Experts decode what the Care Quality Commission’s 275-page document on meeting new standards means for residential and domiciliary care providers and adult placements
Since 2008 registered providers have received a quality rating (zero to three stars), with poorer performers receiving more inspections.
Efforts have also been made to assess providers on the basis of outcomes for users rather than processes. However, progress has been limited by the national minimum standards, which have long been criticised as too process-based.
These standards will be scrapped this year, as Health and Social Care Act 2008 regulations come into force that will make assessments more outcome-focused.
Adult care providers must register with the Care Quality Commission under the new system by October.
In doing so they will have to show they meet standards for compliance with the regulations, which were issued by the CQC last month and directly replace the standards.
Working out how to comply will involve managers wading through a 279-page document covering 28 separate outcomes in six key areas: user involvement and information, personalised care, safeguarding, staff suitability, quality and management, and management suitability.
Sixteen of the outcomes apply to all health and social care providers. The other 12 apply to different types of provider.
Provider umbrella bodies advise that services will have to produce much more evidence of self-assessment than in the past.
The CQC could respond to a failure to comply by further inspection or enforcement action such as placing conditions on registration, fines and cancelling registration.
by Frank Ursell, chief executive officer of the Registered Nursing Home Association
As has always been the case, much of what is required by way of registration standards for residential care homes and nursing homes are the same. Invariably, in registration standards, the main difference is the requirement for a nurse to be on duty 24 hours a day and the manner in which healthcare is provided. So it is with the CQC standards.
Each of the outcome groups in the new standards contain several prompts, which are intended to focus on what meeting the standard should look like. There are general prompts for all providers and specific prompts for named service types. Nursing homes are designated as Care Home Services with Nursing – CHN. Some nursing homes might also be required to meet other designated services such as Long Term Care (LTC), Rehabilitation Services (RHS) or Hospice Services (HPS).
There are specific prompts for both care homes and nursing homes in outcomes 1, 3, 4, 5,12,14, 21 and 25, but only outcome groups 11 and 14 have prompts which are limited to nursing homes.
Outcome 11 deals with safety, availability and suitability of equipment and requires nursing homes to ensure that “equipment required for resuscitation or other medical emergencies is available and accessible for use as quickly as possible” and that the equipment is tamper-proof.
This could be considered to be a first-aid style requirement and it is difficult to see why care homes without nursing shouldn’t also be required to provide such equipment, as many already do.
Outcome 14, supporting workers, provides the second nursing home only prompt, which, in essence, relates to the requirement for nurses who are registered with the Nursing & Midwifery Council (NMC) to demonstrate to the NMC that they continue to meet the professional registration requirements and are supported by the nursing home in doing so.
Nursing homes will continue to provide a healthcare-driven service. The new standards will, to some extent, make the same requirements of this provision of nursing care, but in a different order.
by Colin Angel director of policy and communication at the United Kingdom Homecare Association
The language used suggests that the guidance applies more to institutional settings than it does to home care. So, my first piece of advice is that providers assume that all sections of the guidance apply to them, unless clearly indicated otherwise.
Outcome 3 (fees) is important to any provider with direct payment recipients, self-funders, and those who top-up their council-purchased home care. The agency’s contract with these users must identify which parts of the service are chargeable, and indicate if there are any unpredictable or variable rate costs.
Providers’ preparation for the new regime in October 2010 is a good opportunity to review their contracts with private funders.
With this in mind, UKHCA will shortly publish specimen terms of business that its member-organisations can choose to adopt and adapt according to their business needs.
The section on safety, availability and suitability of equipment needs to be read carefully. Home care providers regularly use equipment, such as lifting aids, supplied by social services or the NHS. Although maintaining or repairing these items is not the provider’s direct responsibility, the guidance rightly requires users to be protected from unsafe equipment. Providers should therefore check that their existing policies cover the actions they will take if the equipment they use is incorrectly maintained or installed, or if their care workers have not been trained in its use.
Home care providers often assist with meal preparation, but the food itself is largely purchased (or at least chosen) by the service user or their family. Outcome 5 (meeting nutritional needs) requires staff to provide or prepare food that “facilitates a healthy, balanced diet”. Inevitably there will be occasions when providers have to give careful consideration to how they comply with this requirement, while not interfering with users’ choice.
“Cleanliness and infection control” also needs attention. The CQC will assess providers against the Department of Health’s code of practice for health and adult social care on the prevention of infections. Be careful not to overlook compliance with the code. While the CQC don’t write the rules, they will inspect against compliance.
by Sharon Blackburn, poilcy and communications director, National Care Forum
It is important for care homes to understand that just as with the national minimum standards the guidance is not enforceable in its own right, only when used in conjunction with the legislation and regulations.
Of the 28 outcomes, numbers 1, 3-7, 9-12, 14, 21 and 25 have specific prompts for care homes. In Outcome 9, prompt ‘H’ reads: “Ensure medicines required for resuscitation or other medical emergencies are accessible in tamper evident packaging that allows them to be administered as quickly as possible.”
In care homes without nursing this has previously not been required and has been the domain of the GP. Although some homes have stored the necessary drugs on behalf of a GP Practice – not all have.
The CQC is not required by the Act to produce guidance about legislation governing the prevention and control of healthcare-associated infections. This guidance is available at the Department of Health’s website
There is a clear shift in the guidance to the service provider being responsible for being aware of and for evidencing how they meet other legislation (outside of the Health and Social Care Act 2008) that is key to the service they provide.
I would strongly encourage people to familiarise themselves with the section “Preparing to use our guidance”, which includes information on why the guidance has been drawn up and the different categories of service it applies to.
When care providers apply for registration they will need to demonstrate how they comply with the guidance.