Trade Associations meeting Adult social care Trade Associations meeting 13 July 2016 1 1

Agenda Welcome and introductions Deborah Ivanova 10.00 Agenda item Lead Time   Welcome and introductions Deborah Ivanova 10.00 Minutes and actions from last meeting 10.05 Ratings and updates Learning disabilities services Inadequate services DCA registration changes (correction) Care home closure document publication Factual accuracy update 10.15 Issues raised by Trade Associations 10.45 Next phase: Safe and Caring Ronald Morton 11.00 AOB 11.25 Implementation meeting 11.30 2

Welcome and introductions

Minutes and actions from last meeting

Ratings and updates

Current ratings overall and by key question for active locations Current ratings up to 30 June 2016 Note: Figures in chart are percentages Source: CQC ratings data

Current overall ratings by service type Source: CQC ratings data

Current overall ratings by size of care home Note: One inadequate rated residential home has been omitted due to data quality issue Small = 1-10 beds, Medium = 11-49, Large = 50+ Source: CQC ratings data

Current overall ratings by size of domiciliary care agency The chart to the right presents data we have for DCA locations that have been rated and the number of people using the service. There is a trend suggesting that locations providing care to a smaller number of people are performing better than larger services. This analysis is only based upon 1,682 rated DCA locations. The chart to the left provides an overview of 3,418 DCA locations, around 40% of the services registered with CQC, and the number of people using the service. Note: The grouping on the x axis is as follows; 25 is 1 to 25 people, 50 is 26 to 50 people and so on. Source: CQC ratings data and CQC community PIR data from May 2016

Overall ratings by publication quarter Residential social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 186 666 1,048 7 2015 Q2 192 896 1,304 4 2015 Q3 174 927 1,277 15 2015 Q4 164 878 1,514 13 2016 Q1 190 979 1,816 18 2016 Q2 127 678 1,254 Residential social care ratings, by publication quarter Calendar quarter Inadequate Requires improvement Good Outstanding 2015 Q1 27 153 313   2015 Q2 19 387 3 2015 Q3 28 183 470 2 2015 Q4 29 225 728 13 2016 Q1 41 284 869 2016 Q2 93 Source: CQC ratings data

Overall ratings by region (rated locations) Figures in chart are percentages of rated locations Source: CQC ratings data

Learning disability ratings analysis – current ratings up to 30 June 2016

Current ratings for services learning disability services Source: CQC ratings data

Current ratings by type of learning disability service Source: CQC ratings data

Ratings maps: Inadequate adult social care services – current ratings up to 28 June 2016

Nursing Homes rated inadequate CQC current ratings at 28/06/16. Percentage of care homes with nursing rated inadequate

Residential Homes rated inadequate CQC current ratings at 28/06/16. Percentage of care homes without nursing rated inadequate

Domiciliary care agencies rated inadequate CQC current ratings at 28/06/16. Percentage of domiciliary care agencies rated inadequate

All adult social care rated inadequate CQC current ratings at 28/06/16. Percentage of all ASC locations rated inadequate

Update: Domiciliary Care Agency change of address From 11 May, single location domiciliary care agency providers that change address will not be treated as a new application and they will keep their rating. Previously shared that this would be applied retrospectively, however, we have been notified that this is something that is being explored opposed to having already been implemented. 20

Update: Care home closures document publication Hoping to launch the care home closures document next week – date to be confirmed. This is the piece of work that we are joint producing with NHS England, and other signatories, including ADASS, Local Government Association, Department of Health and Care Providers Alliance. A lot of wider engagement activities will be happening to raise awareness, and from a media perspective, we’ll be focussing on opinion pieces on behalf of Andrea: Local Government Chronicle Guardian Social Care Network bi-annual column in the Caring Times. 21

Update: Factual accuracy From our Provider handbook: The Factual Accuracy process gives Providers the opportunity to challenge the accuracy and completeness of the evidence on which the ratings are based. Any factual accuracy comments that are accepted may result in a change to one or more ratings. Registered persons have 10 working days to review draft reports for factual accuracy and submit their comments to CQC. 22

Quality assurance and factual accuracy Our Quality Assurance Programme identified some improvement areas these include: Consistency Design of the Form Sign posting non Factual Accuracy responses Variations in format Guidance 23

Factual accuracy: phase 1 (1) Phase 1 of the project is underway. Initial improvements – an updated form, including: Cover sheet with guide on raising comments: Before publication – via Factual Accuracy Form After publication – as outlined in Final report letter Conduct of Inspection Representations 24

Factual accuracy: phase 1 (2) Sections for Typographical/numerical errors Accuracy of existing evidence Additional evidence for completeness Coming soon: Updated Guidance Note: Providers are encouraged to submit comments via the form provided to facilitate a timely response. 25

Issues raised by trade associations

Issues raised by the trade associations Delays in re-inspection especially of requires improvement services (Ann Mackay) Complaints handling by CQC (Duncan White)

Safe and Caring key lines of enquiry, prompts and characteristics

Safe and Caring: The questions We are considering prompts around use of the finances of people who use services i.e. protection from financial abuse. What sources of evidence should we look at? What are your views about including restraint and duty of candour in Safe? Caring The majority of services are Good or Outstanding for Caring. What evidence should we focus on to get to the heart of the caring question? How do we understand domiciliary care services are caring when we cannot see care being given?

Co-production feedback Key lines of enquiry and Characteristics should be simplified in both presentation and content. Safe: How well a service protects people from abuse and avoidable harm Personal outcomes – feeling and being safe Caring How well a service involves people and treats them with compassion, kindness, dignity and respect Personal outcomes – treated well and respected

Key changes for Safe Learning from our inspections Service user finances – no key lines of enquiry or prompts around this. Is the question “do you feel safe” the best question to ask people using services?

Key changes for Safe Cross sector alignment (proposals) Restraint and Duty of Candour included in Safe Key learning from internal and national reports Services rated Good had business continuity plans and e.g. seasonal risk assessments Merge key lines of enquiry and reduce overall number: S4 How are people’s medicines managed so that they receive them safely? S5 How well are people protected by the prevention and control of infection? ‘Are there reliable systems, processes and practices in place to keep people safe and safeguarded from abuse’

Key changes for Caring Learning from our inspections Specific prompts for individual personalised care Evidence currently reported under Care is quite limited Current key topic areas: Staff approach/kindness Confidentiality Involving people Privacy and dignity Wellbeing End of life care Advocacy Equality and diversity

Key changes for Caring Cross sector alignment Suggestion from other sectors that Advance Decisions should be moved from Caring to Effective. Key findings from internal and national reports Services rated as good accommodated the spiritual and cultural needs of people at the end of their life: Adapted the service provided. Care plans included people’s preferred place of care at the end of their life.

Key timelines – what happens next Share initial findings May 2016 Internal and external engagement April- July 2016 Proposals and drafting Summer 2016 Jan–Mar 2017 Sign off for new handbook March 2017 Publish revised inspection framework and handbooks November 2016 Field test/consultation

AOBs

Implementation meeting