CQC warns of fragile sector as care services struggle to maintain ‘good’ ratings

The watchdog said it was "worrying" that a quarter of adult social care services originally rated 'good' had deteriorated at re-inspection

A quarter of care services rated ‘good’ by the Care Quality Commission had deteriorated when the watchdog returned to inspect for a second time.

The CQC’s report on the state of adult care services found that in 26% of 1830 services originally rated ‘good’, the quality of care had worsened, resulting in ‘requires improvement’ (22%) or ‘inadequate’ (4%) ratings.

The regulator said this was “worrying” and suggested that providers cannot always maintain a level of good practice within their services.

“This early information suggests that the sector continues to be fragile,” the report said. “Providers cannot afford to be complacent and need to monitor their services constantly, particularly when there are changes.”

The report also found that only 56% of services initially rated ‘requires improvement’ had improved after a CQC inspection.

The report was based on findings from 33,000 inspections of around 24,000 locations carried out between October 2014 and May 2017.

It also found that one in five care services are still not good enough, with 19% rated ‘requires improvement’ and 2% rated ‘inadequate’. The majority of services (77%) were rated ‘good’.

Community social care services, including home care providers and Shared Lives schemes were rated the best overall, while nursing homes continue to be the lowest performing.

‘Poor safety ratings’

The CQC inspects against five key questions: is the service safe, well-led, responsive to people’s needs, caring and effective?

The report found that services continue to perform highly for ‘caring’,  with 92% rated ‘good’ in this area. Safety had the poorest ratings, with 23% of services rated ‘requires improvement’ and 2% ‘inadequate’.

The report said that poor safety can mean there are inadequate systems in place to manage medicines or determine staffing levels, which could mean people don’t get their prescribed medicines to help them stay well.

The report also detailed the successful criminal prosecutions CQC has carried out against providers. Recurring themes included issues with documentation, such as medication errors, poor risk assessments and use of equipment, and a lack of adequate training for staff.

The report said there were currently two prosecution cases listed for a magistrates court hearing, with a further six in the pipeline.

‘System in trouble’ 

Andrea Sutcliffe, chief inspector for adult social care at CQC, said most of the sector was meeting the ‘Mum’ test, a guideline that asks inspectors to consider whether a service is good enough for their loved ones. But she added there was still “too much” poor care.

“It appears to be increasingly difficult for some providers to deliver the safe, high quality and compassionate care people deserve and have every right to expect. With demand for social care expected to rise over the next two decades, this is more worrying than ever,” she said.

Caroline Abrahams, charity director at Age UK, said the report’s findings were alarming and signalled older people were now effectively “playing a game of Russian Roulette” when they needed care.

She added: “It is extremely troubling that a quarter of all care services rated as ‘good’ and then re-inspected have since declined.  When significant numbers of previously effective providers are unable to sustain a good quality service you know the system’s in serious trouble.”

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