Useful Guides

CQC – New Fundamental Standards: Part 3,The Standards

The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 include 11 fundamental standards, which replaced the 16 equivalent Essential Standards of Quality and Safety in April 2015.

To ensure the people who use services are put at the heart of planning and are involved in every aspect of their care and support, the Care Quality Commission ( CQC) focus their inspections on the quality and safety of services, based on the things that matter to people. They ask five key questions about the service. These are:

The Keys Lines of Enquiry ( KLOES)

The five key questions are broken down into a further set of questions. These called the Key Lines of Enquiry or you may have heard them referred to as KLOE for short. As well as the Key Questions and the KLOE, CQC also uses Prompts. An example of how this fits together is shown below:

Sources of Evidence

To help the inspection teams direct the focus of their inspections, they use a standard set of ‘key lines of enquiry’ (KLOEs) and prompts. To support the process, CQC published the Adult Social Care Key Lines of Enquiry and Prompts: Sources of Evidence. So, for example, sitting alongside the prompts, CQC to look at the following in relation to Safe and the KLOE s1

Equality, Diversity and Human Rights

An advantage of this approach is that Inspectors can be consistent when the undertake inspections of the same Service over time, and between Services. But from a provider’s perspective, you will need to be able to provide the Inspection team with the evidence. They will also want to see evidence in other areas that link not only with the CQC Fundamental Standards but also CQC’s strategic objectives such as;

  • whether services work in a person-centred way to meet the needs of people from all equality groups, for example lesbian, gay, bisexual and transgender people (LGBT+)
  • whether services are meeting the Accessible Information Standard, which looks at how providers identify, record, flag, share information about, and meet the information and communication needs of people relating to disability, impairment or sensory loss
  • how leaders and managers are promoting equality, diversity and human rights in their service, including for their staff
  • whether people from different groups have equal access to care pathways and all parts of the service.

But the true measure of how a service performs, is what the people who use the services think. Are the services you provide meeting their needs, wishes and expectations? Are your services putting them truly at the heart of the delivery in other words creating person centred care and are service users involved fully to ensure they achieve positive outcomes. To assess this, CQC use information from conversations they have with service users, from commissioners of services, safeguarding incidents, whistleblowing concerns, accidents, incidents , short observational  framework for inspection which is a tool used to capture the views of people who may not be able to express their views themselves. All of this helps CQC to form a judgement about the quality of the service and determine a rating for each of the five key questions.

The Key Questions including Safe are embedded throughout the QCS Management system; QCS does not regard the Health and Safety Policy or the Safeguarding Policy as the only source of ‘Safe’ evidence. Every policy is assessed to confirm its contribution to safe care and practice  and the other Key questions before publication, on the principle that policies and procedure form an intrinsic part of every aspect of a care service.

While in the ideal world all staff know and understand all policies, a robust management system ensures that a staff member who only reads the policy related to their current activity is working to safe principles in that activity.

Personalisation has always been a fundamental principle within the QCS system. All policies promote the individual application of process rather than blanket application, but most importantly of all  care planning  is made the central pivot of all processes in the Service. The QCS system encompasses the strategy that all activity in the Service happens because one or more care plans call for it. The corollary is that if an activity is not called for in a care plan, the question must be asked: “why is it happening?” The answer could be “because we have always done it”, which is wasteful and potentially depersonalising and therefore should cease, or because of some underlying legal requirement, in which case the requirement should be double-checked for validity and only imposed if there are no alternatives. Everything in the care planning system, including the policy and procedure and care plan format is designed to make it easier to take the personalised approach as opposed to others.

By definition, the effective use of the care planning cycle embedded in the QCS format makes responsiveness easier – the service user is constantly reminded that they have the right to be represented in the process and in control of it, and the staff user is supported along a path which encourages them to constantly review the effectiveness of the care and support is provided. This human rights-based approach is reflected in every policy QCS publishes, with every policy created and reviewed through the prism of human rights.

The QCS Management system is fully compliant with the Fundamental Standards.  It's backed up by the QCS Customer Care team to answer questions and concerns, With 24/7 access via your desktop and mobile app, this means that QCS management system users have immediate access to the tools to support them through registration and inspection

Philippa Shirtcliffe

Head of Care Quality QCS

Updated July 2019

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