CQC Compliance – The Most Common Mistakes and How to Avoid Them

The Access Group has been working with care providers across the UK for over 30 years. Through the use of our digital platforms, we have helped care services not only meet but exceed expectations and achieve outstanding outcomes. Over the years, we have seen care services fail and succeed when it comes to care compliance, so we know what they should and shouldn’t be doing to succeed.  

Using our experience and expertise, we have created this article that takes a closer look into the most common mistakes made in CQC compliance and how to avoid them. We hope to shed light on how providers can navigate this crucial and complex aspect of care with skill and assurance, which will put them on the road to success while improving the lives of their service users.

CQC Care Home Compliance

CQC compliance means adhering to the regulations and standards set by the commission to ensure that your care service meets the essential requirements and criteria. This applies to all care services, including care homes, domiciliary care providers, supported living and care agencies.

CQC Compliance Checklist

At the heart of CQC compliance is the CQC compliance checklist. This is a comprehensive tool that covers several domains, including safety, effectiveness, responsiveness, and more. The checklist can be used as a roadmap by care providers, outlining what’s expected to maintain high-quality care. Neglecting any aspect of this checklist is a common mistake that can result in compliance issues.

Certain care software, like Access Care Compliance, has pre-built audits and a mock inspection you can use to measure where you are against the Single Assessment Framework and plan (through Action Planning) where you wish to be in future, plus you can create your own audits and checklists.

CQC Judgements

Monitor, inspect and rate. CQC monitors services, carries out expert inspections and judges each service, usually to give an overall rating and conduct thematic reviews. Below are the common areas of non-compliance:

• Delivery of Care (Regulation 9)
• MCA (Regulation 11)
• Mitigating Risk (Regulation 12)
• Managing Medication (Regulation 12)
• Safeguarding (Regulation 13)
• Complaints (Regulation 16)
• Good Governance (Regulation 17)
• Staffing (Regulation 18)

It’s also worth being aware of ‘Notifications’ (CQC Registration Regulations 2009). If you as a care service don’t submit your notifications as required by the regulations, then you will never get better than requires improvement in well-led.

Common Areas of Non-Compliance and How to Fix Them

Now you know the most breached regulations, we will be taking a closer look at the 4 common areas of non-compliance and what you can do to fix them, followed by the specifics of some of the regulations.

1. Audits

Not completing or completing actions from audits can be applied to several of the most breached regulations listed above. When you don’t record evidence of delivery of the action, this can lead to non-compliance. Basically, if you do not complete actions from audits, why bother auditing?

For example, you can go out to someone’s home and support them to take their medicines as prescribed. But if the MAR record is incomplete, you can’t just say that you have definitely given that person their medicines and done it correctly. Your words are not enough.

The CQC also wants to see that what you have found in your audits has been acted upon and that actions have been taken to address any findings. For example, if you’ve found there have been accidents or near misses in moving and handling, have you added extra staff training? Then, is there a date you are tracking against to verify whether this has addressed the issue?

To maximise CQC compliance and your chance of the best rating possible, you want this chain of discovery, action and review to be linked together and easy to show and demonstrate to inspectors. You don’t want lots of disparate documents and records, notes here and there.  

Audits can be effective regardless of whether you are using software specifically designed for the task, spreadsheets, or other methods. The principles of good auditing apply regardless of the method used. Many argue care auditing software has significant advantages over traditional auditing methods though. So to test this I wrote this article comparing manual auditing vs care compliance software.

2. Training

Another common issue is insufficient staff training in all areas of care and compliance. When your employees don’t understand what standards they should be working towards and complying with, it can lead to failures and problems regarding quality of care.  It is important to ensure that leaders (Registered Managers and Senior Team members) all understand each of the 5 Key Questions and the regulatory framework they relate to.  With that understanding, the audits, observations and operational practices they complete become ‘conscious compliance’ with the regulations.

The best way to resolve this is to ensure your care team are well-trained and continually updated on best practices essential for CQC compliance.  When we think about Safely Recruiting staff, this should be done in accordance with Regulation 18.  The CQC are unambiguous about the employment checks required, so they should be part of a care provider’s process and their Audits should objectively test them.

Enabling your team to be consciously competent brings their accountability and team members’ responsibility to life, so not only the Registered Manager, but all of the team appreciate their role in achieving a Good or Outstanding rating.  Any shortfalls should be shared with the team anonymously, so there is an evidential Learning Culture.

3. Medication Management

A lot of people get medication management wrong and it’s known as one of the hardest parts of providing a service. Training and competency assessment is a big area people get wrong.

For example, when you’ve had your medication management training, someone has to test your competency. These people need to be competent to be able to test you, this isn’t something that can’t be done once and never done again. Your Medication Management Policy should state how often it should be done e.g. every 12 months. The MAR chart quite often goes wrong as people don’t fill it out correctly.

Medication errors are a common compliance issue, so you must do everything you can to improve your medication management processes. A robust system for medication receipt, storage, administration and documentation is crucial.

Maintaining thorough and organised records and utilising digital record-keeping will streamline your processes, enhance accuracy and boost medication safety, which will reflect positively during your CQC assessments and in the health and well-being of your service users.

