LINks and CQC briefing: 2 enter and view - Care Quality Commission
LINks and CQC briefing: 2 enter and view - Care Quality Commission
LINks and CQC briefing: 2 enter and view - Care Quality Commission
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<strong>LINks</strong> <strong>and</strong><br />
<strong>CQC</strong><br />
working<br />
together<br />
Introduction<br />
2<br />
<strong>LINks</strong> ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong><br />
<strong>CQC</strong> inspections<br />
September 2012<br />
This is one of a series of new <strong>briefing</strong>s for local involvement networks (<strong>LINks</strong>) about<br />
how to work with the <strong>Care</strong> <strong>Quality</strong> <strong>Commission</strong> (<strong>CQC</strong>). It builds on the Guide for<br />
<strong>LINks</strong>: How <strong>LINks</strong> can work with the <strong>Care</strong> <strong>Quality</strong> <strong>Commission</strong> (June 2011) which is<br />
available free at www.cqc.org.uk/public/sharing-your-experience/involving-peoplewho-use-services.<br />
The <strong>briefing</strong>s have drawn together learning <strong>and</strong> examples from <strong>CQC</strong>’s work with<br />
<strong>LINks</strong> over the last three years <strong>and</strong>, in particular, from work with 26 <strong>LINks</strong> who took<br />
part in a national <strong>CQC</strong> development project during 2011/12. <strong>CQC</strong> would like to thank<br />
all the <strong>LINks</strong> for their contributions. The <strong>briefing</strong>s also include learning for<br />
Healthwatch which we hope will be of interest to local authority Healthwatch<br />
commissioners <strong>and</strong> shadow Healthwatch organisations.<br />
<strong>CQC</strong> is the independent regulator for health <strong>and</strong> social care services in Engl<strong>and</strong>. We<br />
value any information from people who use services <strong>and</strong> their representatives to help<br />
us check on the quality <strong>and</strong> safety of care, <strong>and</strong> we have a statutory duty to ‘have<br />
regard’ to the <strong>view</strong>s of <strong>LINks</strong>.<br />
<strong>CQC</strong>’s local relationships with <strong>LINks</strong> will remain in place until 31 March 2013 <strong>and</strong><br />
transfer to local Healthwatch from 1 April 2013. The learning from our work with<br />
<strong>LINks</strong> will be used to develop a guide for local Healthwatch about working together<br />
with <strong>CQC</strong> from April 2013. <strong>CQC</strong> will work closely with Healthwatch Engl<strong>and</strong> from<br />
October 2012 to best coordinate its work with emerging Healthwatch.<br />
LINKs <strong>and</strong> <strong>CQC</strong> working together – 2: <strong>LINks</strong> ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections 1
<strong>LINks</strong> <strong>and</strong> <strong>CQC</strong> – principles of working<br />
together<br />
<strong>CQC</strong> works with all <strong>LINks</strong> across the country to exchange information that can help<br />
us both to tackle poor care. We respect the independent status of <strong>LINks</strong>, <strong>and</strong> the<br />
different roles we play in holding services to account for the care they provide. We<br />
recognise the need to maintain public confidence in both our organisations, <strong>and</strong> to<br />
be open <strong>and</strong> transparent about how we cooperate <strong>and</strong> when we need to work<br />
separately. We strive to use our resources effectively, avoiding duplication of effort.<br />
About this <strong>briefing</strong><br />
This <strong>briefing</strong> explores how LINk <strong>enter</strong> <strong>and</strong> <strong>view</strong> visits <strong>and</strong> <strong>CQC</strong> inspections can<br />
complement each other, with illustrative local examples. It sets out:<br />
• What are LINk ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits<br />
• What is a <strong>CQC</strong> inspection<br />
• ‘Enter <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections – a comparison<br />
• Exchanging information about visits <strong>and</strong> inspections<br />
• How to make LINk visit reports useful to <strong>CQC</strong><br />
• Examples of <strong>LINks</strong> <strong>and</strong> <strong>CQC</strong> working together<br />
• Learning for Healthwatch<br />
Key messages<br />
• <strong>LINks</strong> can, under certain circumstances, visit publicly-funded health <strong>and</strong> care<br />
services to help monitor the services <strong>and</strong> to gather people’s <strong>view</strong>s about care –<br />
as part of a wider engagement strategy.<br />
• The Department of Health’s Code of conduct (2008) provides good practice<br />
guidance <strong>and</strong> is supported by <strong>CQC</strong>.<br />
• High quality LINk evidence <strong>and</strong> reports from their visits can provide invaluable<br />
information to <strong>CQC</strong> to support the regulation of health <strong>and</strong> social care services.<br />
• <strong>LINks</strong> can make use of <strong>CQC</strong> national reports <strong>and</strong> local inspection reports about<br />
services to inform its priorities, <strong>and</strong> its <strong>enter</strong> <strong>and</strong> <strong>view</strong> activity.<br />
• Coordinated LINk visits <strong>and</strong> <strong>CQC</strong> inspections can together, provide strong<br />
evidence of the st<strong>and</strong>ards of care provided by a service, <strong>and</strong> the experiences of<br />
that care from people who use it <strong>and</strong> their families <strong>and</strong> friends.<br />
• Working together, <strong>CQC</strong> <strong>and</strong> <strong>LINks</strong> can make the most of this evidence to tackle<br />
poor care, as well as minimise the burden of monitoring <strong>and</strong> inspection on<br />
