Updated CQC Inspections: Effective Feedback Collection

Published On: 4 October 2023

During the latter part of 2023, the Care Quality Commission (CQC) intends to update how services are inspected and move to a single assessment framework. The familiar five Key Questions will remain along with currently thirty-four Quality Statements and six Evidence Categories will complete the framework, the now familiar Key Lines of Enquiry (KLOEs) disappearing.

Feedback from staff and service users will be collected via its new portal to allow for easier and more frequent contact from service providers. It will be used to assess a service against the CQC’s quality statements.

In this blog, we look at the key changes around feedback and the implications for services, along with practical ideas to create effective systems and processes.

The importance of voice and listening when it comes to gathering feedback from service users

A fundamental value of care is really listening to the voice of individuals and putting them at the heart of decision-making. This is not just to provide evidence for a CQC inspection, or to satisfy evidence categories in the single assessment framework, but because it is the right thing to do.

This is always challenging for services because it has to be done in a meaningful way to the individual and not just tokenistically. All services should hopefully aim to be seen as truly listening to what is being said, both by individuals in their care, and also by their staff.

Sometimes the very nature of the complexities of a supported individual’s needs that has brought them into a care environment, may mean they experience distressing times more frequently than others. There may also be significant challenges when trying to communicate effectively.

Strategies to reduce these challenges in partnership with the individual include:

  • Time: Allowing time so as not to rush people or feel rushed takes the pressure off everyone.
  • Ensuring the person has an independent advocate, promoting the individual’s views, ideally avoids conflict and is independent of the service and families.
  • Continual reminders to staff, delivered in a variety of ways, how they value everyone’s voice.
  • Maintaining strong, appropriate and relevant communication with families, friends and the person’s supporters to pool ideas to better serve the individual.
  • Considering specific augmentative communication, visual supports, and communication apps.
  • Staff training and updating previous training around communication and behaviour support strategies.
  • Regular and planned meetings with agendas accessible to all for contributions and reference between meetings.

We should continually look for ways to communicate more effectively by involving other specialist professionals. Seeking multi-disciplinary support should be a key priority. This includes Speech and Language Therapists who not only have expertise in assessment and diagnoses but also up-to-date knowledge and resources to aid the individual and staff to communicate more effectively. We can also involve Behaviour Support Teams and Psychology services by working on short and long-term goals to increase the individual’s repertoire of experiences and skills.

CQC Single Assessment Framework requirements for staff and leaders

The new framework emphasises the importance of feedback from staff and leaders. This is now a required evidence category, meaning it is a key component of the assessment process. In practical terms, it will mean that staff and leaders must be prepared to provide honest, constructive feedback about the quality of care and their experiences in their workplace. Potentially, this may be a painful process to start with for those establishments not already engaging in such practice. However, there is real growth potential for both organisations and their staff from the process.

When organisations seek to collect views from staff and leaders, they may need to:

  • Be creative in ways staff can offer feedback anonymously at first. This may be especially beneficial when organisations are starting out or are attempting to change to a more open and honest culture, but staff lack the confidence to affect change or fear consequences.
  • Create the right conditions for any feedback. This includes time being allotted to reflect on the importance of the task, and explaining when and where staff are expected to offer their views aids the process, showing mindfulness of shift patterns and work schedules.
  • Explore consideration of ‘a no blame culture’ with the senior management to encourage openness and insights from the staff team.
  • Make it a priority to show commitment and importance organisationally.
  • Leaders must remain open and supportive to embrace all feedback including any that may be hard to hear from their staff.
  • Recognise the helpful intention with which the feedback is given.

Staff must also take responsibility for their actions so feedback may highlight any deficits in staff skill sets/competencies and lead to more bespoke personal development goals. It also gives opportunities to compare current good practice guidance to actual workplace practices.

