Legal entities
CQC will register the ‘legal person’ who is the service provider. The legal person may be one of the following: an organisation, an individual or a partnership. It is always for the provider to declare what type of provider they are and to ensure they make accurate applications for registration.
Individual: If you are a sole trader, you should register as an individual. You should also select this type of entity if you are not in a legal partnership or an organisation but you allow other professionals to assess or treat patients as part of your service. For the purposes of registration, these colleagues will be treated as employees of the provider.
Partnership: To register as a legal partnership, you must have a formal partnership agreement in place, which includes agreement to share both liabilities and profits: this is a key way of differentiating a legal partnership from just having informal arrangements, for example to share expenses. Please note that for legal reasons, limited liability partnerships (LLPs) should register as an organisation, not as a partnership.
If you are a provider that allows other professionals to assess or treat patients as part of your service, for example ‘associates’ in a dental practice, they will be treated as employees of the provider for the purposes of registration and you should, in most cases, register as an individual. More details on the associate model can be found below. This is because the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 define ‘employment’ as including that under a contract of service, an apprenticeship, a contract for services or otherwise than under a contract, or the grant of practising privileges.
If you operate in this way, you must have arrangements in place that meet the requirements set out in Outcome 12 of the essential standards: “Requirements relating to workers”
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Dentist associate model
Where a dentist allows other dental care professionals to see patients as part of their practice, for the purposes of CQC registration these people will be treated as their employees. This is permitted under the regulations even though no formal contract of employment will be in place. The provider must then ensure they make arrangements for granting the associate dentists (ie, their informal partners) permission to see patients as part of the practice.
Organisation: If you are a registered company or charity, a limited liability partnership (LLP) or other corporate body of persons, you should select this option.
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Locations
A location is the place where regulated activities are provided or provided from. A location can cover an area – but it is the 'main address' at which the regulated activity is carried on (such as a dental practice), or carried on from (such as a domiciliary agency branch) that CQC expects to see in applications for registration.
The term location is important because providers will need to declare compliance against each regulated activity at each location. Monitoring this declaration is an important part of how CQC make judgements about continuing compliance with the essential standards of quality and safety.
Locations will be listed as ‘restrictive conditions’ on your certificate of registration, and it is therefore necessary to define locations in a consistent and proportionate way. Also, you will be required to set out, in your statement of purpose, the locations at which the regulated activities are carried on.
A location is:
1. A place to which people are admitted to for the purpose of receiving a regulated activity, or
2. A place in which people live as their main or sole place of residence or in which they are educated, and they receive care or treatment there, or
3. A walk-in centre, or
4. A primary medical, primary dental or out-of-hours service, or
5. The branch of an agency providing care, or
6. A station from which an independent ambulance service operates, or
7. A stand alone purpose-built diagnostic or screening facility.
If none of the above applies, then a location is also:
8. A place where regulated activities are managed from.
There are some additional rules that cover specific scenarios.
If you have queries about locations, please refer to CQC guidance on locations, What is a ‘location’? : Guidance for providers, assessors and inspectors
Providers should carefully read the guidance to make sure that they are correctly identifying locations against the rules, eg:
Rule 4
A location is: A primary medical care service, primary out-of-hours service or primary dental care service
Where a service provider provides a primary medical service, primary out-of-hours service or primary dental care service carrying on one or more regulated activities, the place in which that service is provided is a location.
Where other registerable community services are provided within the same premises as a primary medical service, primary out-of-hours service or primary dental care service, those community services will not be included within the primary medical service, out-of-hours service or primary dental care service’s location but should be considered in the light of rule 8(b).
Where the place contains two or more legally distinct primary medical services, primary out-of-hours services or primary dental care services, then each service under former legislation should cite the premises as a location.
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Declaration of compliance
You are asked to declare if you comply with all the regulations for each regulated activity you carry on at each location at the point in time you complete your application.
If, for example, you complete your application in November 2010 but declare non-compliance for a particular regulated activity, you will need to explain in your action plan how you will be compliant by 1 April 2011.
• You must ensure that you have evidence available to support your declaration against each regulation, including evidence from people who use services. You do not need to submit this evidence but ensure it is available if we ask for it.
• Each essential standard applies equally to each provider. However, if you believe that an essential standard is not applicable to your service please review the Guidance about compliance: Essential standards of quality and safety carefully. If you still believe that a standard is not applicable, you must declare non-compliance in your declaration (you cannot declare compliance for something you do not do) and explain why the standard is not applicable in the action plan template provided. In this circumstance we will not require an action plan, just an explanation of how the regulation is not applicable.
Meaning of compliant, and non-compliant
- If you declare compliance with the regulations you must be able to show, if asked, that people who use services experience the outcomes set out in the Essential standards of quality and safety. The ‘outcome box’ in each section of Essential standards of quality and safety shows what people who use services should experience.
- If you declare non-compliance with the regulations, you have not met the regulations as described by the outcome statements in Essential standards of quality and safety.
You must state reasons for non-compliance and how you will address the issues, and provide an action plan and date when you will be compliant. Non-compliance is serious and compliance must be achieved as soon as possible.
