The care home sector in the spotlight

In March 2019, older people’s charity, Independent Age, raised a number of issues relating to worsening quality of care homes. In this blog we address how care homes are regulated and the issues highlighted in the report by Independent Age.

Regulation of care homes

Care homes, including residential and nursing homes in England are regulated by the Care Quality Commission (CQC) – a public body sponsored by the Department of Health and Social Care. Care homes are required to register with the CQC, and as part of the registration process, they need to demonstrate compliance with a set of requirements in the area of standards of service quality and safety.

Following registration, the CQC will conduct regular inspections and give ratings, which regulated care homes are legally required to display on their premises. As such, the inspection process is of vital importance to the home’s reputation.

During the initial inspection, the CQC will consider whether a care home and the services it offers are suitable, whether there are enough staff members and whether they have got the right skills, qualifications and experience to carry out their work. The CQC will also assess matters such as the effectiveness of a care home’s policies (e.g. data protection and health and safety), its systems and procedures, how the home is run and how it plans to make decisions.

The CQC has a list of five questions they ask of all care services:

1. Are they safe? The CQC will focus on whether people in care homes are protected from abuse and avoidable harm.
2. Are they effective? The CQC will consider whether the care, treatment and support received by service users achieves a good outcome, is evidence-based, and helps residents maintain quality of life.
3. Are they caring? The CQC will assess whether care home staff are involving residents in decisions about their care and whether they are treating service users with compassion, kindness, dignity and respect.
4. Are they responsive to people’s needs? The CQC will assess whether services are organised to meet the needs of service users.
5. Are they well led? Lastly, the CQC will consider whether the management and leadership of a care home makes sure it is providing high quality care based around  individual needs, whether it encourages learning and innovation, and whether it promotes an open and fair culture.

During an inspection, the CQC will follow key lines of inquiry, which are closely based on the five questions. After the inspection takes place, the CQC issues the inspected care home with a draft report, which includes a narrative and ratings. A care home receives ratings for each of the five key questions as well as an overall rating. The ratings are either outstanding, good, requires improvement or inadequate.

When an area of concern is identified in the report, a care home must respond by developing an action plan to address such concerns and make improvements. The CQC will follow-up on any actions they tell the provider to take, by either contacting a care home or carrying out a further focused inspection.

Independent Age

The report by Independent Age raised a number of issues relating to worsening quality of care homes. The report compared publicly available CQC inspection data from January 2018 and January 2019 to identify the percentage of care homes that are either “Inadequate” or “Requires Improvement”. The report found that ratings worsened for more than a third (37%) of local authorities in the UK, compared to a 22% drop in quality of care for years 2017 to 2018. It also found that there were 16 local authority areas across the UK where between 30% to 40% of care homes were rated as “Inadequate” or “Requires Improvement”. For example, in Portsmouth and Manchester, 4 out of 10 care homes received these ratings. The findings indicated that 2.6 million older people are more likely to face a poor choice of care home.

Enforcement action

If a care home fails to meet the CQC’s quality and safety standards, the CQC has the power to take enforcement action. The type of action depends on the seriousness of failings and can have an effect on the home’s ability to run its services.

The CQC can take the following enforcement actions:

• Requirement or warning notices, which set out the list of improvements that a care home needs to make and deadlines for implementing them;
• Making changes to care home’s registration, which might involve imposing limitations on what services a care home may provide;
• Placing a care home under special measures, which entails close supervision of the quality of care provided;
• Simple caution, which is a formal written record that an offence has been committed, usually issued instead of prosecution. A caution is kept on record and is taken into account when the CQC considers future enforcement action;
• Fines;
• Prosecution in cases where people are harmed or at risk of harm.

How we can help?

The CQC will take a swift action when it identifies concerns with respect to safety and quality of care home services. It is important that care homes engage in the communication with the CQC, as not responding to concerns raised might have significant consequences. The CQC’s underlying remit to protect service users means that it will not shy away from using its enforcement powers where it sees fit.

We provide specialist advice in relation to inspection reports, complaints about the manner in which inspections are carried out and proposed enforcement action. If you require assistance or a confidential initial discussion, please contact us.