Let’s start with getting registered.

Since announcing that I was going to start a blog I’ve had a number of people asking me about getting registered, in-particular as a Registered Manager. Before we dive in I’d like to be really clear, these are my thoughts and my experiences, they are in no means the holy grail and I’d always recommend you picking up the phone to your local CQC officer and introducing yourself (I did).

Whilst I’ve had lots of experience of CQC in both the NHS and the world of Private Care this blog will be focussed on the world of Private Care (maybe one day I’ll do one from an NHS perspective).

First things first, the CQC want you to get registered and provide high quality care. Before you can meet this ambition you need to be able to assure them around your knowledge of running services. The framework that they use is called the fundamental standards and can be found littered throughout the five domains or SCREW as I like to refer to them as:

1)    Safe

2)    Caring

3)    Responsive

4)    Effective

5)    Well Led

You may hear the term ‘Key lines of Enquiry’, these are a set of questions that enable the CQC to demonstrate that you are able to assure them that your services our (guess what?) Safe, Caring, Responsive, Effective and Well led.

Are they safe?

Safe: you are protected from abuse and avoidable harm.

Are they effective?

Effective: your care, treatment and support achieves good outcomes, helps you to maintain quality of life and is based on the best available evidence.

Are they caring?

Caring: staff involve and treat you with compassion, kindness, dignity and respect.

Are they responsive to people's needs?

Responsive: services are organised so that they meet your needs.

Are they well-led?

Well-led: the leadership, management and governance of the organisation make sure it's providing high-quality care that's based around your individual needs, that it encourages learning and innovation, and that it promotes an open and fair culture.

Whilst I don’t want this particular blog to drift into a CQC inspection it is really important to know the five domains and the types of questions that they will/could ask.

Start to talk yourself through each of the domains, how do you ensure that your services are safe, caring, responsive, effective and well led?

To make things more interesting the above inter-connects with the following regulations:

Regulation 9 – Person Centre Care

How are you going to make sure that your service is patient centre? Here’s a few of my thoughts:

• Make sure the individual is involved with the assessment

• Make sure their loved ones are invited

• I bet you’ll want (where possible) them to write their care plan!

• You’ll probably want them (again, where possible) to make sure they write a copy of their notes once the visit has taken place

• The Care plan will be written in a language that is understood by them

 Regulation 10 – Dignity and Respect

The main points in the equality act are age, disability, gender re-assignment, marriage and civil partnerships, pregnancy and maternity, race, religion or belief, Sex

Whilst I’m not going to go into every single one, make sure you have an example of how you would support someone with one of the above. As you’ve twisted my arm here’s one for you:

We once supported a young Muslim gentleman whose dad didn’t want any female staff because of the type of care that was being delivered. We also cared for an more mature lady who requested same sex carer.

Regulation 11 – Need for consent

Everyone that you care for must give consent (If they have the ability to). As part of your assessment process there should be an element around consent. If someone can’t provide consent then you should complete a capacity assessment as delivering in accordance with consent could mean you don’t deliver on some other aspects of care.

Regulation 12 – Safe care and treatment

As above it’s really important to make sure you and your team are delivering safe care. Think, recruitment, induction, think training, think governance, think questionnaires and reviews (to name but a few)

 Regulation 13 – Safeguarding service users from abuse and improper treatment

Whether you are new to this area of work or not, please make sure you give the safeguard team (at the local authority) a call, introduce yourself and ask if there is any up and coming training which you or your team could join. You should know your local safeguarding policy. Your company will have one and the local authority will have a process.

 Regulation 14 – Meeting nutritional and hydration needs

Please make sure this is covered off in your assessment. For example there is likely to be higher risk of an individual not meeting their nutritional needs if they live on their own and have no family. How will you know? Think about ways you can ask during your assessment. Will you carry out a physical/baseline set of obs as part of your care? Think what you would do if their weight started to drop or if you noticed dry and cracked lips on one of your visits?

 Regulation 15 – Premises and equipment

I guess that when you complete any assessment you’re also completing an assessment of the area in which your staff are going to be working?

 Regulation 16 – Receiving and acting on complaints

You and your company should have a complaints policy, if you haven’t please make sure you get one. Remember to tell the CQC it’s about being proactive, as a manager you should have sight over all areas of your services. Make sure you have a process in your busy week to pick the phone up and call people, check in with them, it will save time later on when you’ve picked up if something isn’t going to plan. You don’t want to spend hours and hours dealing with complaints if you can just pick the phone up to someone and check in with them

 Regulation 17 – Good Governance

People get confused with this from my experience. Governance is about information, it’s information that used correctly can ensure you sleep at night as you have all the oversight of your services that you could ever need, not structured correctly can lead to dangerous practice. I’ll carry out a whole section on this is it’s far too intense to cover here. What you need to think about before your interview is how do you ensure your services have good governance that stands up to scrutiny, both internally both also externally.

 Regulation 18 – Staffing

This regulation is about you assuring the CQC that you are going to have enough suitably qualified and competent staff. You must know how many staff you have, what are you induction processes? How much training are you going to be providing people? How will you know if you have enough staff hours to take someone else on? What is plan b and plan c if someone phones in sick and can’t cover a shift? What are your processes around skill mix and rostering?

 Regulation 20 – Duty of candour

For some strange reason people get worried about duty of candour as if your admitting liability. First things first, things go wrong! Duty of Candour is about being open, honest and transparent. Have the confidence to say when things have gone wrong, but be comfortable with articulating the learning and how you will ensure if doesn’t happen again. Things go wrong in the private and public sector every day. People loose confidence in services when leaders aren’t honest about what needs to change. Ensure that you have the learning process in place, we send out learning lessons emails every week, we also hold learning the lessons sessions within our business meetings. Staff also need to be able to articulate what has changed based on the learning that has taken place.

Remember, saying sorry is not admitting fault!!

 So there you have it, looks easy, daunting and or confusing? Please don’t worry, you’ve got this. So things to remember and learning:

All regulations will be covered by the five domains

Go through the regulations and make a few points on each

Have examples for each regulation

The CQC want you to pass

I want you to pass

If you have any questions or thoughts please share them. As previously mentioned, these are my thoughts and experiences. Everyone has different experiences, when I set up my business I was interviewed for 3 hours as I was registering the business also, my registered manager was interviewed for about an hour. The CQC inspector was really nice, she didn’t put any pressure on me and we talked through my thoughts and plans.

When i set the business up we decided to operate from a room in our house to begin with. Too many people think you need to have an office to start up, you don’t, you need to be able to lock away private files away (filing cabinet from Ikea!) and you need to be able to meet people in private. When we went out to assess people we went to their homes and if anyone ever wanted to discuss anything in private that they couldn’t discuss at home then we used to rent out office space for the hour. If anyone from the Local Authority wants to meet you go to their office, it also gives you the opportunity to network with people in the office!

If you need any support please be sure to check out how we can help.

Till the next post, see you all soon.

M