This declaration will not be made publicly available by CQC.
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Completing the action plan
You need to identify the areas in your service that do not meet the regulations. The Guidance about compliance: Essential standards of quality and safety describes what compliance with the essential standards looks like and you should use the guidance to help you assess:
- How and why you are not compliant; and
- What measures you will take to become compliant with the regulations. Each action plan must have a date for completion attached to it.
- An action plan must be completed for each regulated activity where non-compliance has been declared. A comprehensive action plan must be provided so that assessors and inspectors are able to fully understand what you are doing to become compliant with those regulations within a specified period of time. The action plan is a critical element to ensuring that the correct conditions are imposed and that subsequent reviews are carried so that you are correctly registered.
- An action plan should follow ‘SMART’ principles:
- Specific – does it identify the details of what the non-compliance is, and what action needs to be taken? Does it explicitly say what you want to achieve, and who is going to make these changes?
- Measurable – does the action plan say how you are going to ensure that improvements have been made? What measures are you going to put in place? Who will do this?
- Achievable – are the measures you are going to put in place, achievable, attainable and sustainable?
- Relevant – have you described the resources needed to implement the changes? Are these in place?
- Time bound – is there an appropriate date by which the improvements will have been made? How will this date impact on people who use services?
Compliance conditions will be applied to your registration from 1 April 2011 if you do not achieve compliance by this time. CQC applies these when you must make improvements to your services in order to meet essential standards. More information on conditions can be found on CQC website.
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Registered manager
Each provider must be registered. In addition, where the provider is not themselves in charge of the day-to-day running of the service, a manager must also register. The person undertaking this registered manager role is accountable for the day-to-day running of the regulated activities of the service and therefore should be an individual who has the capability and authority to do so.
If you are an organisation, partnership or individual who is not in day to day charge of the service, you will also need to submit a registered manager application. The relevant form should be downloaded from CQC website and the associated guidance How to complete the registered manager application form to register under the Health and Social Care Act 2008 : Guidance for transition registered manager applicants in primary dental care providers and private ambulance providers is here
Every registered manager applicant must complete a registered manager application form at the same time as the provider application. Each registered manager applicant will be contacted for an interview, which will be conducted over the phone or face-to-face. Interviews will be held before the Notice of Decision is issued.
Registered managers can be registered for more than one regulated activity and for more than one location.
If a manager is applying to manage multiple locations for one provider or to manage locations for two providers CQC will look at the locations in question to determine whether it is possible for one person to practically be in full-time day-to-day charge of both or all locations, across one or more providers.
The registered manager needs to apply for an enhanced CRB disclosure from the Care Quality Commission before submitting their application, which CQC will countersign. If the applicant is a partner in a partnership (ie, also the provider) and already has a PCT-countersigned enhanced CRB check, CQC will not ask you to produce another. If the applicant is not the provider, then CQC require a CQC countersigned enhanced CRB check.
When applying for registration and after registration has been agreed, a registered manager must have the information and documents specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 available should CQC ask to see them.
CQC will only ask for some of the documentation to support the application. However it may ask for further information if it has any reasons to question the validity of the application. CQC will ask to see proof of identity when the registered manager applicant is interviewed and retain a copy for its records.
Skills and competence to manage the regulated activities you are applying to be registered for
When completing this section, the applicant may wish to include the following:
- Current job role within the service
- What the manager will do to check that the practice continues to meet the essential standards
- How they ensure that the practice provides a safe service for children and vulnerable people.
The assessor may ask specific questions about this section in the registered manager interview.
If the applicant is intending to manage more than one location, they will need to outline:
- Supporting management arrangements
- Time spent at each location by the applicant
- Details of resources i.e. senior staff at each location
- Details of deputising arrangements.
These areas should also be considered for the subsequent section considering how a job share can be managed.
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Preparing for interview
CQC will interview all registered manager applicants to assess their fitness to manage the regulated activities they have applied for. CQC will contact applicants to arrange a convenient time for the interview.
You should read and become familiar with:
1. Guidance about compliance: Essential standards of quality and safety
2. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010
3. The Care Quality Commission (Registration) Regulations 2009
4. The Health and Social Care Act 2008 (especially Part 1).
These documents are on CQC website and CQC recently sent each provider a copy of the Essential standards of quality and safety. It contains the two sets of regulations at the back.
Make sure that you are familiar with your Statement of Purpose, even if you didn’t write it.
Give some thought to how you will describe what you do to involve patients in the way that the practice is run and what you can tell the interviewer that shows how you recognise and promote equality and diversity, and respect patients’ human rights in your practice.
The interview can be by telephone or face-to-face and will include questions about:
- Your job role within the practice.
- Your knowledge of the essential standards of quality and safety.
- How you will ensure that everyone in the practice meets the standards at all times.
- Your understanding of the legal responsibilities of a registered manager, including what notifications you must send to CQC.
CQC will use the information that it collects from the interview, the application form and the Criminal Records Bureau to make a decision about the application.
CQC will send you and the registered service provider a notice of its decision.
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