providers.<br />
LINKs <strong>and</strong> <strong>CQC</strong> working together – 2: <strong>LINks</strong> ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections 2
What are LINk ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits<br />
“<strong>LINks</strong> may, in certain circumstances, <strong>enter</strong> health <strong>and</strong> social care premises<br />
to observe <strong>and</strong> assess the nature <strong>and</strong> quality of services <strong>and</strong> obtain the <strong>view</strong>s<br />
of the people using those services. In carrying out visits, <strong>LINks</strong> may be able to<br />
validate the evidence that they have already collected from local service<br />
users, patients, their carers <strong>and</strong> families, which can subsequently inform<br />
recommendations <strong>and</strong> be fed back to relevant organisations. Properly<br />
conducted <strong>and</strong> co-ordinated visits, carried out as part of a constructive<br />
relationship between <strong>LINks</strong> <strong>and</strong> organisations commissioning <strong>and</strong>/or providing<br />
health <strong>and</strong> social care services, may enable ongoing service improvement.<br />
<strong>LINks</strong>’ role is not to seek out faults with local services, but to consider the<br />
st<strong>and</strong>ard <strong>and</strong> provision of care services <strong>and</strong> how they may be improved.”<br />
(Department of Health, 2008)<br />
Regulations based on Section 225 of the 2007 Local Government <strong>and</strong> Public<br />
Involvement in Health Act require certain health <strong>and</strong> care providers to allow<br />
“authorised representatives to <strong>enter</strong> <strong>and</strong> <strong>view</strong>, <strong>and</strong> observe the carrying-on of<br />
activities on, premises owned or controlled by the services-provider”. “The 2008<br />
Entry Regulations cover the issue of ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ in two ways:<br />
• Firstly, in terms of a duty upon services-providers to allow the LINk’s authorised<br />
representative to <strong>enter</strong> <strong>and</strong> <strong>view</strong> <strong>and</strong> observe the carrying-on of activities on<br />
premises they own or control.<br />
• Secondly, there are particular requirements placed upon the individuals who<br />
carry out the activity as authorised representatives.”<br />
With certain exceptions, a LINk may visit any NHS trust, GPs, dentists, optometrists<br />
<strong>and</strong> pharmacists; local authority social care premises <strong>and</strong> places that are contracted<br />
with the NHS or local authority to provide health or social care services. It may carry<br />
out announced or unannounced inspections.<br />
A Code of Conduct relating to Local Involvement Networks’ visits to <strong>enter</strong> <strong>and</strong> <strong>view</strong><br />
services (2008) is available at:<br />
www.dh.gov.uk/en/Publications<strong>and</strong>statistics/Publications/PublicationsPolicyAndGuid<br />
ance/DH_087285<br />
The Code sets out good practice in ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’, including preparing for a visit,<br />
managing a visit <strong>and</strong> using the findings. It recognises that visiting services is only<br />
one method a LINk can use to monitor the quality of care provided or to gather the<br />
<strong>view</strong>s of people using the service, <strong>and</strong> their families. <strong>CQC</strong> encourages all <strong>LINks</strong> to<br />
make use of the Code of Conduct.<br />
LINKs <strong>and</strong> <strong>CQC</strong> working together – 2: <strong>LINks</strong> ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections 3
What is a <strong>CQC</strong> inspection?<br />
The <strong>Care</strong> <strong>Quality</strong> <strong>Commission</strong> inspects care in hospitals, care homes, dentists <strong>and</strong><br />
other services, including those provided in people’s own homes, <strong>and</strong> we publish our<br />
findings on our website <strong>and</strong> in our inspection reports.<br />
We inspect most health <strong>and</strong> social care providers every year or every other year. We<br />
re-inspect services that aren’t meeting government st<strong>and</strong>ards, <strong>and</strong> we inspect at any<br />
time when there are concerns about poor care. All of our inspections are<br />
unannounced unless there is a good reason for us to let the service know we are<br />
coming. During our inspections we:<br />
• Ask people about their experiences of receiving care.<br />
• Talk to care staff.<br />
• Check that the right systems <strong>and</strong> processes are in place.<br />
• Look for evidence that the service isn’t meeting government st<strong>and</strong>ards.<br />
Sometimes our inspectors are accompanied by an Expert by Experience (a person<br />
who has experience of receiving care) who also talks to patients.<br />
Types of inspections<br />
We carry out three types of inspections.<br />
• Scheduled: these are unannounced inspections that focus on a minimum of five<br />
of the government st<strong>and</strong>ards, <strong>and</strong> they’re also tailored to the type of care that is<br />
provided at the service.<br />
• Responsive: these are unannounced inspections that are carried out where there<br />
are concerns about poor care.<br />
• Themed: these inspections focus on specific st<strong>and</strong>ards of care or care services.<br />
Information from <strong>LINks</strong> that tells us about people’s experiences of care or<br />
observations about care environments may help to inform a scheduled inspection or<br />
to trigger a responsive inspection. It may help us decide which st<strong>and</strong>ards to check<br />
<strong>and</strong> what to look out for when we inspect a service.<br />
Our findings<br />
