Challenging a CQC Rating

This article was written by Helen Wallwork who, with over 15 years’ experience in the field, heads up the specialist healthcare sector team at Stephens Scown LLP.

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The Care Quality Commission (CQC) acts as the regulator of health and social care services in the UK. The CQC will regularly inspect care homes, hospitals and medical practices and publish a report on their findings.

During the inspection, an inspector will consider the home’s performance in 5 key areas by reference to the Health and Social Care Act Regulations.

It is not uncommon for providers to feel that the report produced by the CQC contains factual inaccuracies or that the wider context of a situation has not been taken into account.

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There are two stages of challenge in respect of the inspection process:

The first stage is the Factual Accuracy Challenge. This is where you have an opportunity to challenge any factual inaccuracies with the draft report. This can be typographical errors, incorrect facts or information which you feel was wrongly excluded by the inspector.

The second stage is the Ratings Review Request. This is where the provider is not happy with the ratings it has been given and wants the area ratings and/ or the overall rating reviewed. It is important to be aware that the only ground for requesting a review is that the inspector did not follow the correct process for making ratings decisions. You cannot request a review simply because you disagree with their decision.

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To maximise your chances of a successful challenge, here are our 4 top tips for challenging a CQC report:

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1. Act promptly

The CQC have strict deadlines by which any challenges need to be submitted. It is important to make sure that you diarise the final submission date and obtain legal advice as soon as possible.

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2. Understand the process

The CQC has published forms that it expects providers to use when challenging a draft report. Whilst it can be tempting just to submit a complaint by e-mail or letter, you will have a greater chance of successfully challenging the contents of the report if you follow the correct procedure and use the right forms.

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3. Provide evidence

If you have any evidence which supports your position, make sure that you provide this to the CQC along with your application form. It may be that the inspector did not see a chart that you use to record bed changes or medication provisions and this led to adverse conclusions in the report. The challenge is an opportunity to show that you did have the correct procedures and checks in place at the time of the inspection.

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4. Be proactive

‍If the inspector does highlight any issues in your policies, consider whether you can make any reasonable adjustments. The CQC will often be less inclined to penalise providers who have taken action quickly and tried to remedy any breaches.

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Our healthcare team has experience in challenging ratings, appealing penalty notices and getting reports amended. If you are a provider and are looking for legal advice and support in respect of a recent CQC decision, please get in touch with Helen on 07891 240961, or by emailing h.wallwork@stephens-scown.co.uk.

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About Stephens Scown

Stephens Scown was the first large law firm in the UK to become employee-owned, and has recently gained B Corp™ Certification, which underlines our long-term commitment to also being a force for good in wider society, balancing people, planet and profit. This vision and ethos of doing things the right way for our people, clients, planet and community perfectly match the care and values of those working within the care sector.

The specialist Healthcare team at Stephens Scown is fully tuned into the pressures, opportunities and innovations affecting health and social care providers and the challenges brought about by significant changes in the healthcare sector in recent years.