Preparing for and managing the CQC assessment, Hertfordshire County Council

Essentials

• There’s never enough time, act with urgency.
• A core team that prioritises Care Quality Commission (CQC) preparation could include your prinicpal social worker (PSW) or board-level lead, an inspection manager, business support and leads from performance and practice.
• Director visibility to all staff – focus on continual improvement (regardless of CQC), benefits of a good rating and welcoming the opportunity for feedback.
• Prepare timelines and plans for comms, assessment preparation and post assessment activity.
• Identify all potential evidence available for the local authority information return (IR) but don’t collect if IR specifies time range.
• Accept all offers of support and use learning from the LGA and ADASS, buddy local authorities and children services experience of Ofsted. 
• Treat all peer reviews and buddy sessions as the real thing,
• Keep your self-assessment (SAT) up to date with quarterly reviews.

Assurance

• Review the IR and identify your gaps in assurance – agree with Board what needs to be done.
• Focus on ‘what we are doing to improve’, rather than ‘we will be completely ready.’
• How do you learn from feedback and take action. How strong is your co-production model? How do you evidence this? 
• Use the CQC assessment to prompt assurance in areas like learning from, continuous professional development, mandatory training, reflective practice, performance management.
• Review, update and promote policies, strategies and plans and Market Position Statements and look for evaluations.
• Quick wins? Local surveys, peer reviews opportunities …

Practice

• How do teams ensure quality of assessments?
  Is the person’s voice at the centre and fully reflects their views and wishes?
• Are teams regularly reviewing and reprioritising any waiting lists in line with guidance (based on risk) and ensuring good communication to those waiting?
• How would you evidence this?
• Has a carer’s assessment been offered?
• Is the review overdue?
• Are outcomes clearly recorded?
• Do teams complete audits and discuss learning?

Data and performance

• Review what data and intelligence you have related to the IR.
• Understand how data is shared from top to bottom of the council and how leaders get assurance.
• Explain national performance comparators and use to motivate staff.
• Create central area to access data and reinvigorate any self-service programmes you already have.
• Specific data packs for leadership and those that are going to be interviewed.
• Data relating to equity, equality, diversity and inclusion, including the demographic make-up of the population – overall and by locality.
• How is it reflected in services and areas such as safeguarding and used to influence strategy and services.
• Ensure SAT is strong – evidence, data, coproduction, innovation all key.

Pre-notification timeline
 

• Set up regular ‘keeping in touch’ meetings for board and core team
• Step up Task Force and allocate jobs - be clear on deadlines and priority.
• Review evidence return at pace – start with long list and agree data pack requirements.
• Review and update your SAT so it complements IR.
• The CQC ask for contact details for key partners – send them a briefing before you return document as they contact them quickly. 
• The CQC send out a provider survey

• Intense and resource heavy with limited time.
• Keep a close eye on the detail and double check all evidence – CQC read everything they are sent.
• Challenge your own data and check what is being counted regarding waiting lists and performance.
• Ensure your data and analytics colleagues are supported.
• Be prepared to update the data for when they come on site.

• Waiting lists are a big focus (including equipment and adaptations) – how can you caveat this with waiting well, risk management, information and advice? 
• Teams need to understand the data, reasons for long waits and how these are reported and recorded.
• Expect last minute requests when the IR evidence throws up questions.
• CQC expect updated data during the assessment.

• Include themes and trends as well as reasons for why some adults and carers may wait longer.
• In theme narrative provide mitigation and prioritisation criteria including ‘waiting well’.
• Assume CQC know nothing about your processes. If you aren’t already doing it, then start capturing this data regularly now.
• Ensure you include demographics data, context, monitoring arrangements and mitigations in theme narrative.

Categories are provided by the CQC.

Pre-notification we identified cases where a Connected Lives audit within the last 10 months had been graded as good or outstanding.

Invited managers to submit additional cases and all given a wider case audit.

The primary criteria for cases:

• Would be willing to talk to the CQC
• Recording and practice of a good standard
• The person or carer had had a largely positive experience of social care.

The CQC select 10 cases and gave 10 days to provide requested documentation (summary sheet, assessments from last 12 months and reconfirm willingness to speak to CQC).

Six were selected and visited prior to or at the start of assessment week. Practitioner only contacted if required for clarification (not interviewed about their intervention). 

Ensure people are kept well informed, don’t let it be a surprise when the CQC call.

The CQC is prescriptive with requirements of pre-visit presentation

They allowed three hours. 

Included pathways and structures – we needed to recreate a lot of this.

We included Hertfordshire-specific information such as our practice model.

Include your council structure and what each directorate do.

The CQC specified teams they wanted to interview and level and role of staff, but we were able to identify individuals.

Identify staff now and deliver targeted support to people – consider:

• safeguarding 
• transitions
• front door 
• selection of frontline practitioners (range of experience and roles), 
• hospital team 
• out of hours and AMHPs.

No managers in interviews or at drop-in sessions, and some have felt excluded from process as a result.

Issue for commissioning as many have manager in their job title.

Push a positive message of staff involvement but don’t underestimate anxiety of staff

All being interviewed had a preparation session with ADASS East, Partners in Care and Health and a follow up with the PSW

Get the right mix of people with a good spread of experience, take time in selecting people.
 

• Keep partners informed and up to date
• The CQC will contact people prior to coming on site – providers, partners, vol sect, community groups, carers – can you get intelligence/feedback.
• Contact key providers to inform them they may be contacted.
• Ensure anyone named on contact list is aware they have been provided to CQC.
• Positive comms key, consider webinars. 
• S75 – key partners involved with all keeping in touch sessions.
• Who is most appropriate/has strong relationship to brief?

• Staff needed help to articulate examples and outcomes not process and describe work in terms of Connected Lives our practice model.
• Being alert to what we do well and not so well.
• Be proud of the ‘every day’ work – it doesn’t have to be a big innovation.
• How staff have acted on feedback by listening to people or learning from audits/peers/complaints.
• Awareness and examples of inequalities and seldom heard groups – how we respond to that.
• Examples of co-production.
• Be explicit of ways and forums to raise gripes and grumbles before CQC interview.

Interview questions will depend on the evidence you submitted, be prepared for:

• the voice of the person and acting on feedback
• inequalities and how you work with, include and listen to seldom heard groups
• co-production and impact
• partnership relationships
• support to carers and young carers
• what are you proud of and what would you change if you had a magic wand
• what's it like to work here? Why do you stay?
• waiting lists – risk management and how you secure assurance
• challenge and scrutiny from Members
• your priorities for the year ahead
• not a lot on the Quality Statements themselves

CQC themes from joint partner interviews

• Joint working examples, strengths, culture, accountability.
• How the local authority engages with health, collaborative working and joint initiatives.
• Alignment of strategies
• Challenging areas such as inequalities and if there’s a shared view
• Discharge to assess programme
• Workforce strategies
• Partnerships and relationships at different levels and where we would like to develop them
• How we escalate and deal with issues, what are the pressures?
• How people access services, including interplay at the front door.
• Locality working and protocols.
• Safeguarding arrangements.

• Capitalise on our Good rating to attract and retain staff to work in care in Hertfordshire.
• Monitor improvement plan, overseen by ACS Board members.
• Maintain our self-assessment and evidence bank for regional improvement programmes and re-assessment.