CQC Returning to Good: What Adult Social Care Providers Need to Know
Understanding CQC’s Returning to Good Programme
CQC is returning to eligible adult social care services with ageing Good ratings to confirm whether those ratings remain accurate.
The CQC Returning to Good programme is focused on services where CQC considers the existing Good rating likely to be maintained, with current priorities generally including ratings that are at least six or seven years old.
For providers with an ageing CQC Good rating, the programme raises a straightforward question:
Does the rating awarded several years ago still accurately reflect the quality people experience today?
Why Is CQC Returning to Good-Rated Services?
CQC has said it intends to focus a significant proportion of its adult social care assessment activity on services with ageing ratings.
The aim is to increase the number of assessments being carried out while taking a more proportionate approach to services where a Good rating is considered likely to remain appropriate.
The purpose of the programme is not simply to revisit historic inspection findings.
It is to confirm whether the existing rating remains an accurate reflection of the service operating today.
Which Services Could Be Reassessed?
Not every service with an older CQC Good rating will automatically be reassessed using this approach.
CQC has published specific eligibility criteria.
Services considered under Returning to Good must:
- be rated Good overall
- be rated Good across all five key questions
- generally have a rating that is at least six or seven years old
- have a registered manager
- show no indication that the rating has changed
- not provide care or treatment to children
- meet CQC’s criteria relating to services for autistic people and people with a learning disability
- have no ongoing enforcement activity
The programme can include care homes, residential services providing nursing care, supported living services and homecare services where the eligibility criteria are met.
Providers should therefore review CQC’s current guidance rather than assuming that the age of their rating alone determines whether their service will be included.
What Is Different About the Returning to Good Approach?
Returning to Good uses a more streamlined assessment approach.
CQC initially assesses fewer Quality Statements than it would during a wider assessment, but there is a greater focus on people’s experiences and outcomes.
Assessors will spend more time gathering feedback from:
- people using the service
- visitors
- visiting professionals
- staff
- leaders
Where possible, they will also observe care and support in practice to understand what people’s everyday experiences are like.
Records and other documentation remain important, but CQC says these checks will be proportionate, targeted and informed by what people say and what inspectors observe.
For providers, that means quality needs to be visible beyond policies and audit folders.
What people experience in practice needs to reflect what the service says it delivers.
Which 18 CQC Quality Statements Will Be Assessed?
The Returning to Good programme initially focuses on 18 CQC Quality Statements across Safe, Effective, Caring, Responsive and Well-led.
Under Safe:
- Learning culture
- Safeguarding
- Involving people to manage risk
- Safe and effective staffing
- Safe environments
- Medicines optimisation
Under Effective:
- Assessing needs
- Delivering evidence-based care and treatment
- Monitoring and improving outcomes
- Consent to care and treatment
Under Caring:
- Kindness, compassion and dignity
- Independence, choice and control
Under Responsive:
- Person-centred care
- Listening to and involving people
- Equity in experiences and outcomes
Under Well-led:
- Shared direction and culture
- Governance, management and sustainability
- Learning, improvement and innovation
These 18 statements provide the initial framework for the assessment, but CQC can expand its scope if concerns or evidence of outstanding practice are identified during planning.
What Does the Greater Focus on People’s Experiences Mean?
People’s experiences sit at the centre of the Returning to Good approach.
CQC wants to understand what life is actually like for people using the service, rather than relying primarily on written evidence.
That means providers should consider whether:
- people feel listened to
- individual preferences are reflected in everyday care
- people are supported to make choices
- care remains person-centred
- people feel safe
- concerns are responded to appropriately
- staff understand the people they support
This does not make documentation less important.
Instead, CQC will use records and evidence to validate whether what inspectors hear and observe is consistent with the service’s own documentation and governance.
What Will CQC Look at in Practice?
The programme places greater emphasis on observation of care and support.
For providers, that means everyday practice becomes particularly important.
An assessor may be looking at whether:
- staff understand people’s needs and risks
- care reflects individual preferences
- people are treated with dignity
- medicines processes are followed safely
- staffing arrangements support people’s needs
- staff know how to raise safeguarding concerns
- leadership is visible and effective
- learning from incidents and complaints results in improvement
A policy may describe how something should happen.
CQC will be interested in whether that standard is actually being delivered.
What Happens if CQC Identifies Concerns?
Returning to Good is a streamlined approach, but it does not limit CQC’s ability to investigate further.
If concerns or outstanding practice are identified during the planning stage, CQC can expand the assessment to include additional Quality Statements.
Where that happens, CQC will revert to its usual published assessment approach.
Inspectors will continue to use professional judgement and corroborating evidence when reaching conclusions about quality and safety.
Providers should therefore avoid viewing the 18 Quality Statements as a narrow checklist.
The wider quality and governance of the service still matter.
What Will the Assessment Report Look Like?
Reports produced through Returning to Good are more concise than CQC’s usual assessment reports.
Where practice continues to meet a Good standard, CQC will not necessarily provide detailed supporting evidence.
Instead, reports focus more heavily on areas where:
- practice is outstanding
- some shortfalls are identified
- significant shortfalls are identified
The summary of findings will also include information about what people told CQC and their experiences of care.
For providers, this reinforces the importance of understanding how people’s experiences align with governance and compliance evidence.
What Should Providers With an Ageing Good Rating Do Now?
Providers do not need to wait until CQC announces an assessment before reviewing where their service stands.
A useful starting point is to ask:
Does our current practice still support the Good rating we hold?
That means looking at more than whether policies have been reviewed.
Consider people’s experiences.
Speak to staff.
Review the 18 CQC Quality Statements.
Look at how incidents, complaints and safeguarding concerns result in learning.
Check whether governance systems provide meaningful oversight.
Most importantly, consider whether the service described by your records is the same service people actually experience.
How Can a Mock CQC Inspection Help?
An independent Mock CQC Inspection can help providers understand how their service may stand up to current regulatory scrutiny before CQC returns.
Fulcrum Care’s comprehensive in-person mock inspections review areas including care plans, medication records, staffing, safeguarding, governance and quality assurance while also considering how practice is being delivered within the service.
The purpose is to provide an independent perspective on current compliance and highlight areas where further action or assurance may be needed.
For providers with an ageing Good rating, this can help answer the same question CQC’s Returning to Good programme is designed to test:
Does the existing Good rating still reflect the service operating today?
Fulcrum Care also provides a Remote Mini CQC Mock Inspection for providers looking for a more focused review of selected compliance documentation and evidence.
If your service has held a CQC Good rating for several years and you would like an independent view of your current inspection readiness, contact Fulcrum Care to discuss the most appropriate level of support.