Commissioners Audit or Inspection
Scope of this chapter
Commissioners work for the local authority or the NHS. They have a responsibility to ensure that the services delivered to residents are effective, good value for money and meet contractual requirements. One of the ways in which they do this is to carry out audits or inspections of the service. These audits or inspections are in addition to any inspection carried out by the Care Quality Commission.
This chapter explains what to expect from a commissioner's audit or inspection and what can happen if a commissioner identifies an issue with the service.
Related Chapters and Guidance
Often commissioning organisations will allocate services to each of their commissioners.
This allows the commissioner to get to know the service and for the service to get to know their commissioner.
It helps ensure a proportionate response when any issues are identified and for the commissioner to be able to effectively monitor progress made.
There is no set process for a commissioner’s audit or inspection. Each commissioning organisation will have its own protocols in place. This protocol should be clearly set out in the contract between the service and the organisation.
It should include:
- The frequency of audit or inspection;
- How the audit or inspection will be carried out;
- Incidents/issues that the service must tell commissioners about;
- The action that commissioners can take if the service is in breach of contractual obligations.
If this information is not clear, the registered person can contact the commissioning organisation/s to find this out.
Depending on whether the audit or inspection is general or in response to a specific issue, the commissioner can gather and review a range of information.
This could be:
- Speaking to the registered person and staff;
- Speaking to people that use the service and their carers/families;
- Speaking to relevant professionals (social workers, nurses);
- Reviewing any safeguarding concerns or enquiries;
- Reviewing any complaints;
- Reviewing any CQC service inspection reports;
- Looking at individual care or support plans and how needs are being met;
- Looking at procedures and processes;
- Looking at training records and HR information.
Broadly speaking, for a whole service audit or inspection, the table below sets out the key things that the commissioner will want to know.
Commissioning organisations may also have different or additional factors they require the commissioner to look at, which could include whether the fees being charged by the service may need to be reviewed.
Core values of the service
What does the Statement of Purpose say?
Can the service evidence they are working in line with the Statement of Purpose?
Effectiveness at meeting needs
Does the service meet people's needs?
Does the service have a person-centred approach?
Is the service safe?
Are safeguarding procedures in place and being followed?
Are premises safe and well maintained to prevent accidents?
Are recruitment and employment procedures in place, and being followed? These include; DBS checks, reference checks and that staff have the necessary, qualifications, skills and competencies.
Are all training requirements in place and being met for staff, including induction and ongoing training requirements?
Are regular supervision practices in place?
Is there a problem with staff retention/high agency use?
How does the service deal with sickness and gaps in service? What systems are in place to manage this?
Is regular feedback from the person and any carers/families being sought?
What internal monitoring systems are in place to support quality assurance?
Is the service well led?
Are there clear policies and procedures in place?
Does the service have a contingency plan?
Complaints and improvement
What is the procedure for complaints?
What has been learnt from situations that have gone wrong and how is this recorded?
What is the service’s plan for improvements and change?
If the local protocol is that an audit or inspection report is prepared, a copy of this should be provided to the registered person.
A copy of any reports will normally be provided to the CQC so that any findings by the commissioner can inform any potential need for them to carry out an inspection or any other action.
One of the main roles of commissioners is to support the service to be effective and to meet contractual obligations. If an issue is identified, commissioners should work with the service to resolve it. This could be to support access to any training provided by their organisation, or to support the registered person with an action plan to implement change. The commissioner will likely remain involved to monitor how things are going and whether any further action is needed.
If a safeguarding issue is identified the commissioner is obligated to raise a concern with the local authority safeguarding team, even if action is being taken by the service to reduce risk.
If the service appears to be in breach of regulations subject to inspection by the Care Quality Commission, the commissioner will notify them so that they can take any action they deem appropriate to carry out a service inspection. The CQC can also offer advice to the commissioner about any potential need to suspend or end the contract.
The last thing a commissioner wants to do is end the contract. However, if a service continues to be ineffective or in breach of contractual obligations, this decision can be made.
Last Updated: March 18, 2022