Professional Comment

What Are the Issues Being Raised About CQC Inspections?

As care providers express concerns about the stress caused by Care Quality Commission (CQC) inspections, Carl May-Smith, a Barrister specialising in health and care at UK and Ireland law firm Browne Jacobson (, examines the issues and offers advice for operators.

The National Care Association (NCA) has reported a ‘considerable rise’ in calls received following CQC inspections, with conversations detailing negative experiences.

In a letter to the CQC’s CEO Ian Trenholm, it said there were ‘deep concerns’ from members about the stress caused by inspector visits on care staff amid a recruitment and retention crisis, while it accused the regulator of presiding over a culture that is ‘hostile at the ground level’.

Issues raised by the NCA reflects what we have heard from our care home clients, which cite the current inspection regime and culture as one of their primary challenges. It mirrors recent, more high-profile, criticisms of the Ofsted inspection regime in education.

The data suggests ratings have been adversely affected since the regulator has greatly reduced routine inspections and this has continued under its new inspection framework.

The data suggests this is affecting ratings. In the month to 22 April 2024, the proportion of care homes receiving ‘requires improvement’ ratings was 41%, while those rated ‘inadequate’ was 24%. Traditionally, we would expect these to be about 18% and 1% respectively.

In the NCA’s letter, it references comments from a care home manager about the gruelling nature of a recent inspection and the need for the utmost preparation.

Our advice has always been to take a proactive approach to managing inspections, and experiences of those on the ground suggests this has never been more critical.

What is new about the CQC’s inspections?
The CQC’s refreshed assessment framework was introduced this year as part of its new strategy launched in 2021.

One of the key changes in the strategy is the move away from reliance only on set-piece inspections to regulate and rate providers.

Inspections now generally take place in response to concerns, with a broader set of data collected from services on a more regular basis, allowing ratings to change more responsively.

The rationale behind this, it said at the time of the strategy launch, was to reduce inconsistencies that can arise from over-reliance on the view of a lead inspector on a single day.

In reality, routine inspections have greatly reduced. Where inspections are carried out, they are generally to address concerns and providers should expect these will be challenging.

First impressions count in a proactive approach to inspections
It is often said that a CQC inspector’s first impression can set the stage for a whole inspection process.

This first impression may well have been formed before a visit commences where potential risks have already been identified

Our advice to providers is to ensure they are proactive in mitigating potential CQC concerns when they arise, to avoid being on the back foot from the moment an inspector walks through the door.

With this in mind, it’s essential to bring frontline staff who will interact with the CQC up to date with the new assessment framework, which has replaced hundreds of lines of enquiry with fewer than 40 areas across the five domains: safe, effective, caring, responsive, and well-led.

It’s also important that staff understand inspectors’ priorities, which will likely focus on services where there are concerns and are of current CQC focus, recently including restraint, fire safety and duty of candour.

Many providers, particularly larger organisations, will carry out self-assessments and these should also be reviewed to mirror the new framework.

Preparation is everything
As part of the increased focus on services with concerns, greater emphasis has been placed on observations of care, such as medicine rounds.

Providers are now expected to share information such as policies, procedures and safety records in advance of, rather than during, visits.

Losing the opportunity to explain any issues to an inspector in person means managers must be prepared to do this on a remote basis.

Frequent reviews of paperwork will enable them to identify any potential red flags on the horizon so they can provide context and mitigation when requested to provide information.

Positive engagement with families and staff
Another key priority for the CQC is to gain a greater understanding of people’s experiences of care.

This has not yet been matched with a methodical approach to collecting feedback, with inspectors increasingly contacting service users, their family members, staff and even commissioners before and after inspections take place to gather this intelligence.

They are asking specific questions about individual concerns raised during visits and the result is one negative account can have a disproportionate effect on inspection outcomes.

It’s therefore vital that providers open positive communication lines via regular engagement with these stakeholders.

Collecting feedback is good practice anyway as it helps with internal quality assurance, but in the context of inspections, data can provide evidence to challenge conclusions based on individual complaints. It enables providers to demonstrate they are listening and addressing issues.

If an employee feels an inspector’s question about staff capacity is their first opportunity to have a voice, they may vent on this and other issues.

But if the provider has adopted a proactive approach to gathering feedback and taking action, they are more likely to support their employer.

Stay in the loop
Along with keeping on top of everything internally, providers should keep abreast of what’s happening in the external environment via a proactive relationship-building strategy.

With the CQC now assessing local authorities and soon integrated care systems, commissioners are also under the inspection microscope. Providers should be aware of conversations that could be taking place between commissioners and inspectors to understand how this might affect them.

Being proactive in communications with local inspectors is integral to avoid any ‘reactive inspections’ that could be prompted by concerns raised by various parties.

More broadly, as the sector gets to grips with the CQC’s new approach to inspections, much can be learned from peers.

Keeping in touch with other providers, whether directly or via forums such as Browne Jacobson’s Health and Care Connect, helps with understanding best practice and shared challenges to avoid making similar mistakes.