CQC Inspections; prevention better than cure
DENTAL BULLETIN, ISSUE 23
The words ‘CQC inspection’ can strike fear into the heart of most dentists. Even if you have fully prepared for the day, a sense of panic can still wash over you; what if I have forgotten to put in place a policy for tooth pick assembly; what if the receptionist forgets how to answer the telephone; what if the nurse wears the wrong colour scrubs.
Fear not; with good planning and preparation you can feel confident when the inspectors enter your premises.
Here we give some practical tips to help you deal with your inspection before, during and after it takes place and hopefully take some of the headache out of it.
It is just over a year since the CQC implemented its new regime for inspecting dental practices. In Issue 9 of our Dental Bulletin we considered the new regime, which removes the rating system and instead focuses on five key questions for inspection (safe, effective, caring, responsive and well-led). The new regime is less of a ‘tick box’ exercise and more holistic in its approach.
Before your Inspection
The key to passing an inspection is preparation; but what does this entail?
Firstly, put in place all relevant policies and procedures, such as infection control, employment policies and health and safety requirements. It may seem like a chore to set these up but in fact they are useful tools for you when running your practice. They can be a quick reference guide, they can be used as training material for new staff members and be part of a regular review process for all staff.
Secondly, hold regular training sessions with your team to go through the policies and any updates that have taken place. This not only ensures everyone is working from the same page, but it can be a useful team bonding exercise and a way to obtain staff feedback on procedures with a view to improving them. This could be done as part of monthly team meetings by taking one policy and having a brief discussion on it. Alternatively, you could seek an outside company to provide the training so this can form part of CPD requirements also.
Thirdly, once you have all your policies and procedures in place don’t just leave them on the shelf to gather dust. Regularly review your legal obligations and update documentation. If you think of them as a manual to help you run your business efficiently you will be more inclined to give them the attention they need.
Two weeks before your inspection takes place the CQC will write to you. If you already have the relevant documents in place and have trained staff on them, two weeks should be plenty of time to put in place any final preparations for the inspection. Hold a meeting with staff to ensure they understand the process and the importance of the inspection and to go through any queries they may have. Prior to the inspection, you will need to send the CQC your statement of purpose, information about complaints/compliments and staff details.
A point to note is that before the CQC has even written to you they have already contacted your NHS area team and Healthwatch for information to assist them with their report.
During your Inspection
On the day of your inspection, the inspectors will interview staff and patients and speak with you and the registered manager.
Our advice is to be as helpful as possible. This is your chance to show your service is safe, effective, caring, responsive and well-led. There is no reason why you cannot raise points the inspector does not cover, if you feel they have missed something or you want to show them something specific. As mentioned above the new process should be holistic.
At the end of the inspection, the inspector will provide feedback. This is not the final outcome but it is worth taking notes in case any issue arises later down the line. These do not need to be detailed; just some bullet points of key information. Given this is not the final report we would recommend listening to the comments only, rather than trying provide any response or explanation. You will have a chance to do this later down the line.
After your Inspection
You will be sent the draft CQC report and you can challenge any factual inaccuracies within it. This can be where your notes of the feedback meeting come in handy. You will get 10 working days to challenge the report. The CQC will state that you cannot challenge the findings of the report. However, as a public body they should consider all representations made. It is therefore worth bearing in mind that an inspector has a duty to properly evidence their judgments and the evidence should be “understandable, reliable, accurate and corroborated”. Ask yourself can you mount a challenge based on this?
At this stage we would only recommend challenging any incorrect information within the report. Do not accept mistakes or set out how you will rectify them. This can be provided in your action plan should any negative findings be made. If you do challenge any findings ensure you provide evidence. The CQC is unlikely to change any inaccuracies that are not supported with evidence.
Remember; findings can go up or down so pick your battles wisely.
The only other challenge you can make is if you have been issued with a warning notice. This process is the same as a challenge to the factual accuracy of a draft report and must be made within 10 working days.
Any challenge is reviewed by the CQC and the final report is prepared. This is then sent to you and published on the CQC website.
If you are happy with the outcome, why not publicise the findings on your website or social media.
If you wish to appeal the findings your only internal option is to seek a review. The CQC website confirms that you can request a review of the final report but only on the grounds that ‘the inspector did not follow the process for making ratings decisions and aggregating them’, which is potentially very limiting.
If you do wish to seek a review based on the incorrect process being followed, you have five working days to register your intentions. You will then be sent instructions on how to review the findings and have 15 working days from when these instructions are received to submit full details of your request for a review. There is only one opportunity to do this so it is imperative the review is as robust as possible.
You cannot appeal against the findings simply because you disagree with them. Technically speaking any factual inaccuracies you have highlighted in a challenge should be reflected in the findings made.
What the CQC website does not mention is that you can appeal certain findings to the Health and Social Care First Tier Tribunal. Hopefully, you will not reach this point but you can find more information about this here.
Again we would highlight that any challenge or review you submit can result in the findings going up or down. It therefore may be more beneficial to accept a finding of the CQC and use your energy to put in place a detailed action plan. The CQC may be more inclined to amend findings where a provider has accepted errors and made changes as opposed to one who has challenged their decisions. That being said do not feel bullied by the CQC; you also have the option to complain about an inspector if you feel their conduct is inappropriate.
In this article we deal with the practical steps you can take to help you prepare for a CQC inspection. However, you will still need to ensure that you have in place all written policies and procedures as mentioned above and you have reviewed the guidance for dentists. This can be a daunting job and can detract you from running your business and treating patients. At JFH Law we can assist you with this process and put in place the relevant documents such as employment policies, health and safety documents and infection control procedures, to take even more of the headache out of an inspection. We can create bespoke policies for your practice, tailored made to your business needs.
Alternatively, if you already have in place the necessary documentation we can assist with reviews and training staff to ensure you remain ahead of the game.
If you would like to discuss any part of this article or need any assistance with a CQC inspection, please contact Laura Pearce on 0207 388 1658 or at firstname.lastname@example.org.
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Laura Pearce, Senior Solicitor