Its 7am, the doorbell rings and stood on the doorstep of your care service are two CQC inspectors ready and eager to go through your Home with a fine tooth comb. The natural reaction of your staff team, including the Home Manager is probably to panic but that is the worst thing that you can do.
Whilst providers roughly know when to expect unannounced inspections they are, by their very nature, a surprise. The point is that the CQC want to descend on a service at a time when it is operating as it normally would. This usually happens early in the morning during a typically hectic flurry of morning bed changes, serving of breakfast and administration of medication.
The CQC will observe practice, speak to service users and their families and review care documentation. Their presence can be intimidating to some staff but it is essential that providers prepare their staff adequately for an inspection and ready them for how an inspector will interact with them and what they will be looking for.
I have seen, on many occasions, draft inspection reports that state that staff did not fully understand something when questioned by the CQC inspector. The service is then deemed to be non-compliant in this area because it has not been proved that staff are competent in their understanding of a particular issue. This usually relates to the service’s safeguarding policy or the concept of mental capacity (as staff can often find these issues quite complex). When a draft is received that makes such a statement a service will challenge the CQC and say that the policies that are in place are clear on the matter in question and staff are fully trained in order to execute the policy, however, if the CQC has questioned a staff member who has felt uncomfortable or lacks confidence in their own knowledge and ability, then it will be concluded that the staff member simply did not know the answer. This is obviously unfair but can be easily avoided and thus limiting the impact on a service’s overall rating.
Full mock inspections are an excellent way to prepare staff for a visit from the CQC. These should include staff interaction and be as close to the real thing as possible. After standard training sessions staff should be questioned on their learning in the same way that the CQC would make an enquiry during an intensive and pressured review. Listening to and developing these answers will go some way to building staff confidence and assuring them that the knowledge is there – it simply needs to be accessed.
Services might also consider challenging staff, periodically, to show them where they would find specific documents, where certain keys are kept or for basic information about service users without reference to documentation. All of this is preparatory work that will not only prepare them for an inspection but also improve their skills generally.
Having a culture of transparency, staff feedback and whistleblowing will ensure that any concerns that the staff team have are addressed effectively at a local level which will hopefully negate the desire for staff to make direct complaints to the CQC either at or around any inspection. Such concerns often find their way into inspection reports and can be used as evidence that a service is not well-led or that there is an issue with the quality of care being provide. Staff should feel as though the management team are approachable and will listen to their thoughts.
Reducing the “shock” of an unannounced inspection is vital in empowering staff to relax and do themselves justice when an inspector calls. Care staff work extremely hard but probably are not familiar with the intense levels of scrutiny that can be associated with a CQC inspection. They will feel exposed, at risk and responsible for the overall success of the day. Managerial support and assurance given on an ongoing basis should help staff to be able to show the CQC just how talented they are and that the people in their care are treated safely and with dignity.