Our inspectors judge whether or not services are meeting the government st<strong>and</strong>ards.<br />
If the service is not meeting the st<strong>and</strong>ards, the inspector will decide whether there is<br />
a minor, moderate, or major impact on people who use it, <strong>and</strong> they may decide to<br />
take Enforcement action.<br />
You can see whether or not a care service is meeting the government st<strong>and</strong>ards by<br />
visiting its profile page on our website at www.cqc.org.uk. The st<strong>and</strong>ards are<br />
grouped under five headings, with a green tick or a grey cross beside it, which is<br />
updated every time a new report is published.<br />
LINKs <strong>and</strong> <strong>CQC</strong> working together – 2: <strong>LINks</strong> ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections 4
‘Enter <strong>and</strong> <strong>view</strong>’ visits <strong>and</strong> <strong>CQC</strong> inspections – a<br />
comparison<br />
LINk <strong>enter</strong> <strong>and</strong> <strong>view</strong> <strong>CQC</strong> inspection<br />
Providers have a duty to allow a LINk to<br />
<strong>enter</strong> <strong>and</strong> <strong>view</strong> publicly funded health <strong>and</strong><br />
care services <strong>and</strong> observe the care<br />
provided. They can refuse to allow entry<br />
under certain circumstances, such as if the<br />
visit compromises either the effective<br />
provision of a service or the<br />
privacy or dignity of any person.<br />
A LINk cannot access parts of a service –<br />
such as where the premises are noncommunal<br />
parts of care homes.<br />
Only authorised representatives of the<br />
LINk can undertake an ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’<br />
visit. The LINk must have agreed<br />
procedures for making decisions about<br />
who can be an authorised representative.<br />
Representatives can be authorised only if:<br />
• They have undergone a Criminal<br />
Records Bureau check, in line with<br />
section 113A of the Police Act 1997,<br />
<strong>and</strong> have a certificate to verify this; <strong>and</strong><br />
• A ‘nominated person’ of the LINk has<br />
considered the certificate <strong>and</strong> is<br />
satisfied that the person is suitable to<br />
carry out visits.<br />
A LINk is expected to document the<br />
findings from the visit. The Code of<br />
Conduct states that reports should offer a<br />
balanced assessment of the service <strong>and</strong>,<br />
where appropriate, make<br />
recommendations for improvement.<br />
In all cases, a copy of the draft findings<br />
<strong>and</strong> any recommendations should be sent<br />
to the provider to check for<br />
<strong>CQC</strong> has the power to <strong>enter</strong> all regulated<br />
health <strong>and</strong> social care services to inspect<br />
them against the st<strong>and</strong>ards of quality <strong>and</strong><br />
safety set by government.<br />
It can inspect a service that provides<br />
‘regulated activities’, wherever it deems it<br />
necessary to do so, as set out in the<br />
Health <strong>and</strong> Social <strong>Care</strong> Act 2008.<br />
<strong>CQC</strong> can inspect any part of a service<br />
where regulated activities are taking<br />
place, or if it needs to gather information<br />
to fulfil its regulatory role.<br />
<strong>CQC</strong> inspectors can undertake an<br />
inspection with a number of other people.<br />
These may include specialist<br />
professionals in a particular field, Mental<br />
Health Act commissioners, <strong>and</strong> Experts<br />
by Experience (see link above for details).<br />
People who accompany an inspector are<br />
working on behalf of <strong>CQC</strong> to help the<br />
inspector make a judgement about the<br />
quality <strong>and</strong> safety of care provided by that<br />
service. Their evidence is used by the<br />
inspector <strong>and</strong> informs their judgement<br />
<strong>and</strong> the inspection report they write.<br />
<strong>CQC</strong> produces an inspection report<br />
following every inspection <strong>and</strong> publishes<br />
this on its website. A draft is shared with<br />
the provider for factual accuracy.<br />
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factual accuracy <strong>and</strong> to allow for any<br />
recommendations to be considered.<br />
<strong>LINks</strong> are not able to <strong>enter</strong> <strong>and</strong> <strong>view</strong><br />
children’s social care services.<br />
<strong>LINks</strong> can observe care <strong>and</strong> talk to people<br />
using services, visitors <strong>and</strong> staff. They<br />
require permission from the provider or an<br />
individual if they wish to look at policies<br />
<strong>and</strong> procedures, case notes <strong>and</strong> other<br />
written evidence.<br />
What <strong>LINks</strong> say<br />
<strong>CQC</strong> inspects children’s health services.<br />
However, it only inspects children’s social<br />
care services as part of a joint inspection<br />
programme with Ofsted. From 2013 this<br />
will look at the multi-agency<br />
arrangements for the protection of<br />
children in local authority areas.<br />
<strong>CQC</strong> inspections involve inspectors<br />
spending time observing care, <strong>and</strong> talking<br />
to people using services, visitors <strong>and</strong><br />
staff. They will also check policies <strong>and</strong><br />
procedures <strong>and</strong> track case notes.<br />
As part of the national <strong>LINks</strong> <strong>and</strong> <strong>CQC</strong> project, a small number of <strong>LINks</strong><br />
accompanied <strong>CQC</strong> staff on their inspections to better underst<strong>and</strong> what the regulator<br />
does. They said:<br />
“Our LINk can devote more time to listening to residents <strong>and</strong> finding out in<br />
