people using services.
• Everyone has a role and it should be played professionally; with respect and dignity for all parties.
• Everyone needs to be thoroughly prepared. The inspector needs to understand the service, including pre-inspection analysis of the provider's information; and the provider should help everyone in their service to understand the inspection process and methodologies.
• The inspector will not predict the rating until all the evidence has been gathered and analysed; this will not be at the inspection. However, they will be open minded to all ratings, i.e. they will always be prepared to see outstanding care.
• Great communication is the key to a constructive, professional relationship, and all parties will provide regular opportunities for open and transparent input and feedback.

Make sure the inspection starts well – good communication is key

Both parties…

• On arrival everyone should be introduced and their role in the day agreed and explained.
• Both parties should agree their key contacts for the day; i.e. who is the most senior person on duty in the service; do they need or want to contact their manager?
• Opportunities will be agreed for open and regular dialogue during the day.
• Where possible, agree who will be present at the feedback and agree an approximate time; be prepared to change this if necessary but communicate well.

CQC…

• Explain the purpose and type of inspection planned.
• Describe the plan for the day but that the inspection may have to change as the day progresses. The lead inspector will keep the agreed contact person informed if changes are needed and why.
• Familiarise, and be aware of any activities planned for the day.
• Take into account the current staffing arrangements, including the implications of turnover and absence.
• Establish any 'need to know' information about the people using the service.
• Remember that the people working and using the service might well be nervous; try to put everyone at their ease and encourage the provider to showcase best practice.

Provider…

• Make sure the inspector has all the information they need about any risks, planned activities, staffing or people using the service.
• Reassure and empower care workers and other staff so they know what to expect and are encouraged to speak openly with the inspection team.
• Make sure, where possible, people using the service know what is happening and how they can be involved.
• Use the opportunity to ask questions and iron out any misconceptions or anxieties about the inspection.
• Get ready to use every opportunity to showcase best practice.

A positive inspection experience – good communication is still key

Both parties…

• Put the needs of people using the service first.
• As far as possible, be available for regular updates and to provide clarification where necessary.
• Treat everyone with kindness, respect and compassion.
• Use and refer to the methodologies provided by CQC to ensure consistency with other inspections.

CQC…

• Feedback should be given throughout the day and any immediate risks explained straight away.
• Questions should be asked in a clear way and explained or rephrased if not understood.
• Explain what is happening or being looked at and why throughout the day.
• Know when staying longer would be unreasonable and arrange a second day if needed.
• Inspect for opportunity and accept the provider's welcome.

Provider…

• Staff should be visible and, where possible, available throughout the day.
• Use every opportunity to show how good practice positively impacts people using the service.
• Empower and encourage everyone to be confident and welcome the inspection and inspection team members.
• Ask if worried or concerned about the inspection process.

A good end to the inspection – communication is still key

Both parties…

• Ensure proper time is set aside for inspection feedback.
• If necessary, arrange an alternative date and time, which is suitable and mutually agreeable.
• Discuss the evidence gathered, which will also include information from prior to the inspection day.
• If relevant, agree where and how additional evidence can be sent.
• Actively listen to each other and respect any differing views.
• Do not try to predict, request or share an indicative rating.

CQC…

• Summarise the key points; you will have had regular dialogue throughout the day.
• If immediate improvements are required, explain clearly what they are and why.
• Provide written feedback as per CQC methodology.
• Be clear on the next steps and timescales, i.e. what is the report process; what do providers do if they are concerned about the content or rating; will the inspector contact the provider at the point of the draft report; who to speak and how?
• Ask the provider for their experience of the inspection.
• Reassure the provider that should any additional evidence come to light arrangements will be made to share it as soon as possible.
• Thank the provider, staff and people using the service for their hospitality.

Provider…

• Use feedback as an opportunity to add anything that might not have been seen during the day.
• Ask questions for clarification if needed.
• Make sure you have enough detail about any concerns the inspector has raised with you.
• Seek clarification if needed about the next steps in the inspection process.
• If you are unsure, ask how CQC will make a ratings judgement.
• Offer to provide the inspector with feedback about what went well or less well during the inspection.
• Read and sign the feedback form to confirm receipt (this signature is to confirm provider has read and received a copy, not that you agree with the feedback given).