Preparing staff for Care Quality Commission assessment: workshop toolkit

This toolkit is designed to support the lead officer in a council, tasked with supporting colleagues for a pending CQC assessment within adult social care (ASC).

The toolkit has been developed by the Local Government Association (LGA) and Association of Directors of Adult Social Services (ADASS) as Partners in Care and Health (PCH). It is intended for councils to help prepare frontline staff and managers who may need to engage with the Care Quality Commission (CQC) in a focus groups, one-to-ones, or whose records could be part of a CQC case tracking sample. Feedback from councils having undergone CQC assessment found having focused preparation workshops with staff were of value.

The toolkit is built on experience and learning to date (as of July 2023) including frontline staff workshops delivered by PCH-commissioned consultants as part of an offer made to councils during 2024..

Whilst aiming to be as comprehensive as possible, this toolkit is not intended to be prescriptive, and should be viewed as a complement to other support offers, including those from the ADASS regions.

This toolkit is built on a set of core objectives which have worked well in earlier workshops and underpin the PowerPoint presentation slides (Tool 3).

We have based the workshops and the contents of this toolkit on the following objectives. 

By the end of each workshop, frontline staff and managers will: 

• understand CQC’s assessment approach and how as frontline staff and managers, they will contribute evidence as part of the assessment (this may be in person, via case records or other evidence)  
• be clear about the councils’ duties under the Care Act, and specifically how it relates to their role, and can provide examples relevant to the four CQC assessment themes 
• be able to describe the council’s vision and be able to articulate its strategy and priorities, providing real examples to illustrate these from their own practice
• increase their confidence in talking to CQC about how they engage with the assessment through practice sessions, tips, and feedback from other councils’ experience of CQC assessment.  

Councils may wish to add further objectives relevant to their own context, and to develop additional content as needed. The only caveat is they need to be achievable within the time allowed for the workshops. 

There are several ways in which workshops can be delivered using the content provided as part of this toolkit. This should be agreed as part of scoping discussions and we encourage councils to use the toolkit materials to best meet local needs. 

Delivery options could include: 

• standard workshops (two hours) for all frontline staff who may have the opportunity to speak with CQC (separate for managers and staff) and can be organised in mixed or service specific groups
• cascade model where some managers undertake training on the basis that they will then cascade to colleagues in their team
• PSW model where PSWs use the content to run workshops or practice sessions with teams. 
• regional or sub-regional workshops where councils pool resources to deliver core and bespoke content across several councils; this will ensure consistency and could also contribute a degree of independent peer challenge and support. This approach could be aligned to ADASS regional support for councils preparing for CQC assessment.  

It is acknowledged that where workshop participants have been sent information in advance of the workshop, they have been well prepared and have a good understanding of the objectives of the session. It is useful if communications to staff includes a message from an SLT sponsor so that colleagues know that this is being driven by them to support colleagues in readiness of a pending CQC assessment.  

Tips for things to include when writing to staff about the workshops:  

• explain that this process is good opportunity to identify and talk about strengths and things that need further improvement
• logistics: dates, times, venues, duration, refreshments
• booking: are staff allocated a slot, or do they book on? Is attendance mandatory? What to do if they miss their session? 
• what to bring: laptops or phones for QR codes if using e.g., Mentimeter polls or in-workshop feedback  
• workshop outline, including workshop objectives
• explain that it will be an interactive session, with opportunities to ask questions and practice talking to CQC .
• who will be leading/facilitating the workshops and how they’ve been organised in the way they have, for example, by service area, job role 
• explain that there will also be workshops for manager or other staff groups where appropriate. 
• confirm who else may join, for example, SLT sponsor at the start, or the PSW  
• any expectations of staff, for example, cascade this to colleagues, stay for the full workshop, requirement to provide workshop feedback (both to SLT and about the organisation of the workshop)   
• confirm confidentiality and how workshop feedback will be used (see above) 
• any preparation needed in advance of the workshop which could include thinking about what they are proud of in their work, and any worries and concerns they have about CQC assessment or thinking about what evidence they can call on in support of their good practice. 
• what will happen after the workshop (for example, workshop slides, feedback to SLT, and sharing any plans for further staff support)   
• reminder of any existing sources of support, for example, intranet site, dedicated mailbox, surgery/drop-in sessions .

As part of this toolkit, we have included a set of PowerPoint presentation slides (Tool 3) that can be used during the workshops, and it is possible to add logos and branding relevant to the council. These slides are built on the material developed by PCH as part of our support offer running up during 2024. You can alter the running order and add your own bespoke content as needed.

The slides (Tool 3) are designed for sessions lasting two hours, with up to 25 participants per session, and are best used alongside this guidance and the guidance slides found in this toolkit. If running larger groups (up to 25) there needs to be a minimum of two facilitators to manage and support discussion, collate feedback, and support group work. A key element of the workshop is practicing what it might feel like to speak to CQC in small groups so facilitators will be needed for these. To support these practice sessions, rooms need to be set up café style or with circles of chairs. Formal venues such as council chambers or lecture theatres are not suitable for these workshops.

The slides contain notes for those leading/facilitating the workshops.  An example workshop outline is included on the guidance slides which can be shared in advance with participants and on the day.

