CQC Inspection Research Articles

Demystifying a CQC inspection

Demystifying a CQC inspection

1186 IMPROVED PERFORMANCE AGAINST SSNAP PARAMETERS FOR THROMBOLYSED STROKE PATIENTS FOLLOWING CHANGES IN PRACTICE

Abstract Background The CQC inspection of the Royal Lancaster Infirmary (RLI) in May 2021 rated the performance of the stroke department unsatisfactory, leading to a number of changes. A retrospective audit was performed to determine the impact of these changes for thrombolysed stroke patients. Aim This retrospective audit assessed the performance of the stroke department at the RLI against the parameters set by the ‘Sentinel Stroke National Audit Program’ (SSNAP), comparing 6-month periods before and after the CQC inspection in May 2021. Method Using electronic medical records and SSNAP data, we reviewed every thrombolysed stroke patient at the RLI between November 2020 until April 2021 and from May 2021 until November 2021, assessing 10 parameters and comparing the results with SSNAP targets. Since May 2021, changes to practice introduced included opening a new, larger stroke unit located directly opposite the Emergency Department, ring-fencing stroke beds, doubling the number of stroke specialists and stroke consultants reviewing all suspected stroke patients face-to-face within working hours. Results 46 patients were thrombolysed with 42 confirmed as having had ischaemic strokes on subsequent MRI imaging. All patients were discussed with a stroke consultant before thrombolysis. Mean time from arrival to CT improved from 51 to 34.5 minutes, admission to stroke unit from 7hr53 to 4hr36 and to thrombolysis from 2hr18 to 1hr22. The number of thrombolysis complications decreased from 5 to 2. Since the changes, the SSNAP grade for stroke unit admission improved from C to A and specialist assessments from E to B. Conclusion The changes implemented following the May 2021 CQC inspection have had a positive impact on the care of thrombolysed stroke patients and overall SSNAP grades at RLI. Improvements are still required and the next steps include improving the efficiency of thrombolysis times and further improving SSNAP grades.

Progress on the recommendations for an equal experience of CQC regulation for ethnic minority-led GP practices

The Care Quality Commission is the UK's regulator for health and social care providers. It faced criticisms regarding the fairness of its processes from minority-ethnic-led primary care providers in 2020. There were concerns that the regulatory outcomes for minority ethnic-led primary care services were more frequently subject to inspection, were more likely to receive an adverse outcome, suffer a negative impact on their own health/ wellbeing, and inspectors did not give due consideration to the multiple deprivation indices in the population and areas they operated in, as well as the availability of manpower or resources. 
 A survey conducted by the BAPIO GP forum[1] reported that the inspections were not considered practical or constructive and took the general practice team away from patient care. [2] Of particular concern was the perception that the system was unfair and discriminatory for Black and Asian GPs' small practices and those in the inner city or rural locations with multiple deprivations. The authors urge the CQC to ensure that the profession is supported and that any inspection process is fair and non-discriminatory and improves patient care. 
 CQC commissioned research to explore the nature of its relationship, or the existence of any causal link, between ethnic minority-led GP practices and regulatory outcomes such as ratings and frequency of inspection.
 However, in this survey, ethnic minority-led practices were more likely to report that the quality of care improved following a CQC inspection. In this article, the National Primary Care Advisor to CQC explores the findings of this research and outlines the actions in progress to address these concerns.

CQC Inspections: When an inspector calls

CQC Inspections: When an inspector calls

Perspectives on UK Care Quality Commission’s Inspections of Primary Care Practices

Background
 In the middle of a pandemic, when the health and social care services were experiencing their worst challenges and staff were facing burnout, the feedback from primary care professionals raised concerns on the UK Care Quality Commission’s inspection regime and specially on its effectiveness, impact on services and particularly relating to its equality, diversity and inclusion aspects. 
 Methods
 An online anonymised survey was carried out in July 2021 and received 130 responses, the majority from the GP partners but also locum and sessional colleagues as well as other members of the
 general practice team.
 Results
 About 80% of respondents reported having a good rating or an outstanding rating. But fewer than 20% of the participants felt that their experience of the CQC inspections was positive. More than 85% of respondents feel that the inspections did not add value to the clinical care or prevent harm. 80% felt that the inspections were not fair, transparent, objective, or replicable and found these to be traumatic rather than being a positive or constructive experience. More than 50% felt that Practices led by Black and AsianGPs small practices and those inner city, and rural practices in areas of deprivation receive disproportionately poorer outcomes. Three in four respondents felt that the inspections were intense and took staff away from direct clinical care. Almost 86% of respondents felt that the inspectors demonstrated insights into the systemic challenges faced by primary care. About half of the respondents did not feel supported by the LMCs and/or their CCG. 
 Discussion & Conclusion
 The findings demonstrated that the inspections were not considered to be effective or constructive and took the general practice team away from patient care. Of particular concern was that perception that the system was unfair and discriminatory for Black and Asian GPs small practices and those in inner city or rural locations with multiple deprivation. The authors urge the CQC to ensure that the profession is supported and that any inspection process is fair, non-discriminatory and improves patient care.

