Care Quality Commission (CQC) – Registration, Regulation and Enforcement

Challenge a refusal or proposal to cancel registration

Registration with the CQC is required for any person who, or organisation that, provides a regulated activity in England. Failure to register with the CQC when providing a regulated activity constitutes a criminal offence under section 10 of the Health and Social Care Act 2008.

Once an application for registration is made to the CQC, it must consider whether the applicant is fit to provide services and comply with the regulations. If the CQC is not satisfied as to these issues, the application for registration may be refused.

Following an inspection, should the CQC consider that a service provider is no longer fit, it may serve a Notice of Proposal to Cancel Registration. Upon effect of the Notice, the service will be closed.

In either circumstance, we can help. Prompt action is required as representations are time-sensitive. We will work with you to provide the critical advice and assistance that you need and to progress the matter swiftly to an appeal, should it prove necessary.

Challenge a Warning Notice

If it appears to the CQC that a service provider is in breach of the regulations, that care has fallen below the legally required standard, or a breach of a registration condition has occurred, it may issue a Warning Notice pursuant to section 29 of the Health and Social Care Act 2008.

You will have an opportunity to make representations about the matters in the notice, but this must be done within 10 working days.

Whilst the CQC does not routinely publish the full content of any Warning Notice, any information which is published can have a detrimental effect on the reputation of a service provider. Further, enforcement action can attract a fine.

We will guide you through the process and prepare written representations which can make all the difference.

Deal with conditions of registration

The CQC can also impose conditions on a service provider’s registration in circumstances where there are issues as to the delivery of a regulated activity. Such conditions can have a commercial and reputational effect on your business and therefore require a swift and careful response.

In circumstances where the CQC issues a Notice of Proposal to impose a condition on registration, you have 28 days to make representations. We can advise on the strength of the CQC’s case, prepare the representations and liaise with the CQC, in a collaborative manner, if considered in your best interests, and progress the matter to an appeal, should it prove necessary.

Challenge an inspection report

The inspection process is very important: the inspectors will speak to members of staff and observe care whilst bearing these five questions in mind regarding the service:

1. Is it safe?
2. Is it effective?
3. Is it caring?
4. Is it responsive to people’s needs?
5. Is it well-led?

Following an inspection, the CQC will issue a draft report which will include detailed commentary about the service, a rating in each domain and an overall rating.

You will have the opportunity to challenge any factual inaccuracies at this stage, but this must be done promptly, as the report will be made public soon thereafter. This can be a very important step in the process if there are inaccuracies or omissions which may enhance a rating or the overall tenor of the report.

We can assist by preparing the Factual Accuracy Comments form, which details any inaccuracies with supporting evidence.

We are adept at dealing with rating reviews in circumstances where the CQC has failed to follow its processes for making ratings decisions. Such requests must be submitted within 15 working days of the publication of the report and as such, early instruction of lawyers is advisable.

Should the CQC have failed to follow its own processes or some other legal requirement, or have acted in a way which is irrational, we can advise you on the merits of challenging them by way of a judicial review.

Lodge a complaint regarding the inspection process

The complaints process is entirely separate from the process to challenge the factual accuracy of an inspection report. The CQC’s National Complaints Team will consider and respond to matters which relate to issues such as:

• Unprofessional conduct of its staff
• Administrative errors
• A failure to follow procedure

We assist clients with drafting and submitting complaints to the CQC. We liaise with the CQC as to the complaint and provide evidence as required for the investigation.

Enforcement action and judicial review

The CQC has enforcement powers to meet its overarching aim of protecting the users of regulated services from harm and the risk of harm.

Where breaches of the regulations constitute a criminal offence, the CQC can:

• Issue a simple caution
• Serve a penalty notice
• Commence prosecution

Prosecutions are initiated in the Magistrates’ Court and can lead to convictions and considerable fines. We have extensive expertise in dealing with regulatory prosecutions. We will build a team of lawyers drawn from the Criminal Litigation Team as well as the Regulatory Team, meaning that the most specialist lawyers will be involved in securing the very best possible outcome.

In circumstances where you remain dissatisfied with the outcome of an inspection report/rating following the factual accuracy process, the available remedy is judicial review.

Review and/or improve governance and compliance

We are able to work closely with trusted consultants. As a collaborative team we have vast experience in compliance, as well as knowledge and understanding of governance and CQC requirements.

Our work in this area is directed towards turnaround management solutions and assessing compliance in accordance with CQC regulations. We can assist you by:

• Preparing action plans to achieve compliance in accordance with CQC standards and guidance;
• Auditing and reviewing policies and procedures;
• Arranging mock inspections with full feedback; and/or
• Assisting you to complete a full suite of CQC compliant policies and procedures ahead of registration applications.

Deal with concerns as to CQC fit and proper persons requirements

One of the measures used by the CQC to ensure safety and quality of services is that directors of registered providers and any employed staff must be “fit and proper” to enable them to provide the regulated activity. This requirement is contained in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The CQC can take action in circumstances where there are concerns that a registered provider is run by or employs unfit people.

We will guide you through the process providing pragmatic and straightforward advice to deal with any concerns and/or handle any enforcement action.