Tips for running a typical workshop to meet the core objectives include:

• Welcome and introduction to the workshop from the SLT sponsor. The introduction should include setting the workshop(s) in the context of wider council preparations for CQC assurance and key headlines and principles from the council’s adult social care vision and ambition. This should including how any areas for improvement from the council's own self-assessment are being addressed.
• Facilitator introduction to include themselves, workshop outline, workshop objectives, including any bespoke objectives agreed in the scoping discussion, and ground rules.
• A ‘temperature check’ at the start and end of each workshop to test levels of staff confidence about talking to CQC. Ideas for this are included in the PowerPoint presentation slides (Tool 3).
• Overview of CQCs four assessment themes, the ‘we’ statements, and alignment to the Care Act.
• Overview of CQC’s process from notification to draft report and rating
• Celebrations (what we do well) and worries/concerns
• Our council’s story: key themes and messages from our self-assessment and evidence to be sent to CQC-including what we do well, where we can improve, and our plans to do this. 
• ‘Talking to CQC’ practice sessions and developing examples from own practice, linked to the four themes.
• Learning from other CQC assessments: what CQC may ask, interview tips, dos and dont's.
• What happens next: feedback to SLT, feedback about the workshop, sharing slides, sharing learning with colleagues (if part of a cascade model), how any unanswered questions will be managed, and any further reading/resources if appropriate.  

Tips for feeding back to SLT include: 

• sharing headline feedback from the workshops, particularly areas of strength, and staff worries and concerns. 
• assessment of the degree to which what the council have said in their self assessment for CQC aligns with what frontline staff and managers know about the council’s vision, strategies, and priorities for adult social care, including any areas requiring improvement or risk the council is aware of, and how these are being addressed.  
• assurance that staff are confident about discussions with CQC, that they can describe the work they are proud of, can offer evidence of how they have made a difference in people’s lives, and know what action is being taken to address any areas requiring improvement or risk.  
• agreement on what additional support may be needed by staff, address any unanswered questions, and communicate this to those participating in the workshops.   

In addition to feedback collected to share with SLT, we recommend councils seek feedback about the workshop itself from participants, ideally before the workshop closes. We have included an example Evaluation template (Tool 4).

It’s also worth considering asking SLT for views on the usefulness of the scoping discussion and their feedback session for future iterations of workshop delivery. 

The workshops will generate a lot of valuable commentary, feedback, insights, and questions, not all of which can be dealt with in a short workshop. 

Participants have told us that it is important that SLT close the feedback loop by responding to what they’ve heard from staff, telling them what action or plans are in hand to provide further support, and dealing with their queries and concerns. 

This may include signposting further resources or reading. SLT could also consider how teams can continue to develop/support each other through supervision, case file audit, developing case studies and practicing talking to CQC in team meetings. 

Use of the STAR method for developing case examples which could be used in discussions with CQC proved a popular idea in earlier workshops. An additional resource with more questions to help staff prepare for a conversation with CQC forms part of this toolkit. 

The following is a summary of some headline learning from councils where CQC assessments have already been undertaken:

• It is important to remember: This IS an inspection, not a place to moan but an opportunity to showcase great practice.
• Understand where your work ‘fits’ into the four CQC themes.
• Familiarise all staff with key messages from your self assessment.
• Be able to show evidence of application of the Care Act in practice.
• Consider Care Act refresher training for staff.
• CQC places a strong emphasis on people’s lived experience of disability or ill-health and of the support and services they need; provide real examples of how this has shaped, and continues to shape, your approach.
• CQC is interested in the ‘customer journey’ from front door to drawing on support; this includes transition from children's to adult’s services, including for young carers and parent-carers, and universal support such as information and advice.
• Case files and audits need to show consistent attention to wellbeing, assets or personalised care and support .

 Questions CQC may ask

• Can you give examples of how the voice and influence of people with lived experience has changed the way we work?
• Can you give examples of how you have used learning or done things differently to improve outcomes for people?
• How do you manage waiting lists for assessment and support?
• How does supervision and staff support work in your team ?
• What does the culture of adult social care feel like in your council ?
• Do people get discharged from hospital in a safe and timely way ?
• Is adult safeguarding delivered in a personalised way and do you feel confident in your knowledge and practice when dealing with a safeguarding enquiry? 

Questions that CQC might ask

• What do want to celebrate and what are our worries/challenges?
• How do we manage risk? What evidence of learning and doing things differently do we have?  
• Examples of the voice and influence of people with lived experience – what coproduction work do we undertake?  
• Highlights of self-assessment, corporate priorities, ASC strategy/vision/values/ambitions/ practice model.  
• What’s it like to work here? 

Reflections from an assessed council, on their journey

We constantly questioned the evidence we were presenting to the Care Quality Commission."

Ensure your self-assessment, evidence and data aligns to support your key assertions."

We were better at describing activities, plans and processes, but are less skilled at giving real-world practice examples or showing evidence of impact."

Be aware of your challenges and be open about them – don’t let the CQC be the ones to find them. Councils should be given credit for being aware of the challenges they face and, have actions to address them. Even outstanding services will have challenges that they are working on."

We took the approach that we did not want any surprises. We would test ourselves by saying ‘what do we think we know; and how do we know it?"

We were always clear where we had areas for development - and for each of those we set out a headline action plan of what we were trying to do."

This process will uncover weaknesses and you are much better to be transparent and set out what you are doing to tackle theme e.g. where there were backlogs it was spelled out alongside plans to tackle them."

You cannot leave any stone unturned. Everything flows from the self-assessment questionnaire. You really must evidence what you say in that and then show with the case tracking that you are doing that. If you get that right then that flows into the fieldwork. You have a clear narrative.’ 

Common areas of weaker practice from the initial pilot site reports

• awareness of and response to EDI issues is a common area of for further development. 
• CQC felt more work was needed by councils to understand how to reach people whose voices are seldom heard  
• support for unpaid carers, including young carers and parent-carers was almost always found to be an area for improvement  
• staff were not as skilled at understanding or talking about co-production. 

Resource

This resource will be updated as CQC develops its processes further and as PCH learns more from the councils that are going through assessment. For further information, resources and support on CQC assessment, please see: