1. 1 Regulating supported living services Simon Spoerer Design Team Leader CQC Adult social care policy team

2. Compliance to ‘Fresh Start’ 2 From Is it compliant? to Is it good?

3. Revised Assessment & Judgement frameworks 3 ‘Is it compliant?’ to ‘Is it good?’ Key Lines of Enquiry (KLOEs) Prompts Sources of evidence Characteristics of Ratings Decision tree Improvement levers (Enforcement policy and decision tree)

4. Assessment & Judgement frameworks 4 Two sets of KLOEs & Characteristics Community services, eg DCAs Housing with Care Residential services, eg Care homes Residential colleges Very similar, same basic approach, detailed differences

5. Rating decision tree 5

6. Assessment & Judgement frameworks 6 Issues: HwC is neither residential care nor ‘standard’ domiciliary care: Same / similar populations & risks ‘Unit of inspection’ No CQC record of supported schemes Deprivation / restrictions of liberty Regulated activity Scope of regulation (EXC) Personal care / Social care Person’s own home

7. Diverse circumstances - Innovation Dispersed Ex-care homes 1 to one CQC location and scheme 1 to many location & schemes (can be large number of schemes) Personal care only Personal care and social care Shared houses and flats Single household Purpose built Adapted Shared site Shared building

8. Not being changed Community KLOEs and Characteristics Unit of inspection Normally one inspector, one day Current ‘taxonomy’ Current questionnaire & main PIR Notice of inspection (when given) Reporting arrangements

9. Pilot changes Better sampling Improved information Revised process & approach guidance Planning Scope Impact of delivering & inspecting services for people in own homes Mental capacity Restriction & deprivation of liberty Regulated activities Premises safety

10. Additional PIR information Supported Living Schemes and premises Numbers Hours of care & support Occupancy agreements Staffing arrangements Choice & control Personal finances Restriction & deprivation of liberty Safety concerns 10 Extra care housing Schemes Numbers Fit and proper workers Duty of Candour Fit and Proper Persons Restriction & deprivation of liberty Personal finance Safety concerns Other providers

11. Scope Personal care Physical assistance or prompting with eating / drinking; toileting; menstruation; washing and bathing; dressing; oral care; care of the skin, hair and nails. 11 Social care Personal care PLUS social work, social support & protection; including by informal networks. Promotion of independence & social inclusion, improvement of opportunities & life chances; strengthening / supporting family & community relationships; protection & promotion of human rights related to social needs.

12. Inspecting and reporting responsively Some HwC services explicitly and consciously provide only personal care. They must do so with regard to the Fundamental Standards regs: Person centred Dignity & Respect Consent Safe Governance 12 Others take a wider social care perspective Person’s whole life; goals, skills, abilities Protection from isolation and loneliness Social contact and companionship. Person-centred activities, hobbies and interests. Relationships with family and community Statement of purpose / Brochures / Commissioning

13. 13 Own home

14. 14 Choice and control / MCA

15. 15 Pathway tracking People and sites/premises that reflect: The needs and characteristics of all of the people using the service The types and settings of all of the premises that the location supports People with specific needs that can expose them to particular risks of harm Sites with practice that the provider is particularly proud of

16. 16 Regulated activities It’s a duck

17. Unsafe premises KLOE W4 mandatory (cooperation with other agencies)

18. 18 Reporting

19. To contact us: housingwithcarereview@cqc.org.uk 19 Get involved in our future strategy consultation: www.cqc.org.uk/content/2016-2021-strategy-consultation