This week, we continue our series on starting a care agency, turning to the Care Quality Commission (CQC) Fundamental Standards. If you haven’t read the following first two parts of this series, we suggest you go back and read them now.
Starting a care agency.
The Fundamental Standards: Legislative basis
The Fundamental Standards are underpinned by two sets of regulations:
- CQC (Registration) Regulations 2009, Part 4.
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Part 3
It is important to note that each of the above contain regulations that can be directly prosecutable. The only difference is that the 2014 regulations allow for a defence of ‘reasonable steps and due diligence’ – i.e., you did all you could under the circumstances to avoid a breach of the regulations – while the 2009 regulation do not. A familiarity with prosecutable offences is therefore advisable.
Starting a care agency: The Five Key Domains
The five domains are an inherent part of the 2014 regulations. The run through them as a structure that supports the Fundamental Standards as the minimum requirement to deliver the service. The domains also form the basis for CQC inspections and your performance under the domains will inform how the CQC rates your services.
The CQC can rate your service as either outstanding, good, requires improvement or inadequate. Given the impact of these ratings on a social care business, avoiding any breach is imperative for the ongoing success, sustainability and growth of your organisation. The five domains are posed on the CQC website in the form of the following questions:
- Is the service safe?
- Is the service effective?
- Is the service caring?
- Is the service responsible to people’s needs?
- Is the service well-led?
Over this and the next few weeks, we will examine each of these domains from the perspective of setting up a social care service, beginning this week with the first domain: is the service safe?
Key domain 1: safe
The CQC defines safe as being protected from abuse and avoidable harm. But as social care providers often find out, this can mean many things to many people – including CQC inspectors and local authority (LA) monitoring teams!
Protection from abuse is covered in Chapter 14 of the Care Act 2014 Statutory Guidance, which is produced for LAs to assist in their compliance with the law. Within the guidance, there are sections of the role of various LA partners, including social care service providers.
Familiarity with this document and how it is interpreted and administered by your LA Adult Services Team is the first and most important place to start. To note: adult safeguarding is the umbrella term under which this domain sits and is the term that is predominantly used in the sector, including throughout the statutory guidance.
Reading all of Chapter 14 is a time-consuming effort. But unless you have the following existing experience in your management/governance team, then it essential:
- Experience of managing a safeguarding incident or situation.
- Reporting to and liaising with – including the preparation of oral or written reports for – the LA and multi-agency partners, including police, NHS, ambulance and emergency services.
- Thorough working knowledge of your LA Adult Safeguarding Protocol agreement (usually available from the local Safeguarding Adults Board website) and its multi-agency partners.
- Familiarity and confidence in the role of your organisation, as set out in the protocol.
Preventing abuse and avoidable harm
Avoiding harm (whether deliberate, a result of neglect, or accidental) is the primary aim of the various policies and procedures you are required, as a social care provider, to have in place. It is these that come together to mitigate and manage situations, both before and after they have occurred, to protect your service users. This may sound straightforward. It is not.
The reason is simple: you can put as many policies in place as you like, but you cannot account for the human factor: the action and reaction of the staff that provide your business’s day-to-day services.
Your staff is therefore the first line of defence when it comes to preventing harm and this should inform your recruitment and training policies. It may sound an obvious thing to say, but the more robust your recruitment processes, the less likely you are to find yourself in a situation where staff are involved in causing or allowing harm. The same is true of staff training, which starts at induction and should be a regular part of their employment, even for an individual with existing qualifications and experience.
However robust your recruitment and training processes, however, nothing beats hands-on observation of staff in the workplace. Online training should therefore always be accompanied by spot check observations that take into account the interplay between staff and the service users. Only this provides the opportunity to see if the training has been effective in upskilling those involved in delivering the service.
Similarly, supervision of staff, as a contractual obligation between employer and employee, helps to set and maintain professional boundaries, engages staff to learn from mistakes, and enables an open and transparent culture in which safeguarding service users is placed at the core of service delivery.
Person-centred care: the foundation of safe practice
At the heart of safe practice is a focus on the individual service user that is often referred to as person-centred care. The aim is to make sure the service user is listened to in all discussions that impact them and the provision of their care – from consent to care assessment and planning and reviews. When supported correctly and with appropriate awareness of mental capacity, the right of the service user to make life decisions for themselves is the core principle of person-centred care.
A note about risk assessments: these are often used as barriers, especially when it comes to a service user making decisions for themselves and where there is an element of risk. But when used most effectively as part of person-centred care, they are enablers that help identify the support a service user needs to maintain, as far as is possible, their independence and individual dignity. Which is ultimately what care is all about.
Regulations: friends not foes
Notifying the CQC of reportable incidents in the appropriate and timely manner is a key part of building trust between you, as a new provider, and the regulator. If you are in any doubt, notify! The CQC will let you know if it is not appropriate or needed.
Finally, it is important to see the regulations not as hoops to jump through but as defenders of your safe practices – the most important bulwark between your service users and harm. It is your responsibility to build safe foundations of the business. This includes reporting alleged or proven abuses to the appropriate authorities, including the Disclosure and Barring Service (DBS).
As part of W&P’s offering to aspiring social care providers looking into starting a care agency, our care agency policies and procedures packages, with associated forms, provide an accessible template for establishing a safe care practice. We also offer a Care Agency Business Start-up Package that provides support, necessary guidance and direction to help you get started as a business with CQC compliance.
Next week, we will continue our journey through the five key domains.
Margaret Ross Sands
Business Support Director
Margaret has over 30 years of experience in Health & Social care having worked in various local authorities in England holding senior positions in Contracting, Commissioning, and Operationally for the LA’s own in house Care Service. She has a deep knowledge of Adult Social Care and is our main policy lead in terms of keeping up to date with the latest government legislation, case law and good practice guidance. On leaving the statutory sector Margaret… Read Margaret’s Full Bio