Healthcare professionals and further engagement in research

British Journal of Neuroscience NursingVol. 17, No. 5 EditorialHealthcare professionals and further engagement in researchAlison McLoughlinAlison McLoughlinSearch for more papers by this authorAlison McLoughlinPublished Online:25 Oct 2021https://doi.org/10.12968/bjnn.2021.17.5.176AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Boaz A, Hanney S, Jones T, Soper B. Does the engagement of clinicians and organisations in research improve healthcare performance: a three-stage review. BMJ Open. 2015;5(12):e009415. https://doi.org/10.1136/bmjopen-2015-009415 Crossref, Google ScholarDimova S, Prideaux R, Ball S, et al. Enabling NHS Staff to contribute to research: reflecting on current practice and informing future opportunities. RAND Europe. 2018. www.rand.org/pubs/research_reports/RR2679.html (accessed 20 September 2021) Google ScholarDepartment of Health and Social Care. Developing the role of the clinical academic researcher in the nursing, midwifery and allied health professions. 2021. www.gov.uk/government/publications/developing-the-role-of-the-clinical-academic-researcher-in-the-nursing-midwifery-and-allied-health-professions (accessed 20 September 2021) Google ScholarGibbs CL, Lowton K. The role of the clinical research nurse. Nurs Stand. 2012;26(27):37–40. https://doi.org/10.7748/ns2012.03.26.27.37.c8986 Crossref, Google ScholarJones D, Keenan A. The rise and rise of NMAHPs in UK clinical research. Future Healthc J. 2021;8(2). https://doi.org/10.7861/fhj.2021-0098 Crossref, Google ScholarJonker L, Fisher SJ, Dagnan D. Patients admitted to more research-active hospitals have more confidence in staff and are better informed about their condition and medication: Results from a retrospective cross-sectional study. J Eval Clin Pract. 2020;26(1):203–208. https://doi.org/10.1111/jep.13118 Crossref, Google ScholarNational Institute for Health Research. CQC Inspections to give more exposure to clinical research taking place in the NHS. 2018. www.nihr.ac.uk/news/cqc-inspections-to-give-more-exposure-to-clinical-research-taking-place-in-nhs-trusts/11185 (accessed 20 September 2021) Google ScholarOzdemir BA, Karthikesalingam A, Sinha S et al. Research activity and the association with mortality. PLoS One. 2015;10(2):e0118253. https://doi.org/10.1371/journal.pone.0118253 Crossref, Google ScholarRoyal College of Physicians. Delivering research for all: expectations and aspirations for the NHS in England. 2019. www.rcplondon.ac.uk/guidelines-policy/delivering-research-all-expectations-and-aspirations-nhs-england (accessed 20 September 2021) Google ScholarScala E, Price C, Day J. An integrative review of engaging clinical nurses in nursing research. J Nurs Scholarsh. 2016;48(4):423–430. https://doi.org/10.1111/jnu.12223 Crossref, Google ScholarTrusson D, Rowley E, Bramley L. A mixed-methods study of challenges and benefits of clinical academic careers for nurses, midwives and allied health professionals. BMJ Open. 2019;9(10):e030595. https://doi.org/10.1136/bmjopen-2019-030595 Crossref, Google ScholarWestwood G, Richardson A, Latter S, Macleod Clark J, Fader M. Building clinical academic leadership capacity: sustainability through partnership. J Res Nurs. 2018;23(4):346–357. https://doi.org/10.1177/1744987117748348 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 October 2021Volume 17Issue 5ISSN (print): 1747-0307ISSN (online): 2052-2800 Metrics History Published online 25 October 2021 Published in print 2 October 2021 Information© MA Healthcare LimitedPDF download

Audit of high dose antipsychotic prescribing in the havering community recovery team