Auditing is another common area that can go wrong. For example, people audit their medication management but don’t pick up themselves that there is an issue. Then when the CQC come along and finds the issue and looks at the audit, they will see that they’re ineffective.

For successful and safer medication management, make sure you have policies and procedures in place and make sure your staff follow them correctly and have read them. Then audit the processes regularly and robustly.

4. Feedback and Complaints

Both feedback and complaints are valuable sources of information about the quality of your service. Neglecting to address any concerns raised promptly can lead to compliance issues, as the CQC will assess how providers respond to feedback.

Actively seeking feedback and addressing complaints as soon as they come through will demonstrate your commitment to continuous improvement, which is vital for compliance. Encouraging service users and their loved ones to submit this information in a specific way e.g. via email, phone calls, etc. will make it easier to track and keep on top of everything that comes through.

Compliments tracking is a key activity too, which is often overlooked.  Learning from Compliments is essential to repeat the best care interactions and outcomes, so providers need to record them and track lessons learned.  This is something many providers do within Access Care Compliance, which will support the new Single Assessment Framework evidence, as the first Evidence Category is ‘People’s experience of Health and Care Services’.  Capturing this evidence digitally will make demonstrating Good and Outstanding easier for providers.

5. Delivery of Care

Regulation 9 is one of the most commonly breached regulations for social care providers, but it’s a huge topic. People could consider things like:

• What training did staff receive and was it effective
• What supervision did they get
• How often do managers or leaders observe staff practice
• How do they find out what people’s experiences of the delivery of their care
• How do they know people are receiving good quality care

Three important areas in terms of the regulation are:

1. The robust assessment
2. The planning of care (a care plan) and;
3. Delivery of care.

All of this needs to be carried out correctly for people to receive good quality care. The experiences of people are critical, this information can be gathered through talking to people and observations. The values of staff, the organisation and the culture of the organisation should also be highlighted.

6. MCA

Regulation 11 (MCA or Mental Capacity Act) merely means to seek people’s permission before you support them and get people who are capacitated to provide you with consent using the MCA. This regulation is about people using this act when they need it. Unfortunately, people are always getting this wrong.

Common areas people get wrong are:

• Not assessing capacity properly
• Not making true best-interest decisions
• People do not recognise restraint
• Not following the DoLS (The Deprivation of Liberty Safeguards) procedure

But particularly, it's in terms of most people making the alerts to the local authority when there’s a huge backlog. Another issue is that staff and managers also don’t fully understand the acid test (how do you know someone is deprived of liberty), which can lead to people not taking action to mitigate it.

The right training and providing information on the MCA is key to care staff understanding the regulation and following it correctly. We have written a guide on everything you need to know about MCA, DoLS and LPS to help you gain a better understanding.

7. Good Governance

This regulation involves everything you do that helps you know that your service is compliant with the regulations and delivers high-quality and safe care. It’s made up of many things including audits, leadership, culture and staffing. Basically, anything and everything you do and know tells you you’re running a good service.

When aiming for good governance, make sure you focus on all aspects, no matter how small they may feel. For example, if you do an audit and find a problem, develop an action plan and complete your actions, as this is a common area where people go wrong. 

8. Staffing

Some examples of staffing include how you recruit staff, supervising staff correctly, supporting staff development properly and checking that they are competent. It can be easy for a care service to struggle with staffing regulation, especially if they are understaffed, using agency staff or don’t fully understand all the areas involved. Our guide to safe staffing and regulations in care can help you avoid and/or fix non-compliance if you’re struggling with Regulation 18.

An important area to get your head around is post-pandemic appraisals. Staff need to have an annual appraisal that is actually in the regulations, this is one of the few areas where the regulations get really specific. Due to the pandemic, a lot of services fell behind with their appraisals. Whether the CQC can say staff aren’t well supported due to not having their annual appraisals isn’t entirely known. But staff should be looking at them and if they have fallen behind, actions should be taken to rectify that.

Achieve Care Compliance with Software

CQC compliance is a crucial element of providing high-quality care in England. Care providers must understand what it entails, diligently follow the CQC compliance checklist and steer clear of the common mistakes highlighted in this article. Understanding these mistakes and how to avoid them will not only help you meet regulatory requirements, but it will also help your team deliver the highest level of care to those who depend on your service.

With the right platform, such as Access Care Compliance, you can ensure regulatory compliance is achieved and estimate your future rating with the CQC mock inspection tool. These tools use the regulator’s own frameworks, methodology and guidance to help you prepare, audit and assess your care service in line with their standards. 

In addition, Access Evo, our integrated AI in Care software experience, helps you to identify which locations have a mock inspection rating of ‘requires improvement,’ then create a step-by-step action plan to improve your rating.  

With over 30 years of experience working with services in the care sector, The Access Group know what care services should and shouldn’t be doing to achieve compliance. This knowledge has created the foundation of our software, which has been developed to help you succeed and have the freedom to do more through digitisation.

If you would like to learn more about our Care Compliance software, contact us today to speak to one of our experts or to get your demo booked.