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Home Elderly Care Care Home Regulation: the role of the Care Quality Commission (CQC)

Care Home Regulation: the role of the Care Quality Commission (CQC)

The Care Quality Commission (CQC) regulates all care services in England, including care homes. It’s role is to ensure that care home residents receive “safe, effective, compassionate, high-quality care”.  The equivalent bodies in the nations are The Healthcare Inspectorate in Wales and The Care Inspectorate in Scotland, both with similar responsibilities.  

In this guide to Care Home regulation we’ll give you an overview of what the CQC is, how it regulates care homes and why this matters for you and your elderly parents or relatives when choosing and living in a care home.

What is the Care Quality Commission (CQC)?

The Care Quality Commission (CQC) is the independent regulatory body responsible for inspecting and reporting on health and social care services in England.

The CQC registers, inspects and rates all care homes and publishes its ratings and reports on the website. Care homes are required to make publicly available their latest CQC report on their own website and in the care home.

Care Quality Commission regulating Care Homes

If you are looking for a care home you can search on their website using a number of criteria including postcode, type of care and rating.  The search results of individual homes will include general information about the care home such as ownership, type of care provided, the overall rating for their service provision by the CQC and access to the most recent CQC reports.

The role of the CQC in regulating Care Homes

Care homes are given an overall rating by the CQC inspectorate on the following scale:

Outstanding – The service is performing exceptionally well

Good – The service is performing well and meeting expectations

Requires Improvement – The service is not performing as well as it should and the CQC have given them specific improvements to make

Inadequate – The service is performing badly and the CQC has taken action against the person or organisation that runs the care home

These CQC ratings are the culmination of ongoing monitoring, regular review and inspection of individual care homes.

A CQC inspection involves two parts: desk and phone research, and physical inspection.  Research is carried out amongst current residents and family members about the care received; research among staff; detailed research into the administration of the care home including the data it holds; and with local watchdogs such as Healthwatch.

The second part of CQC care homes inspection is carried out by a member of the Commission who visits the care home. They will observe care being given, inspect the property itself and review documents, records, and policies. At the end of the inspection, they will give a summary of their findings to the staff at the care home, including anything that needs to improve, and they publish the report on the CQC website.

What the CQC looks at when inspecting a Care Home?

The CQC asks 5 key questions that they score individually within their report, in addition to an overall score:

  1. Is it Safe?

Not only is the care home physically safe but also is there any evidence of abuse within the care home? Is it safe to be a resident there?

  1. Is it Effective?

Especially important for care homes providing nursing care, but in general is the care home providing a safe home for their residents, do they effectively care for their physical and mental wellbeing; does the care home provide the best quality of life using the best and up-to-date methods, and, where nursing or dementia care is needed, how well is it offered?

  1. Are they caring?

Does the care home and its staff treat their residents with care, respect, dignity, compassion, and kindness? Are residents treated well?

  1. Is it responsive to people’s needs?

How well is the care home set up to find out and quickly and effectively respond to and service their residents’ needs?

  1. Is it well-led?

Is there good leadership? Do those in management and ownership positions lead well by making sure the care home provides the highest quality, safe care, treats residents and staff well; encourages feedback, deals with complaints appropriately and consistently adapts and improves the care provided?

What is included in the CQC report?

In a CQC Care Home’s report published on their website you will see one overall rating and then the ratings given for each of the 5 different specific areas of investigation (as above). For those reviewed during or after the COVID-19 pandemic you may also be able to see how well infections are prevented and controlled across different categories. You will also be able to see information on:

  • Who owns and runs the care home
  • Where the care home is
  • What specialisms the care home accommodates – such as Dementia care
  • Contact details for the care home including the registered manager
  • When the last inspection was
  • Previous CQC ratings and reports

You will be able to download the full reports for any care home you may be interested in.

How often does the CQC inspect Care Homes?

The CQC aims to inspect care homes every 2 years, although inevitably with Covid, a backlog has built up.  A number of years since the last inspection doesn’t mean you should ignore the existing rating and review, but if there are areas of concern in the current report, questions of the manager and staff should be asked.   

Previous reports for individual care homes are also available on the CQC website.  Reading them will give you a good understanding of progress made, issues raised and resolved, over time.