greater detail how they experience life in the home – such as their daily routine,<br />
how they get on with staff <strong>and</strong> how they perceive their treatment by them; specific<br />
activities they enjoy, <strong>and</strong> things they would like to do but are not able, <strong>and</strong> why.”<br />
“I can see the need for LINk visits not to try <strong>and</strong> replicate <strong>CQC</strong> inspections. There<br />
needs to be a specific purpose for a LINk visit, either prompted by information<br />
received from members of the public or in response to a request from another<br />
organisation.”<br />
“Our LINk can underst<strong>and</strong> how a service connects with other services <strong>and</strong> how<br />
different services work together – from the point of <strong>view</strong> of people using all the<br />
services”<br />
“<strong>CQC</strong> has to focus on the essential st<strong>and</strong>ards but <strong>LINks</strong> can have a wider focus.”<br />
“<strong>CQC</strong> inspections can last a whole day while LINk visits tend to be shorter. <strong>CQC</strong><br />
can gather more information in their inspections.”<br />
“In conversation with our local <strong>CQC</strong> staff team, we have found our reports add<br />
extra details <strong>and</strong> a wider perspective to the existing inspection reports for care<br />
homes.”<br />
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“<strong>CQC</strong> inspectors are able to corroborate evidence in a way that LINk authorised<br />
representatives can’t; for example, by being able to check records <strong>and</strong> care<br />
plans, by being able to go anywhere within the home <strong>and</strong> examine any aspect of<br />
it, <strong>and</strong> talk to any member of staff, resident or visitor.”<br />
Contact: Brighton <strong>and</strong> Hove LINk, Herefordshire LINk, Hampshire LINk <strong>and</strong> Devon<br />
LINk for more information about learning from a <strong>CQC</strong> inspection.<br />
Exchanging information about visits <strong>and</strong><br />
inspections<br />
Sharing LINk <strong>enter</strong> <strong>and</strong> <strong>view</strong> information with <strong>CQC</strong><br />
The Code of Conduct on <strong>enter</strong> <strong>and</strong> <strong>view</strong> visits encourages <strong>LINks</strong> to establish<br />
whether any other visits are being planned around the same time as the LINk’s visit<br />
by <strong>CQC</strong> or other local organisations. It also recommends that <strong>LINks</strong> share their<br />
findings from visits with the regulator, to highlight both positive <strong>and</strong> negative<br />
evidence about the quality <strong>and</strong> safety of care. <strong>CQC</strong> would like all <strong>LINks</strong> to:<br />
1. Talk to your local <strong>CQC</strong> contact if you plan to <strong>enter</strong> <strong>and</strong> <strong>view</strong> a service.<br />
2. Find out what we know about that service <strong>and</strong> whether we plan to inspect it soon.<br />
3. Agree with your local <strong>CQC</strong> contact how to coordinate an <strong>enter</strong> <strong>and</strong> <strong>view</strong> visit with<br />
a <strong>CQC</strong> inspection if they are going to happen close together.<br />
4. Keep in touch – tell your local <strong>CQC</strong> contact what you find from the visit as soon<br />
as you can – especially if you identify any concerns about the quality or safety of<br />
the care.<br />
5. Send us the evidence you gather, whether positive or negative, <strong>and</strong> share your<br />
report by sending it using the webform at: www.cqc.org.uk/localvoices<br />
How to make LINk <strong>enter</strong> <strong>and</strong> <strong>view</strong> reports useful to <strong>CQC</strong><br />
� Include the name <strong>and</strong> address of the service so we can identify it easily<br />
� Explain what you did, who you observed <strong>and</strong> who you talked to – tell the story of<br />
your visit<br />
� Set out what you saw <strong>and</strong> what people told you without interpreting it or making<br />
assumptions<br />
� It helps us if you can group your evidence into themes that relate to the st<strong>and</strong>ards<br />
we check ( see some examples below)<br />
� Try to set out sentences which state your findings clearly<br />
� Avoid scanning your documents as this makes it difficult for us to use<br />
� Keep it simple <strong>and</strong> to the point<br />
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� Send your reports to us at www.cqc.org.uk/localvoices <strong>and</strong> attach them to the<br />
webform.<br />
How <strong>LINks</strong> can use information from <strong>CQC</strong> inspections<br />
<strong>LINks</strong> can expect local contact with <strong>CQC</strong> at least every three months, <strong>and</strong> more<br />
often where there are common issues <strong>and</strong> information to share. These meetings,<br />
<strong>and</strong> the contact in between, will give your LINk the chance to find out which services<br />
we intend to inspect over the coming six months, as well as any concerns or general<br />
findings from recent local inspections.<br />
<strong>CQC</strong> sends all <strong>LINks</strong> email updates on inspection activity <strong>and</strong> national press<br />
releases of interest. We also send <strong>LINks</strong> local press releases at the time local press<br />
offices receive them, to give you notice of reports that may make local news. The<br />
<strong>CQC</strong> website allows your LINk to search recent inspection reports <strong>and</strong> analyse<br />
information from our market reports. These set out the main trends <strong>and</strong> issues our<br />
inspectors are picking up across several thous<strong>and</strong> inspections every three months.<br />
