Service Assessment (Single Assessment Framework)
Scope of this chapter
The Care Quality Commission (CQC) registers, monitors, assesses and rates most health and social care services across England.
This chapter provides an overview of the CQC assessment process (previously called an ‘inspection process’). It includes links to a host of useful external resources from the CQC to support the registered person and their team to understand and prepare for an assessment, and to get the most from it.
The purpose of assessment is to ensure that people using services are provided with safe, effective, compassionate, high-quality care and that all regulations are being met.
Related Chapters and Guidance
- Infection Prevention and Control Inspections
- Commissioners Audit or Inspection
- The Health and Social Care Act (Regulated Activities) Regulations 2014
- The Care Quality Commission (Registration) Regulations 2009
- Regulations, Standards and Provisions
- CQC: Our new approach to assessment
Amendment
In February 2024, this new chapter was added to the section Inspections and Assessment.
The single assessment framework is the framework used by the CQC to assess the quality of care being provided by the services it regulates. The framework is used across all services, which also includes local authorities and Integrated Care Boards.
The framework involves the CQC gathering relevant evidence about the service, and then reviewing the evidence against key questions and quality statements to determine an overall service rating.
The 5 key questions are:
- Safe;
- Effective;
- Caring;
- Responsive;
- Well-led
Within each key question, there are several subcategories, against which there is a quality statement. A quality statement is also known as a ‘We’ statement.
The quality statements (‘We’ statements) are commitments that the service should aim to live up to. They show what is needed to deliver high-quality, person centred care.
As an example, the following table shows the subcategories and the quality statements under the key question ‘Caring’.
|
Key question |
Subcategory |
Quality statement |
|---|---|---|
|
Caring |
Kindness, compassion and dignity |
We always treat people with kindness, empathy and compassion and we respect their privacy and dignity. We treat colleagues from other organisations with kindness and respect. |
|
Caring |
Treating people as individuals |
We treat people as individuals and make sure their care, support and treatment meets their needs and preferences. We take account of their strengths, abilities, aspirations, culture and unique backgrounds and protected characteristics. |
|
Caring |
Independence, choice and control |
We promote people’s independence, so they know their rights and have choice and control over their own care, treatment and wellbeing. |
|
Caring |
Responding to people’s immediate needs |
We listen to and understand people’s needs, views and wishes. We respond to these in that moment and will act to minimise any discomfort, concern or distress. |
|
Caring |
Workforce wellbeing and enablement |
We care about and promote the wellbeing of our staff, and we support and enable them to always deliver person centred care. |
To see all the subcategories, quality statements, and for further guidance on what they mean in practice, please refer to the CQC website: Key questions and quality statements
‘I’ statements
For every quality statement (‘We’ statement) there is a corresponding ‘I’ statement. The ‘I’ statement represents the position of the person using the service and what matters to them.
When self-evaluating how well the service is doing, it can be useful for the registered person to consider whether the people using the service would be able to use the ‘I’ statements in relation to the care provided.
The first time the service is assessed using the single assessment framework, all quality statements will be considered. For future assessments, the CQC may be more selective about the quality statements it decides to focus on.
Under the single assessment framework, there are 6 evidence categories:
- People’s experience of health and care services;
- Feedback from staff and leaders;
- Feedback from partners;
- Observation;
- Processes;
- Outcomes.
For further information see: Evidence categories
The CQC has developed service specific guidance around the evidence categories. This shows the evidence types that could be collected in relation to the key questions (safe, effective, caring, responsive, well-led):
Care homes and supported living: evidence categories
Homecare and shared lives services: evidence categories
The first time the service is assessed using the single assessment framework, all evidence categories will be considered. For future assessments, the CQC will decide which evidence to review and may deem not to review some categories or to focus on certain evidence types more than others. For example, to focus on people’s experiences more than processes.
Under the single assessment framework there are no set timeframes for frequency of assessment. Instead, the CQC will continuously review the evidence available about a service to determine when an assessment should be carried out. This includes evidence it collects and evidence it receives, for example complaints and compliments.
Services with a lower rating are still likely to be assessed more frequently than those with a higher rating. However, any service can be assessed at any time should the available evidence suggest there has been a change in the quality of care provided.
The CQC will email the registered person to tell them when an assessment process is going to start.
Care home assessments will usually start on the same day that the email is sent (no advance notice).
For other service types, the email will be sent 48 hours ahead of the assessment process beginning.
The CQC will decide the best method of assessment.
Under the single assessment framework, the CQC may decide that an on-site visit is not required. In this case, the assessment will be carried out based on evidence collected by the CQC or submitted to them by the service or other parties.
The CQC will decide what evidence they need the service to provide.
Where documentary evidence is requested, this should be provided within the specified timeframes. Most documentary evidence can be provided via secure email.
The CQC may wish to interview the registered person or staff members, even if they do not intend to carry out an on-site visit. These interviews will take place online and the service should facilitate them.
After the assessment, the CQC will apply a scoring system to produce an overall rating that describes the quality of care provided by the service. The overall rating will be either outstanding, good, requires improvement or inadequate.
The scoring system (a summary)
Step 1
Against each quality statement (‘We’ statement), there will be a score given under each of the evidence categories considered. This score will be based on what the available evidence in that category says about the standard (quality) of care being provided against that statement.
4 = Evidence shows an exceptional standard
3 = Evidence shows a good standard
2 = Evidence shows some shortfalls
1 = Evidence shows significant shortfalls
Step 2
The quality statement scores will be combined to give a total score for the relevant key question (safe, effective, caring, responsive, well-led).
This will also generate a rating for each of the key questions (safe, effective, caring, responsive, well-led).
Step 3
The scores for the key questions will be aggregated to give a single overall rating.
Further information
An assessment report will also be produced.
Prior to the final report being published, the CQC will email the registered person a link so they can review the draft report and check its factual accuracy.
The registered person will have 10 working days from the date of the email to review the report and submit any comments about factual accuracy. This can be done by adding a comment against the relevant section of the draft report and uploading any additional evidence.
For further information, see: Factual accuracy check
If there are no comments about factual accuracy, the registered person should confirm that they have reviewed it.
A final report will then be published.
For further information see: How we publish our findings
If the registered person believes that the CQC may not have followed the correct process for making the rating decision, they can request a rating process assurance review.
If agreed, the process assurance review will involve the CQC checking whether it followed the correct processes when scoring the assessment and reaching a rating.
The CQC will only reconsider evidence or judgements made if it finds an error in the quality control process.
Requesting a process assurance review
A process assurance review request can only be made using the online form. A link to the online form will be provided when the final report and rating are published.
Requests must be made within 15 working days of the rating publication.
For further information see: Rating process review
The registered person must ensure that the CQC ratings are displayed in a place where they can be seen. This is a legal requirement.
The ratings and a copy of the final report should also be published on the service’s website (if you have one).
The CQC will also publish the ratings and final report on their website. In the future, the CQC will also show the scores they have used to calculate the final rating.
Under the single assessment framework, the CQC can update either the overall service rating, or the rating for a key question at any time in response to new evidence that it collects or receives. This can be done without the need to carry out another assessment if the CQC does not deem another assessment necessary.
Last Updated: January 26, 2024
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