Care Homes rating guide

With over 17,000 care homes in the UK, your search for the perfect care home for a parent or relative can seem overwhelming.

4% or just over 600 care homes have an Outstanding rating, with the vast majority, over 11,000, operating at the level of Good – ie performing well and meeting expectations.

Care Home Regulation by the Care Quality Commission

Homes with a “Requires Improvement” (2,500 currently) rating may have issues flagged by the inspection that are possible for the care home operator to sort out quickly, sometimes in a matter of days; in these cases, the CQC will carry out a follow-up targeted inspection to assess if recommendations have been carried out and the specific service level has improved.  They will publish an updated report, and whilst the rating won’t change until the next formal inspection, you will be able to ascertain from the report if the necessary changes have been carried out.

If the overall rating is ‘Inadequate’, currently 247 care homes on the CQC register, the care home will be placed in ‘special measures’. This means The CQC will keep it under review and, if they do not propose to cancel the provider’s registration, will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, the CQC will take enforcement procedures – essentially the process of preventing the provider from operating. This will usually lead to cancellation of their registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when inspected and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Reading the reports behind the ratings will give you lots of information about the care home and how it’s residents and their families feel they are cared for.  You should be able to get a sense of the ethos of the home in terms of how it is run.

What a CQC report can't tell you

Finding a care home is complicated, often with cost, timing, availability and location as key elements in the decision. 

The CQC rating and report will help you narrow down your selection, but there will be criteria that you will need to decide upon yourselves. 

Care Home Regulation by the Care Quality Commission

Type of care needed: three levels of care may be provided:  residential care homes provide the minimum of medical and care and are more about everyday help with washing and dressing;  care homes with nursing care will provide medical care 24/7;  specialist care units such as Dementia care have specifically trained staff and bespoke facilities to care for people living with Dementia.   

The care home will carry out their own assessment of your parent or relative to help determine the level of care needed, and whether they are able to provide it. 

Price – The CQC does not judge “value for money” of any service it regulates and monitors. The average weekly price of a residential home is approximately £900, but specialist dementia care can be significantly more than this price.  An Outstanding rating of a care home may put a premium on the price. 

Location – how close is the care home to friends and neighbours of your Mum/Dad? How close is it for family members to visit? Finding a care home with availability to provide specialist care at a price you can afford may be the most difficult decision;

Location – where is it located – in the countryside with a bus/taxi into town, or in a town with access to local amenities? Finding a care home that suits the lifestyle of your parent or relative should not be under-estimated;

Type and style of home – there is a range of care home providers: small owner-managed businesses with one or two homes, often in older properties that have been converted, with a homely feel and perhaps fewer “whistles and bells” that might be provided by large multi-home owners offering luxury hotel-style accommodation in purpose-built facilities;  and then all those in between.  

Facilities and services: access to gardens and outdoor space; other facilities offered such as hairdressing and beauty treatments, a cinema, restaurant or café;  the CQC will review food/menus and activities where they pertain to health, care and safety.

Type of accommodation: are the rooms ensuite? Is there a choice of size of room reflected in the price? Can your parent have their own furniture in their room? Is the home pet-friendly;

Shortlisting, visiting and choosing a Care Home

Visit the care homes on your short list.  You shouldn’t need to make an appointment, but just turn up and ask for a tour.   Speak with the manager and other staff, and if there are issues raised in the CQC report, this is a good opportunity to discuss them.

There are some useful questions to ask and things to think about as you look around, which are included in our Guide here

Care Home Regulation by the Care Quality Commission

The CQC and complaints

The CQC’s inspection process includes asking residents and their families for their views on the care they receive.   If there are concerns and issues, the CQC will include these in their reporting and rating.  However,  the CQC does not have a complaints procedure for individuals.  If you are concerned about anything to do with the care your parent or relative receives, you must talk to the home manager first to try and resolve this.  There will be a formal complaints procedure.  You can also contact local watchdog Healthwatch, which is the consumer champion for health and social care in the UK.

Links to CQC equivalents in the nations are: 

The Healthcare Inspectorate in Wales 

The Care Inspectorate in Scotland