This information can help inform <strong>LINks</strong> priority setting, <strong>and</strong> decisions about <strong>enter</strong> <strong>and</strong><br />
<strong>view</strong> activity.<br />
Examples of <strong>LINks</strong> <strong>and</strong> <strong>CQC</strong> working together<br />
Hampshire LINk<br />
Hampshire LINk has developed a feedback mechanism for residents, family, friends<br />
<strong>and</strong> staff at care homes in Hampshire to share their perceptions of the st<strong>and</strong>ards of<br />
care provided. They share information gathered with <strong>CQC</strong>. Work has included<br />
developing a toolkit of templates designed to enable visits, including:<br />
• An introductory letter to care home managers, residents or their families <strong>and</strong><br />
friends.<br />
• Individual member feedback forms <strong>and</strong> membership organisation feedback<br />
forms.<br />
• Questions to ask while visiting <strong>and</strong> completing a feedback template.<br />
A LINk subgroup worked on the project with advice from the local <strong>CQC</strong> manager,<br />
<strong>and</strong> LINk representatives shadowed <strong>CQC</strong> inspections as a learning experience.<br />
Several referrals of particular concern have been passed to <strong>CQC</strong> following the<br />
setting up of an electronic communication protocol designed to ensure that all<br />
concerns referred to Hampshire LINk are passed onto <strong>CQC</strong>.<br />
A <strong>Care</strong> Homes Feedback Online Survey was also undertaken as an alternative to<br />
visits. This was circulated to 5,000 LINk members <strong>and</strong> stakeholders to identify<br />
examples of good practice <strong>and</strong> areas for improvement in care homes across the<br />
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county. The full report Hampshire LINk <strong>Care</strong> Home Survey 2012: A snapshot of care<br />
st<strong>and</strong>ards in residential <strong>and</strong> nursing homes in Hampshire is available from the LINk.<br />
Contact: Janet Parsons, Hampshire LINk Management Board Member Adult Social<br />
<strong>Care</strong>, parsonsjan@btinternet.com<br />
Derby LINk<br />
Derby LINk has run a programme of visits to care <strong>and</strong> residential homes in the city<br />
looking at the quality <strong>and</strong> experience of care from the perspective of the residents,<br />
their relatives <strong>and</strong> the staff of the homes. Information from the visits has been shared<br />
with <strong>CQC</strong> <strong>and</strong> has informed <strong>CQC</strong> inspections.<br />
The LINk is undertaking visits to some services for people with learning disabilities<br />
<strong>and</strong> some mental health services. They are working with local groups of people who<br />
use these services to develop accessible <strong>and</strong> relevant surveys, <strong>and</strong> developing<br />
training for members to be able to visit these services.<br />
Further work continues with the local <strong>CQC</strong> manager to develop a more formal<br />
communication strategy <strong>and</strong> information sharing protocol.<br />
An Enter <strong>and</strong> <strong>view</strong> report template has been developed which links across to <strong>CQC</strong><br />
st<strong>and</strong>ards. The template covers:<br />
Theme/related to<br />
<strong>CQC</strong> outcomes<br />
Involvement <strong>and</strong><br />
information<br />
Personalised care,<br />
treatment <strong>and</strong> support<br />
Safeguarding <strong>and</strong><br />
safety<br />
How this is gathered by the LINk<br />
The LINk’s residents survey is specifically related to<br />
choice as are the questions asked of staff <strong>and</strong> visitors.<br />
The survey questions relate to the perception of quality of<br />
care for residents, visitors <strong>and</strong> staff.<br />
All the LINk members <strong>and</strong> staff team have undertaken<br />
safeguarding awareness training <strong>and</strong> any identified issues<br />
are discussed with staff at the time of the visit <strong>and</strong><br />
included in their reports. They request incident reporting<br />
data from the local safeguarding board to identify any<br />
trends or previous occurrences.<br />
Suitability of staffing The LINk asks about current staffing levels <strong>and</strong> the<br />
number of qualified staff on duty at any one time. Visitors<br />
<strong>and</strong> residents are also asked about their experiences <strong>and</strong><br />
perceptions of staff <strong>and</strong> staffing levels.<br />
<strong>Quality</strong> of management Staff are asked about the level of support they receive <strong>and</strong><br />
whether they feel they have time to carry out their duties.<br />
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Suitability of<br />
management<br />
This is covered in the LINk’s staff <strong>and</strong> visitor surveys.<br />
The LINk has a complete toolkit for carrying out visits, including survey templates,<br />
report templates, leaflets <strong>and</strong> posters <strong>and</strong> a flowchart of activity.<br />
Contact: Jim Moore: james.moore@communityactionderby.org.uk<br />
Kent LINk<br />
In 2011, the LINk undertook 36 <strong>enter</strong> <strong>and</strong> <strong>view</strong> visits to residential homes in East<br />
Kent, working with the local authority <strong>and</strong> the local older people's forum. Following<br />
the success of this project a further 57 visits to residential homes across the county<br />
were undertaken in 2012. All homes visited have contracts with the Kent County<br />
Council's (KCC) Adult Social Services.<br />
The 2012 visits included observations of the homes <strong>and</strong> the care, <strong>and</strong> talking to<br />
residents <strong>and</strong> staff. Information gathered will be shared with <strong>CQC</strong> <strong>and</strong> KCC. With<br />
