Care Quality Commission continued

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Which regulations does it cover?

The essential standards of safety and quality consist of the 28 regulations and associated outcomes that are described in the guidance about compliance for providers. The judgement framework is concerned with the 16 regulations (out of the 28) that come within Part 4 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009.

These are the ones most directly relate to the quality and safety of care. When the CQC is checking a provider's compliance, these are the regulations that it will focus on:

*Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2009.

The CQC will make the following judgement for each of the 16 regulations:

• Compliance
• Minor concern
• Moderate concern
• Major concern.

These judgements are taken at a point in time. Subsequent follow-up activity requires the CQC to reconsider the judgements in light of any other information gathered. This way, the CQC believes that the system is dynamic and current and it will have an up-to date picture of a provider's provision of care in line with the relevant regulations.

The CQC will assess compliance with the registration requirement on cleanliness and infection control by reference to the Code of Practice for healthcare, including primary care, and adult social care on the prevention and control of infections and related guidance - which is currently a consultation document. The consultation closed 24 June 2010. It should be noted that the CQC judgement framework contains a number of prompts and these are the areas where the CQC will be looking for evidence of compliance with the regulations. Members are advised to review the CQC guidance documents with this in mind.

For example in relation to Outcome 2 (Regulation 18): Consent to care and treatment, the CQC prompts are:

• Are there processes in place to ensure that people are able to give informed consent to their treatment and care?
• If people lack capacity, do staff know how to comply with the Mental Capacity Act 2005?
• Is the consent process reviewed and monitored to make sure that staff are following it?
• Do the systems for consent to care and treatment take into account any guidance issued (government and expert)?

For example in relation to Outcome 17 (Regulation 19): Complaints, The CQC prompts are:

• Is there an effective complaints system?
• Are people made aware of the complaints system and what to do if they are dissatisfied with the response?
• Is the complaints process accessible and available in an appropriate manner and formats to meet the needs of people using the service?
• Are people provided with support to raise a complaint or make comments, and protected from discrimination?
• Are complaints fully investigated, resolved if practicable, and the outcome communicated to the complainant and other interested parties?
• Is a coordinated investigation and response undertaken if there is more than one service specified in the complaint?
• Is a record made of all complaints, investigations, responses and outcomes?
• Are there processes in place to implement learning from complaints?

For example in relation to Outcome 10 (Regulation 15): Safety and suitability of premises, the CQC prompts are:

• Is the design, layout and security of the premises fit for purpose to safely meet the needs of everyone receiving care and treatment including those with disabilities?
• Does the design and layout of the premises promote people's dignity, independence and wellbeing?
• Have all reasonable steps been taken to ensure that premises are accessible to all those who need to use them in keeping with the requirements of the Disability Discrimination Act 1995?
• Are the premises and grounds well maintained and risks to safety identified and managed?
• Are there arrangements in place to comply with all legislative requirements relating to the classification, collection, segregation, storage, handling, transport, treatment and disposal of waste?
• Are there arrangements in place to provide safe and effective care in the event of a failure in major utilities, fire, flood or other emergencies?
• Are all staff, people who use services and others provided with information on the risks to their health and safety, protective measures and what to do in the event of an emergency, for example fire?
• Are there arrangements for learning from relevant safety incidents, safety alerts and national guidance relating to premises and taking action to minimise risk in the future?
• Are there emergency evacuation procedures in place and are they practised?
• Does the provider risk assess when he is not responsible for the premises in which care is delivered?

For example in relation to Outcome 16 (Regulation 10): Assessing and monitoring the quality of service provision, the CQC prompts are:

• Does the provider effectively assess and monitor the quality of its service delivery to ensure that people receive safe and appropriate care and treatment?
• Are there clear lines of reporting/accountability/responsibility and are these implemented?
• Is a system implemented for reporting and learning from incidents?
• Does the provider seek views and comments from people who use services, their carers, staff and other third parties, and use these views to help them assess quality and manage risks?
• Are there effective processes in place for staff, people who use services and their carers to raise concerns and for the service to act on them?
• Does the provider evaluate, take action on, and learn from relevant findings and recommendations from:
  
  
  • expert bodies
  • CQC
  • expert bodies
  • professional bodies
  • national reports and audits
  • bodies representing the views of people who use services?

For example in relation to Outcome 21 (Regulation 20): Records, the CQC prompts are:

• Do the records kept for each person include clear, accurate and up-to date information about their care and treatment?
• Are all the relevant records listed in the guidance about compliance kept?
• Are records stored securely (in accordance with the Data Protection Act 1998) and able to be located promptly when required?
• Is there an effective records management system that staff understand?
• Are staff given induction training about the principles of confidentiality and the Data Protection Act?
• Are records securely destroyed in keeping with the Data Protection Act?

The CQC will use the guidance about compliance to consider:

a) whether a provider continues to be suitable and is allowed to keep their registration;
b) how it judges compliance of a provider with the essential standards of quality and safety;
c) whether concerns about a provider should require them to make improvements or should lead to the CQC using it's more formal powers which include restricting, suspending or in the most serious cases removing their registration.

The CQC has stated that it also wants to make sure that people who use services are empowered to use the guidance and for it to be a tool for them to trigger improvement themselves.

Dental Protection understands that the CQC has no plans to produce a judgement framework specific to dentistry. Looking at the requirements of the CQC it can be seen that many practices will be complying in a number of areas and what a practice will need to do is put itself in the position to provide evidence of demonstration of compliance. Many requirements fit with those of the GDC and the NHS regulations. A practice should review the judgement framework to ensure that when their application for registration is made compliance can be demonstrated in the appropriate areas.

More detailed advice will appear on the DPL website in due course.  In the meantime further information can be found in the guidance section of the Care Quality Commission website

The role of Care Quality Commission

Click here to read about other functions of the Care Quality Commission that are relevant to dentistry.