AimsThe main aim of this audit was to determine the prevalence of HDAP in Havering Community Recovery Team (CRT). The secondary aim was to determine how well HDAP has been monitored and documented - specifically, whether discussions around the reasons for continuing and the risks and benefits have been discussed.BackgroundThere is a focus to reduce high dose antipsychotic prescribing (HDAP) due to the lack of evidence that it is efficacious and that smaller doses have an equivalent effect and are better tolerated. Similarly, the consensus by the Royal College of Psychiatrists is that any prescribing of high dose antipsychotics should be an 'explicit, time-limited individual trial’ with a distinct treatment target. There should be a clear plan for regular clinical review including safety monitoring. The high-dose regimen should only be continued if the trial shows evidence of benefit that is not outweighed by tolerability or safety problems.' Following a CQC inspection in 2014 of NELFT which found that the trust was failing to comply with the relevant requirements of the Health and Social Care Act 2008 with regards to safe use of medicines, yearly audits of inpatient HDAP have been undertaken. Although improvements have been made in the inpatient setting, no such audits have been performed in the community setting and consequently there is no data in NELFT regarding community services compliance with the above regulations.MethodAll 349 patients in Havering CRT clinical records were screen by either using RIO or GP letters from recent CPA reviews. A data collection and analysis tool was created using Microsoft Excel. Data collection and analysis was carried out by the project lead and checked by a fellow project member.ResultOf the 349 patients included for analysis: 16 (4.58%) of patients were prescribed a high-dose antipsychoticOf the 16 prescribed high dose antipsychotics: 0 out of 16 had the high dose antipsychotic monitoring form available12 (75%) had well documented evidence of review of HDAP.4 (25%) had no documented evidence of review of HDAP.ConclusionThere is a small group of patients receiving high dose antipsychotic therapy for which better monitoring is needed. This should include education of staff regarding HDAP, better documentation in their care plans and working with pharmacy to make HDAP monitoring forms available widely in the community.

Understanding good leadership in the context of English care home inspection reports

PurposeAs part of their inspection of care homes in England, the statutory inspector (the Care Quality Commission [CQC]) makes a judgement on the quality of the home’s leadership. Their view is critical as it is intended to inform consumer choice and because the statutory nature of inspection means these views hold considerable authority. The purpose of this paper is to look at the content of a selection of reports and seek to determine what the CQC understands by the concept of “good leadership”.Design/methodology/approachA purposive sample of recent CQC inspection reports was selected and subjected to a qualitative content analysis. Inspections are structured around five main questions. The resulting themes describe areas of focus within the section of reports that feature the question “Are they well-led?”.FindingsInspection reports were found to focus on four main themes: safety and quality of care; day-to-day management of staff; governance and training in the home; and integration and partnership working. In the discussion section, the authors reflect on these themes and suggest that the CQC’s view of leadership is rather limited. In particular, while an emphasis is placed within the literature and policy on the importance of leadership in delivering change and quality improvement, little attention is paid to this within the leadership section of inspection reports.Research limitations/implicationsThe authors’ research is based on a small-scale sample of inspection reports; nevertheless, it suggests a number of avenues for further research into the way in which leadership and management capabilities are developed and monitored in the sector.Originality/valueThe analysis in this report offers a view of how the inspection regime implements its own guidance and how it assesses leadership. The reports, as public-facing documents, are artefacts of the inspection regime and critical not just as evidence of the practice of inspection but as influence on care home operations and the choices of care home residents and their families.

Who watches the watchers? Inaccurate inspection reports cast doubt on Care Quality Commission

Nursing and Residential CareVol. 22, No. 3 CommentWho watches the watchers? Inaccurate inspection reports cast doubt on Care Quality CommissionFrancesca RamadanFrancesca RamadanE-mail Address: [email protected]Editor, NRCSearch for more papers by this authorFrancesca RamadanPublished Online:18 Feb 2020https://doi.org/10.12968/nrec.2020.22.3.130AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References BBC News. Glasgow health board to take legal action over hospital contractor. 17 December 2019. www.bbc.co.uk/news/uk-scotland-glasgow-west-50823112 (accessed 6 February 2020) Google ScholarBoyd M. Sub-contractor stole more than £32000 from the NHS to fund a ‘lavish lifestyle’. Mirror. 21 May 2019. www.mirror.co.uk/news/uk-news/sub-contractor-stole-more-32000-16179272 (accessed 6 February 2020) Google ScholarBurgess K. Health watchdog reinspects care homes following inaccurate inspection reports. Times. 21 January 2020. www.thetimes.co.uk/article/health-watchdog-reinspects-care-homes-following-inaccurate-inspection-reports-wx0snfk76 (accessed 6 February 2020) Google ScholarCampbell D. NHS privatisation to be reined in under secret plan to reform care. Guardian. 25 September 2019. www.theguardian.com/society/2019/sep/25/nhs-privatisation-to-be-reined-in-under-secret-plan-to-reform-care (accessed 6 February 2020) Google ScholarCare Quality Commission. CQC statement on duplicate material in inspection reports. 24 January 2020. /www.cqc.org.uk/news/stories/cqc-statement-duplicate-material-inspection-reports#hide1 (accessed 6 February 2020) Google ScholarFrankova H. Care Quality Commission strengthens its inspection of ‘closed cultures’. Nurs Res Care. 2020; 22(3): 160–162 Link, Google ScholarSlingo C. The Care Quality Commission's crackdown: a rise in enforcement activity. Nurs Res Care. 2019; 21(12): 669–670 Link, Google ScholarPublic Accounts Committee. Care Quality Commission: regulating health and social care. Twenty-fourth report of session 2017–19. 9 March 2019. https://publications.parliament.uk/pa/cm201719/cmselect/cmpubacc/465/465.pdf (accessed 6 February 2020) Google ScholarYorkshire Post. Costly CQC inspections ‘not leading to care improvements’ claims University of York study. 12 April 2019. www.yorkshirepost.co.uk/health/costly-cqc-inspections-not-leading-to-care-improvements-claims-university-of-york-study-1-9706650 (accessed 6 February 2020) Google Scholar FiguresReferencesRelatedDetails 2 March 2020Volume 22Issue 3ISSN (print): 1465-9301ISSN (online): 2052-2932 Metrics History Published online 18 February 2020 Published in print 2 March 2020 Information© MA Healthcare LimitedPDF download

