Supported living services may receive tougher regulation under Care Quality Commission plans to overhaul the monitoring of adult social care in England, issued today.
The regulator also announced a shift away from inspecting all adult social care services at least once a year, saying services would be inspected in inverse proportion to their success in new quality ratings due to come into force next year.
The proposals were set out in a “signposting document” designed to outline the CQC’s initial thinking on overhauling adult social care regulation, ahead of a formal consultation next Spring.
Failings at Winterbourne and Stafford
The adult care changes are part of wider reforms to the CQC sparked by the regulatory failures at Winterbourne View and Stafford Hospital, and a difficult four years for the regulator since its birth in 2009. The changes will see generic inspectors replaced by sector specialists, a pass-fail approach replaced by graded assessments of service quality, and all services judged against five core standards, on safety, responsiveness, effectiveness, leadership and how caring they are.
The adult social care reforms, which will be implemented over the course of next year, will be piloted by the regulator’s first chief inspector for the sector, Andrea Sutcliffe, who took up her post last week.
The document includes changes the CQC will take forward – including appointing specialist inspectors, introducing quality ratings and taking tougher enforcement action in response to regulatory breaches – and ideas for further reforms.
Among the latter is “finding a better way of regulating supported living schemes”. Currently, domiciliary care provided by or within a supported living service must be regulated, but the provision of accommodation is not, even in shared settings.
The CQC said that while supported living had helped promote greater independence, “people who use those schemes do not have the same safeguards as people living in residential care”. It said it would work with others in the sector to “identify a way of regulating these services that enables people to maintain their independence but offers appropriate safeguards”.
Other ideas for further changes include exploring the possibility of using mystery shoppers and hidden cameras to monitor care, in a way that protects privacy.
Adult social care services will be rated on a four-point scale – inadequate, requires improvement, good or outstanding – from next October, with all services rated by March 2016.
The ratings will follow inspections and will be underpinned by rules setting out how inspectors should reach their judgements. This will set out failings that would stop a service being rated good or outstanding, such as going without a registered manager for an extended period of time.
As with the previous system of ratings – introduced by the CQC’s predecessor, Commission for Social Care inspection – services’ ratings will determine how frequently they are inspected, with poorer performers seen more often. This would end the system by which all services receive at least an annual inspection.
However, the CQC has suggested that providers may be able to pay for an inspection earlier than is scheduled in order to improve their rating.
The signposting document also includes details about the system by which the CQC will monitor the finances of the biggest care providers to guard against people’s care being interrupted should any provider collapse. It said the regulator would end up monitoring 50-60 providers under the scheme, which should come into force in April 2015 pending the passage of the Care Bill.
Improve your safeguarding practice
Community Care is holding a conference on safeguarding adults in care homes and hospitals on 4 December in Birmingham. Book now for a discounted place.