ASK THE EXPERT: Challenging the CQC

Philippa Doyle, health and social care associate at legal advisor Hempsons, offers helpful advice on responding to CQC inspections.

The CQC would have you believe that the Factual Accuracy response to inspections is a dark art, especially if you try and use the boxes on their form. But you don’t have to. You can write what you want to write on a blank sheet of paper and this in itself can give your submissions clarity, force and weight.

The Factual Accuracy response is a provider’s main opportunity to right any wrongs. The CQC would have you believe that all you should be commenting on is where, for example, they have got the number of nurses wrong in your report, but actually this is your opportunity to challenge anything and everything, including the rating!

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The ability to challenge the report, though, is no substitute for ensuring that on the day(s) of inspection, you give the inspectors access to everything they need to see and know, and if they don’t ask for something you think is obvious, then volunteer the information, because once the inspectors have ‘left the building’, the ability to provide further information is somewhat limited.

The Factual Accuracy response is not just about correcting typographical and grammatical errors, or inaccuracies in the number of nurses. It’s also about the tone and inferences that can be drawn in what is written and the way it’s written.

An inspection report is designed to be a fair and balanced reflection of the service on the day of the inspection. This can be unfortunate if you happen to have had several members of staff call in sick on the same day, so your reliance on agency staff is higher than usual.  However, it can also be an opportunity to showcase how your organisation’s business planning, induction and training programmes kick into life and that staff sickness will not disrupt the organisation.

An inability to access information that is stored centrally at head office should be prompted by offers to visit head office, or to call someone at head office so that they can talk an inspector through a process. If information is not available upon request, or is not immediately visible, this needs to be addressed head on while the inspector is still in the building, as rectifying this after the event can be difficult.

Our experience in challenging CQC reports has been mixed. The first line of response is with the lead inspector. Some will respond well and many changes will be made. Others do not take kindly to what they see as criticism of their report and changes, if any, will be minimal.

Do make your submissions by reference to:

The Fundamental Standards

The CQC Provider Guide

The CQC Enforcement Guide

Tell a story in your submissions. Explain how and why you do not consider that the description in the report describes your service and/or, notwithstanding any shortcomings identified, does not justify a particular rating, as it is not compatible with the Provider Handbook descriptions.

Don’t ever say that you are not funded enough to provide a particular level of service or that a report ‘isn’t fair’, but do use language such as ‘disproportionate’, especially if you think you have been scored harshly as a result of only one incident.

And so then what do you do? Until very recently our advice has been to lodge a complaint with the CQC complaints team at the same time as submitting the Factual Accuracy Response, and ask the CQC to consider the complaint and the Factual Accuracy Response in conjunction with each other. A dissatisfactory report can stem from a difficult inspection where a rapport was not established with the inspector.

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