advice from <strong>CQC</strong> local staff, the LINk developed an observation sheet that it used<br />
across all the visits <strong>and</strong> tied in with <strong>CQC</strong>’s outcomes.<br />
Each project has produced a report that will be submitted to <strong>CQC</strong> <strong>and</strong> KCC <strong>and</strong> will<br />
hopefully influence future care <strong>and</strong> help share practice. A spreadsheet <strong>and</strong> online<br />
survey was used to collate data from each of the visits.<br />
Information was shared with the local <strong>CQC</strong> team from each of the visits <strong>and</strong><br />
uploaded onto <strong>CQC</strong>'s website. The information covered a range of quality <strong>and</strong> safety<br />
issues in each home, including:<br />
• Name, address <strong>and</strong> type of home.<br />
• Observations about residents’ involvement in care planning, in planning their day<br />
<strong>and</strong> the service provided, including the menu; in routine daily activities such as<br />
helping in the kitchen <strong>and</strong> whether there are regular residents meetings; dialogue<br />
between residents <strong>and</strong> staff <strong>and</strong> between residents; menus <strong>and</strong> choice of meals;<br />
access to snacks <strong>and</strong> food/drink at night; <strong>and</strong> whether residents appreciate <strong>and</strong><br />
enjoy meals.<br />
• Observations about whether residents are moving about the home, in the garden,<br />
evidence of activities <strong>and</strong> residents taking part in activities, whether trips take<br />
place <strong>and</strong> evidence of activities <strong>and</strong> trips.<br />
• Observations about the environment, cleanliness, accessibility <strong>and</strong> adjustments<br />
for people with a disability; whether residents can bring their own<br />
belongings/valuables/furniture; accessibility of information about safety <strong>and</strong><br />
safeguarding, complaints, <strong>and</strong> menus; access to <strong>and</strong> use of bathing facilities;<br />
overall respect <strong>and</strong> care for people using the service <strong>and</strong> whether dignity<br />
champions are available <strong>and</strong> active.<br />
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• Residents’ responses to questions about all of the above <strong>and</strong> their own <strong>view</strong>s<br />
about their care.<br />
The local <strong>CQC</strong> inspection teams have been able to use this information to inform<br />
whether any services need a responsive re<strong>view</strong> <strong>and</strong> in ongoing monitoring of the<br />
services.<br />
Contact: Louise Murrell, louise@kentlink.org<br />
Devon LINk<br />
Devon LINk have re<strong>view</strong>ed their <strong>enter</strong> <strong>and</strong> <strong>view</strong> training materials with authorised<br />
representatives. This included a one-day session with advice from the local <strong>CQC</strong><br />
compliance manager <strong>and</strong> inspector about a <strong>CQC</strong> inspection. As part of the national<br />
project, LINk representatives also attended a small number of <strong>CQC</strong> inspections. This<br />
has helped develop their materials which include:<br />
1. What is involved in a <strong>CQC</strong> Inspection – A Briefing Session to LINk Authorised<br />
Representatives.<br />
2. A simple guide outlining the difference between <strong>CQC</strong> inspections <strong>and</strong> LINk Enter<br />
<strong>and</strong> View visits.<br />
3. A flowchart to illustrate how the LINk <strong>and</strong> <strong>CQC</strong> share intelligence about local<br />
services.<br />
4. A presentation to show how the LINk collects, logs <strong>and</strong> filters data <strong>and</strong> how this<br />
can be used by <strong>CQC</strong>.<br />
5. Examples of questions that can be used to engage with people experiencing a<br />
service.<br />
The LINk has agreed with Devon County Council how they will use <strong>enter</strong> <strong>and</strong> <strong>view</strong><br />
visits to monitor the quality of services as part of the <strong>Quality</strong> <strong>and</strong> Improvement<br />
Monitoring Sub Group. This has also included agreeing the process for reporting a<br />
safeguarding concern <strong>and</strong> a safeguarding training session for authorised<br />
representatives.<br />
Information from the visits already undertaken have already been shared with <strong>CQC</strong><br />
<strong>and</strong> used to inform <strong>CQC</strong> inspections.<br />
Contact: Lorna Davis, lorna.davis@edvsa.org.uk<br />
Sutton LINk<br />
The LINk has over 20 authorised volunteers who carry out monthly visits to hospital<br />
wards <strong>and</strong> care homes. It has developed a range of tools <strong>and</strong> templates to support<br />
its <strong>enter</strong> <strong>and</strong> <strong>view</strong> activity. This includes:<br />
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• A protocol for LINk care home monitoring between Sutton Adult Social Services<br />
<strong>and</strong> Housing <strong>and</strong> Sutton Pathfinder LINk/Healthwatch <strong>and</strong> care home monitoring<br />
form.<br />
The protocol sets out how the LINk will use monitoring visits <strong>and</strong> <strong>enter</strong> <strong>and</strong> <strong>view</strong><br />
visits as part of its work. It sets out how LINk volunteers receive <strong>CQC</strong> information<br />
about a care home to inform their visit, <strong>and</strong> how final reports are shared with <strong>CQC</strong>.<br />
The LINk’s health <strong>and</strong> wellbeing working group may also take further action following<br />
publication, <strong>and</strong> write a letter to <strong>CQC</strong>.<br />