The impact of CQC inspections on provider performance

A report by The King's Fund suggests that the current inspection methodology introduced by the Care Quality Commission in 2013 is better than the previous model and providers agreed – but is there room for improvement?

– and still comply with the CQC!

Dental nurse and compliance lead, Aleksandra MIteva, reveals how to pass a CQC inspection with flying colours – and remain environmetally friendly

How to … prepare for a CQC inspection

Adrian Ashurst discusses how to make sure all members of staff are prepared for an inspection, meanwhile demonstrating good leadership and ensuring all aspects of care are meticulously organised

CQC inspection reports for acute NHS trusts: are there relationships between the comments in inspection reports regarding people with learning disabilities and CQC hospital/trust ratings?

PurposePeople with learning disabilities are at risk of poor health and premature death. Due to these inequalities, NHS trusts are required to make reasonable adjustments to their care, such as longer appointment times, with the legal duty on them being “anticipatory”. The paper aims to discuss these issues.Design/methodology/approachSecondary analysis of CQC acute hospital inspection reports asking the following research questions: Do CQC inspection reports mention people with learning disabilities? Where issues concerning people with learning disabilities are reported in CQC hospital inspection reports, what issues and reasonable adjustments are reported? Are there any relationships between comments made in the inspection reports and CQC ratings of the trusts?FindingsIn total, 29 of the 30 trust-wide inspection reports (97 per cent) and 58 of the 61 specific site reports (95 per cent) included at least one mention of people with learning disability/ies. Most comments about practices for people with learning disabilities were positive across all CQC inspection output types and across all CQC overall ratings, although the proportion of positive comments decreased and the proportion of negative comments increased as CQC ratings became less positive.Research limitations/implicationsOverall the authors found that CQC inspection reports routinely contained some information regarding how well the hospitals were working for people with learning disabilities. The depth of information in reports varied across trusts, with the potential for CQC reports to more consistently report information collected during inspections.Originality/valueThe report updates and extends a report published by the Public Health England Learning Disabilities Observatory in 2015.

CQC's inspection methodology from November 2017

The Care Quality Commission's inspection methodology has changed. In this article, Helena Frankova explains what has changed, and what care providers need to know about how inspections will operate, moving forward. (Helena Frankova is a pseudonym. The author wishes to remain anonymous.)

CQC inspection: Celebrating the good in practice

CQC inspections have become one of the practice manager's main concerns. Julie Price, Head of Risk Management and Education at Medical Protection looks at what practices can do to prepare

Key CQC inspection questions: is your care home outstanding?

The CQC asks five key questions when assessing whether a care home meets their standards. In this article, Adam Bernstein offers a round-up of what inspectors are looking for, including how to achieve an outstanding rating on the inspection report

Key CQC inspection questions: is your care home effective?

One of the five key questions CQC inspectors ask when assessing a care home is ‘Is it effective?’. In this article, Ben Challinor discusses the importance of providing person-centred care in achieving an outstanding rating on the inspection report

Key CQC inspection questions: is your care home well-led?

One of the five key questions CQC inspectors ask when assessing a care home is ‘Is it well-led?’. In this article, Ben Challinor discusses what makes a home outstanding in this area, examining the leading policies that service providers are recognised for

CQC inspection teams should include pharmacists, according to RPS England

CQC inspection teams should include pharmacists, according to RPS England

Lloyds Pharmacy Online Doctor is first to pass CQC inspection across all categories of care

Lloyds Pharmacy Online Doctor is first to pass CQC inspection across all categories of care