Giving and receiving feedback is a skill that can be developed over time. The more staff engage in the process, the better they should become at it as they craft their skill to get the most from individuals. We can continue to train staff in active listening and empathy skills and look for new ways to engage and communicate with individuals more effectively, rather than treat this as a one-time training need.

Linking CQC Single Assessment Framework feedback to positive behaviour support (PBS) plans

Supporting individuals on a daily basis, where communication is not straightforward, can be challenging for everyone. Part of the feedback process allows additional opportunities for staff to demonstrate an understanding of the Positive Behaviour Support (PBS) plans and how they have been implementing them.

There is also a possibility it may identify:

  • A need for specific staff training or refreshers around behaviour support strategies.
  • An opportunity to ask collectively if they have the right function of behaviour identified.
  • If they do have a clear understanding of simple PBS principles.
  • If they need to consider working with or testing a different hypothesis for functions of the person’s behaviour? For example, with appropriate external support, such as a behaviour support team or psychologist.

This takes feedback further than a simple CQC single assessment requirement, and instead makes it a useful opportunity to identify strengths and professional development needs, thereby improving overall care for supported individuals.

CQC Single Assessment Framework requirements for individuals in our care

The ‘People’s Experiences of Health & Care Services’ evidence category is a required category. As outlined earlier, capturing these experiences may not be possible without challenge, and it needs serious consideration of how staff support the individual to express their views.

Good person-centred support in care identifies the individual as the expert on themselves first, above all other (including professional) input. Where the individual lacks the ability to process or express this, staff have to do this on their behalf, truly believing what the record says is what the person would be saying.

The supported individual’s experience, particularly when related to PBS plans and restraint, might include:

  • How well they feel it responds to their needs, especially at times of crisis.
  • How much input they have had into the PBS plan, and how well they feel it fits their unique needs.
  • The attitude of staff towards them at times they feel in distress.
  • If they have experienced physical restraint, how do they feel about the staff motivation and implementation of it?

Progress the individual personally feels they have made, including:

  • Being able to identify changes in themselves when potentially escalating to a crisis.
  • Their own ability to tell staff, or use systems to notify staff of changes in their emotions.
  • How the PBS plan has enabled them to spend more time in everyday activities they enjoy and value.
  • How they now spend less time engaging in areas that others have worries or concerns about for them.

Ideally, the individual will record their views as well as express them, so it is not just staff interpreting what they think the person is saying and then recording that. Over the last few years, there have been many technological advances and platforms for people to do this. Software, mobile phone technology and apps continue to be developed at a pace and offer innovations daily with tools that could be beneficial to care environments.

Using feedback to improve

Collecting feedback is just the first step. Improvements in service delivery to individuals will only follow reflection on the feedback and subsequent change. After investing time, resources, and everyone’s commitment to the process, it will be meaningless and simply a paper exercise unless change happens.

The process for this to happen includes regularly reviewing and analysing feedback to identify common themes or issues, then developing action plans to address these issues. Clear roles and responsibilities for implementation are important and regularly reviewing progress and adjusting plans as needed, ensures everyone maintains focus and energy to create the desired changes. Seeking outside review and input from families, supporters, and advocates of the individual, also ensures that changes are done with rather than to the individuals in our care.

Feedback is just a starting point

Feedback should be seen and welcomed as the starting point of a continuous process of improvement. However, it is not an end point, and certainly, CQC has expressed a desire for the new assessment process to eliminate what it sees as the current unhelpful nature of periodicity with inspections. The new process and portal access for services give the opportunity for organisations to demonstrate excellence in their practices.

The caring values or vision of an organisation should say something about improving the quality of the service they offer to those in their care, and there are lots of ways organisations can be looking towards doing this.

Where organisations truly listen and act on feedback from both staff and the individuals they support, using a variety of methods to collect feedback that best fits the communication strengths of the individual, they can ensure that the service is truly person-centred, responsive, and of the highest quality.

Please let us know if you need any support with behaviour training in your setting.