CQC Rating Reviews: A Guide for Care Homes

A CQC’s rating of a care home can have a beneficial or negative impact on the financial viability and standing of a care home business. Under CQC’s regulations, a rating must be displayed in a prominent place in care homes and also be displayed on the care home’s website, so there is no hiding it. So how does one go about improving a care home’s chances of being given a good CQC rating?

The starting point is in ensuring (among other things) that the care home is in good order (well decorated, safely furbished, well signposted), with good clinical governance (with appropriate policies that are regularly reviewed and updated, staff appropriately trained and assessed in competencies), effective staff supervision and discipline, safe drug administration and onward referral of safeguarding concerns, and good record-keeping, such that during any one inspection the core service is effective and safe for users and visitors. 

Using the Factual Accuracy Check (FAC) process can often improve the prospects of obtaining a good rating, and so that aspect of the inspection process must not be overlooked. It should be remembered that a Rating Review merely concentrates on the approach that CQC took to the analysis of the underlying evidence. Therefore, the underlying facts that are disputed must be challenged at the earlier FAC stage. For guidance on dealing with difficult inspections and seeking to influence a good report outcome through the FAC process, see our guidance: Poor Reports and Bad Inspections

If you have already already taken that approach and are unhappy with the rating that the CQC inspectors have arrived at, you should ask for a Rating Review. Such a review is undertaken by an inspector who is independent of the inspection process that has been undertaken locally.

As the review looks at the way that the rating criteria was applied to the factual evidence, once the factal evidence has been determined (at the earlier stages of the process) there will not be that much room for change. However, in a small number cases we have been successful in assisting care homes to achive a beneficial rating upgrade. It is therefore wise, in some instances, to make a request for a ratings review, that is well-supported by a an appropriate submission that sets out the issues of contention about the incorrect rating, along with a suggested rating that CQC might instead adopt.

The CQC webpage on aggregating findings (the second document)  is useful, to see how inspectors arrive at an overall rating for a care home. This is an important first step in considering whether a Rating Review is likely to make a material difference. The same analysis will also guide you in determining whether to instruct lawyers like us to assist you in drafting a submission, when you are working within finite resources.

In first mentioned document (above), in the second part, is a section that explains how CQC inspectors should apply their judgement to arrive at a suitable and jutstifiable rating. If there are deficiencies in the care home that lead to an assessment under part one (of the same document) that is difficult to challenge, it will be much more difficult to challenge the inspector’s judgement made pursuant to the second part of the document.

As can be seen from that same document, it is essential that an inspection goes well. If there is a history of failings that will be taken into account by the inspectors and will probably affect the rating. On occasions, CQC will amend an overall rating, having made adjustments to the rating for one of the key areas of enquiry – following a request for a review from a care home – but it is not commonplace that they will do so.

The third document explains what the inspectors are looking for, evdentially.

The fourth document explains how the regulations interlink with the inspection process and the use of KLOEs. It is all rather complicated and the documents are not always easy to follow, without committing time to understanding them. In other pages we seek to provide a breakdown of how the inspectors use these policy documents. A care home will only achieve a good rating provides evidence of good levels of compliance.

Each care home may have its own unique profile but CQC will expect a care home to reflect that and not just see standard off-the-shelf polices. They look for finely calibrated policies and care plans, specific to the client group and specific to individual client needs.

Care Home Defence Service represents care homes and other care establishments in challenging CQC ratings. To see how we can assist you, give us a call without obligation and in strict confidence, or use our Contact Form.

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