Legal Opinion

Infection Prevention and Control: The CQC’s approach

Laura Hannah, Partner, Stephensons Solicitors

It would be an understatement to say that 2020 had been a difficult and challenging year for the adult social care sector. The emergence of a global pandemic brought about significant change to the way in which care homes had to operate, as well as the way in which the Care Quality Commission (CQC) monitored and regulated registered care locations.

Infection prevention and control (‘IPC’) became an even more important aspect of the operation of a care home and a bigger part of the CQC’s own regulatory function. The CQC introduced IPC inspections across care locations in England in order to monitor care providers’ approach to the management of infection prevention control. It was reported by the CQC that these inspections were intended to capture good practice and to follow up in locations where there may be risks to residents. The results from those inspections were published and were accessible by the wider public and it was made clear that IPC checks would be undertaken at all future inspections moving forwards. In October 2020, the CQC reported that they had already completed over 400 IPC inspections in the adult social care sector and committed to a further 500 by the end of November 2020.

In November 2020, the CQC published its report, ‘How care homes managed infection prevention and control during the coronavirus pandemic 2020’, which outlined their findings from the published IPC inspections so far. The report showed that, of the 139 ‘risk-based’ inspections undertaken between 1 August and 4 September 2020, the CQC were ‘not assured’ or only ‘somewhat assured’ by 35% of those care homes’ use of PPE. Furthermore, the CQC were ‘not assured’ or only ‘somewhat assured’ by 38% of those care homes’ IPC policies and 32% in respect of shielding and social distancing. However, the CQC were assured by between 76% and 78% of care homes in respect of IPC for visitors; safe admissions; and access to testing.

What does an IPC inspection involve?

The length of an IPC inspection will depend on the size of the service. The inspector will use the set of questions and prompts within the key lines of enquiry document to help them gather the information they need to formulate their judgments. The questions and prompts relating to IPC are set out at key line of enquiry S5.

The CQC’s IPC inspection reports are slightly different to what a provider would usually receive following a comprehensive or focused inspection. Instead of the usual five key questions, the IPC inspection reports set out the CQC’s judgements and ratings in eight different areas, including:

  • Visitors
  • Shielding
  • Admission
  • Use of personal protective equipment (PPE)
  • Testing
  • Premises
  • Staffing
  • Policies

In addition, the ratings differ from the usual ‘good’, ‘requires improvement’, or ‘inadequate’ to confirm whether the CQC are assured, somewhat assured or not assured in respect of each area. A ‘somewhat assured’ judgment is usually given where minor issues are identified with a provider. However, as with the usual inspection reports, providers are given 28 days to challenge any factual inaccuracies in the IPC report before it is published. This is an important step and should be utilised by all providers where the IPC report does not accurately reflect the position of the inspected service on the day of the IPC visit by the CQC. Any such challenge should also be supported by the relevant documentary evidence.

Where the CQC identify concerns with a care provider’s IPC practices, the CQC can decide to take enforcement action against that provider. This could involve issuing a warning notice, the imposition of conditions on a provider’s registration, or in the most serious of cases, the suspension or cancellation of the provider’s entire registration, or a criminal prosecution.

In light of the ongoing Covid-19 pandemic, there is no doubt that IPC will remain a key part of the CQC’s inspection and monitoring in 2021 and it is therefore vital that providers ensure that they have effective IPC in place and that the appropriate actions are taken to mitigate the risk of cross-infection. However, where shortfalls in a care home’s procedures are identified, prompt remedial action is vital to protect the residents from the risk of infection and to limit any enforcement action taken by the CQC.

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