The consequences of failing to adhere with Care Quality Commission’s regulatory framework for registration
The CQC can reject registration applications during the initial checks prior to it being submitted to a registration inspector for assessment. This process is called ‘validation’ and is usually completed within five working days of receipt by the CQC. It should be noted that this is not a rejection of the application itself, but an alert that the application is ‘incomplete’ i.e. missing information or requires amendment and resubmission before it can be assessed. In such instances, the CQC will typically return the application and attach the relevant forms for completion and return. Examples include absence of location details or discrepancies between the provider and associated manager details.
Once past this hurdle, the application will be assessed by a registration inspector. There is no specific timeframe within which this will take place; it depends on various factors, such as the availability of the inspector to conduct a site visit and the nominated individual and/or registered manager’s availability for interview. Assuming there are no delays, you should receive a CQC decision no later than 10 weeks after validation. The application will either be granted by way of a Notice of Decision (NoD) or refused by way of a Notice of Proposal to Refuse (NoP).
By virtue of Section 12 of the Health and Social Care Act 2008, the CQC has the power to refuse a registration application if it is satisfied that “the requirements of regulations under section 20, and the requirements of any other enactment which appears to the CC to be relevant, are not being and will continue to not be complied with (so far as applicable) in relation to the carrying on of the regulated activity”.
Often, the CQC will issue a NoP because it is not satisfied that a number of the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 will be complied with. Examples include concerns over medicines management, staffing arrangements or even the proposed manager having been deemed as not being a ‘fit and proper person’ to manage the regulated activities.
A NoP is exactly that – a notice. Before confirming the refusal, the CQC must issue a NoP detailing the reasons for refusal. An applicant has 28 calendar days from issue of the NoP to make written representations against the NoP.
Written representations are an applicant’s opportunity to respond to the CQC’s concerns, and it is here where we can be of great assistance in reviewing the concerns and drafting appropriate representations. It is imperative any representations carefully address all of the CQC’s concerns in a clear and thorough manner. The applicant can, at this stage, supply the CQC with additional evidence or information in support of their written representations. Examples of details that can be included in a response are amended internal policies, external inspection reports and even photographs to demonstrate that the issues raised by the CQC have been addressed. It is important to remember that this is not an appeal, because a final decision has not been made. This is an opportunity to persuade the CQC to grant the registration application.
Once received, the CQC will put the written representations before their National Representations Team (NRT) for consideration. A decision is usually made within 20 working days, commencing from the next working day after receipt of the representations. In some instances, the NRT may feel that they require more information from the applicant or the team that issued the NoP. The CQC usually allow 7 days for the information to be supplied, and if necessary, give the applicant or the team that issued the NoP another 7 days to comment on the new information provided.
If the written representations are accepted, the NoP will be withdrawn and sent back to the Registrations Team for further consideration. If they are not accepted, then the applicant will receive a NoD, with reasons, and the right to appeal to the First-Tier Tribunal as per Section 32 of the Health and Social Care Act 2008. Should an applicant wish to submit an appeal, this must be submitted in writing within 28 calendar days on which the NoD was served. Again, we are well-versed in dealing with such matters, and can assist and guide you through the process.
If you have received a Notice of Proposal or Notice of Decision from the CQC, we have a specialist team of CQC lawyers who can help you through the entire process, please do get in touch.
Shannett is a Partner in the Regulatory Team providing regulatory advice predominantly in the health and social care sector. She is also a member of the private prosecutions team providing advice to individuals, business and charities in respect of prosecutions were traditional agencies are unwilling or unable to act.
Naa-Adjeley Barnor joined Kingsley Napley in August 2019 as a Legal Assistant in the Regulatory team. Naa-Adjeley investigates and prepares fitness to practise cases relating to professional misconduct, convictions, ill-health and lack of competence on behalf of the Health and Care Professions Council (HCPC) and General Optical Council (GOC).
 Care Quality Commission, Registration under the Health and Social Care Act 2008: Written representations against Notices of Proposal and Appeals to the Tribunal against Notices of Decision and urgent cancellation orders - Guidance for registered providers and managers and applicants for registration, Care Quality Commission July 2020
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