The monitoring form includes issues of access, the entrance, the building, the<br />
communal areas, meals (choice <strong>and</strong> flexibility), residents’ rooms, staffing levels,<br />
security, personal care, health, policies <strong>and</strong> procedures, social activities, end of life<br />
care, residents’ appearance, involvement, general issues <strong>and</strong> family <strong>and</strong> friends.<br />
There is a section for safeguarding concerns <strong>and</strong> further information from family <strong>and</strong><br />
friends.<br />
• A protocol for LINk hospital monitoring visits between the local hospital trust <strong>and</strong><br />
Sutton Pathfinder LINk/Healthwatch <strong>and</strong> hospital monitoring form.<br />
This also sets out how the LINk will share any findings from hospital monitoring visits<br />
with <strong>CQC</strong>, <strong>and</strong> highlights the areas volunteers will cover in their visits. These include:<br />
• Physical factors<br />
• Cleanliness<br />
• Maintenance<br />
• Meeting diversity<br />
• Discharge information<br />
• Privacy <strong>and</strong> dignity.<br />
The hospital monitoring form records details under each of these areas, with<br />
questions as prompts. There is also a specific monitoring form for visits focused on<br />
the provision of food <strong>and</strong> drink for older people <strong>and</strong> a specific <strong>enter</strong> <strong>and</strong> <strong>view</strong> form for<br />
a mental health service visit.<br />
The LINk has also developed a recruitment <strong>and</strong> induction programme, including:<br />
providing references, induction inter<strong>view</strong>, CRB check, safeguarding training <strong>and</strong> a<br />
course on <strong>enter</strong> <strong>and</strong> <strong>view</strong> that includes practical case studies <strong>and</strong> is designed <strong>and</strong><br />
delivered by the LINk. All protocols <strong>and</strong> policies have been shared with <strong>CQC</strong>. The<br />
LINk liaises with local <strong>CQC</strong> staff <strong>and</strong> shares information on a regular basis.<br />
Contact: Janice McCullock, janice@suttoncvs.org.uk<br />
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East Sussex LINk<br />
East Sussex LINk has developed a LINk legacy <strong>enter</strong> <strong>and</strong> <strong>view</strong> package as part of<br />
their transition year work programme as a Healthwatch pathfinder, <strong>and</strong> to strengthen<br />
their existing function for <strong>enter</strong> <strong>and</strong> <strong>view</strong>. They have also worked with <strong>CQC</strong> as part of<br />
the LINk’s <strong>enter</strong> <strong>and</strong> <strong>view</strong> activities, sharing information from visits already<br />
undertaken <strong>and</strong> establishing systems <strong>and</strong> processes for relating to <strong>CQC</strong>. The overall<br />
<strong>enter</strong> <strong>and</strong> <strong>view</strong> package includes:<br />
• Application/recruitment process.<br />
• Training programme with core <strong>and</strong> optional modules.<br />
• Policies, procedures <strong>and</strong> processes.<br />
• Resource pack with templates.<br />
The application/recruitment process includes how the LINk manages the expression<br />
of interest from an individual; the role description; the application form; skills audit<br />
form <strong>and</strong> the invitation to take part in a training programme.<br />
The core training module includes an underst<strong>and</strong>ing of the role of the authorised<br />
representative; safeguarding adults at risk; mental capacity act; deprivation of liberty<br />
safeguards; equality <strong>and</strong> diversity <strong>and</strong> child protection <strong>and</strong> safeguarding procedures;<br />
as well as an underst<strong>and</strong>ing of the regulatory framework for children’s services.<br />
Optional modules include ‘sit <strong>and</strong> see’ which is a locally devised programmes to<br />
improve observation skills; producing reports; working with the regulators (<strong>CQC</strong>);<br />
<strong>and</strong> other learning identified by individuals <strong>and</strong> basic Makaton.<br />
There is a training programme for authorised representatives to maintain <strong>and</strong> update<br />
their skills.<br />
Policies, processes <strong>and</strong> procedures include a range of resources for <strong>enter</strong> <strong>and</strong> <strong>view</strong>,<br />
including developing relationships with <strong>CQC</strong> <strong>and</strong> the local safeguarding board.<br />
The LINk is also exploring the option of providing specialist independent evaluation<br />
services to providers such as for services for people with a learning disability or<br />
services for people with dementia.<br />
Contact: Elizabeth Mackie, Elizabeth.mackie@thecountylink.net<br />
Learning for Healthwatch<br />
The Department of Health will publish regulations setting out the duty on providers to<br />
allow Healthwatch organisations to <strong>enter</strong> <strong>and</strong> <strong>view</strong> services. This will provide the<br />
legislative basis for Healthwatch visits. In addition, Healthwatch Engl<strong>and</strong> will be<br />
developing advice <strong>and</strong> support to Healthwatch about the use of visits in engaging<br />
with local people <strong>and</strong> monitoring services.<br />
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<strong>CQC</strong> <strong>and</strong> <strong>LINks</strong>’ work together has identified the following learning for Healthwatch<br />
on making effective use of visits:<br />
A strategic approach<br />
• Underst<strong>and</strong> the new regulations for <strong>enter</strong> <strong>and</strong> <strong>view</strong> – which services you can visit,<br />
for what purpose, <strong>and</strong> with what effect.<br />
• Underst<strong>and</strong> what <strong>CQC</strong>, local authorities <strong>and</strong> other commissioners are doing on<br />
their inspections <strong>and</strong> visits, <strong>and</strong> the st<strong>and</strong>ards they check.<br />
• Agree criteria for how visits will be used as part of the work of Healthwatch –<br />
what can trigger them, where will information come from to inform them <strong>and</strong> who<br />
you need to work with in making the decision to visit a service.<br />
• Agree how visits will be shared <strong>and</strong> used alongside the work of over<strong>view</strong> <strong>and</strong><br />
scrutiny committees, GP practice participation groups, Foundation Trust<br />
governors, NHS patient-led inspections <strong>and</strong> any other local visits by the public<br />
<strong>and</strong> their representatives.<br />
• Agree the approach to announced versus unannounced visits.<br />
Developing an <strong>enter</strong> <strong>and</strong> <strong>view</strong> programme<br />
• Plan recruitment, training <strong>and</strong> support for volunteers <strong>and</strong> develop materials<br />
needed – <strong>and</strong> discuss this with your local authority. In particular, consider how<br />
training related to safeguarding, deprivation of liberty safeguards, <strong>and</strong> equalities<br />
<strong>and</strong> diversity is incorporated into <strong>enter</strong> <strong>and</strong> <strong>view</strong> training. In addition, support<br />
systems will be needed for representatives following visits.<br />
• Training about <strong>CQC</strong> <strong>and</strong> regulation should form part of the training programme<br />
for volunteers <strong>and</strong> Healthwatch staff.<br />
• Develop information <strong>and</strong> communications for providers <strong>and</strong> commissioners to<br />
explain your approach to visiting services <strong>and</strong> use of ‘<strong>enter</strong> <strong>and</strong> <strong>view</strong>’ – <strong>and</strong> why<br />
Healthwatch may wish to visit services. This includes explaining how you relate to<br />
<strong>CQC</strong> <strong>and</strong> share information with the regulator from visits.<br />
• Where a provider refuses entry, it is important to have a clear process for<br />
h<strong>and</strong>ling this locally. A process for h<strong>and</strong>ling provider concerns about visit reports<br />
or complaints following a visit is also needed. There may be particular issues for<br />
Healthwatch relationships with small care providers to manage.<br />
Gathering <strong>and</strong> reporting information<br />
• Use information from partners <strong>and</strong> other stakeholders, including <strong>CQC</strong> to inform<br />
your decision to visit a service.<br />
• Discuss your <strong>enter</strong> <strong>and</strong> <strong>view</strong> plans at an early stage with <strong>CQC</strong> – to ensure they<br />
complement any inspections or enforcement activity (as well as any discussions<br />
needed with other local stakeholders).<br />
• Plan what you will <strong>view</strong> during the visit <strong>and</strong> who you will talk to <strong>and</strong>/or observe.<br />
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• Agree a consistent format for recording observations <strong>and</strong> inter<strong>view</strong>s.<br />
• Agree a consistent format for reporting on visits <strong>and</strong> identify relevant themes to<br />
group information (where relevant, it may help to use the government st<strong>and</strong>ards<br />
for quality <strong>and</strong> safety used by <strong>CQC</strong> when compiling the report).<br />
Making the best use of the findings from visits<br />
• Enter <strong>and</strong> <strong>view</strong> reports can be effective without making specific<br />
recommendations. They can focus on reporting the details of what they have<br />
seen <strong>and</strong> providing a summary, with some sort of thematic analysis.<br />
• Enter <strong>and</strong> <strong>view</strong> visits need to be agreed with clarity about who will share the<br />
findings with whom <strong>and</strong> for what use. Where visits are undertaken in partnership<br />
with other bodies, this agreement is needed with them as well as within<br />
Healthwatch from the start of the work.<br />
• Share all interim <strong>and</strong> final findings with <strong>CQC</strong> as a matter of course, as part of<br />
ongoing information sharing with local <strong>CQC</strong> contacts.<br />
• There can be pressures from the press to publicise findings from visits – a media<br />
plan can help to manage this.<br />
• Healthwatch needs a clear protocol for the action it will take if it identifies<br />
safeguarding concerns, <strong>and</strong> on deprivation of liberty safeguarding concerns<br />
during visits.<br />
Further information<br />
• <strong>CQC</strong> website www.cqc.org.uk<br />
• Healthwatch Engl<strong>and</strong> website www.healthwatch.co.uk<br />
• Guide for <strong>LINks</strong>: How <strong>LINks</strong> can work with the <strong>Care</strong> <strong>Quality</strong> <strong>Commission</strong> June<br />
2011 available free at www.cqc.org.uk<br />
• A Code of Conduct relating to Local Involvement Networks’ visits to <strong>enter</strong> <strong>and</strong><br />
<strong>view</strong> services (2008) is available at www.dh.gov.uk<br />
• Patient led inspections of the care environment (PLACE)<br />
(These new patient led inspections will replace the current Patient Environment<br />
Action Team (PEAT) inspections, in hospitals offering NHS-funded care. <strong>LINks</strong>,<br />
local Healthwatch <strong>and</strong> Healthwatch Engl<strong>and</strong> are playing a role in developing<br />
these inspections. Further information can be found at www.dh.gov.uk)<br />
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