Countersignature Registration Confirmation Made Easy

Countersign case study proposal template

so today's webinar our two experts will be discussing the cqc's registration process and exploring the steps that can be taken to improve your prospects of obtaining registration as a service provider or manager including when the cqc are proposing to refuse your registration we have two experts that are going to speak our own laura hana who's a partner in the regulatory team at stevenson's and specializes in health and social care regulation laura represents care providers and managers in relation to proceedings before the cqc and the care inspector at wales providing advice on registration enforcement action criminal investigations and appeals to the first tier tribunal lawyer is recommended in the latest edition of the legal 500 is a regular contributor to various care publications and has acted as a judge at the great british care awards for the past four years we also are very lucky to have helen fuller join us helen is the managing director of quality for care so i'll say careful quality sorry and has over 20 years experience in management of health and social care services helen has managed a range of services including residential nursing daycare and dementia care she's also been a nominated individual for a group of services helen set up careful quality in 2012 the primary aim being to support providers to evidence compliance and to support with regulatory requirements careful quality quickly expanded to cover the whole of the uk building up a strong panel of over 35 consultants who carry out mock inspections and support visits to around 640 care services so without further ado i'm going to hand over to helen who's going to speak first so over to you uh helen thank you very much and looking at the process of cqc registration i began thinking about really what potential providers need to think about first and foremost when considering uh registering with the cqc and and i think really it's important to be clear about your your motives for starting a service what really is the driving force what are your vision your values your ethos and how do you want to manage and support that service and make it stand out from from the others so in terms of the pre-application process it's really important to decide clearly on which regulated activities you're applying for now on the cqc website there's a link at the end of this presentation there's a scope of registration document and certainly before any application i would recommend reading through that document and being certain of of the regulated activities that you're applying for and that you're applying for the correct the correct one if you're adding a location you need to make sure that you're actually registered as a provider to provide that regulated activity secondly you need to gather together the information that you're going to need to make the application so information such as director's information data for birth company information and you need to start drawing together your statement of purpose i would suggest initially that you use the template which is available on the cqc website and this will guide you through and actually provide you with a good foundation for for the completion of your application form and you then need to get together things like your core policies your safeguarding policy governance policy and quality policies uh look at your organizational chart and think about who you are going to propose to be your registered manager thirdly you need to establish whether you need to apply via the portal the cpc portal or whether you need to use a downloaded word form to make the application so for example you need to use the portal if you're a new provider um or if you're adding an existing regulated activity and you've already got a provider portal um logging um if you're buying a care service for example you will need to use the word template copies fourthly apply for your manager's dbs well in advance and they can take a couple of weeks to come back and you need that dbs number in order to submit your application so it's quite important that's one of the first things that you actually do fifth i certainly would suggest that you develop a sound knowledge and understanding of the regulations and the chloes that underpin them again the cqc website really is the place to go for guidance um on the regulations and the chloe's and read lots and lots of inspection reports is my advice from services that are similar to the ones that you're planning on setting up so when you're at the stage to actually then submit more make and submit the application don't forget as you're going through the process either on the portal or via the word form you can call the cqc you can call the helpline number there um and they're actually extremely helpful um in guiding you through the process any questions or technical queries you might have when it comes to completing the form either online or the word copy as part of your application you will be asked to describe how you're going to make sure that your service is safe effective caring responsive and well-led so you need to really consider each element from these domains and look at how you're going to make sure that you're meeting the standards and it's really important that whenever you state in this section from what you're going to be doing but you can back this up with solid evidence um and it's actually what you're going to be doing in practice because they will cross reference your application and your statement with what they see when they either carry out your interview or when they come and do your first inspection now the registration process takes around 12 weeks obviously at the moment it's much much longer and you could probably add about five weeks onto that process but this can depend on the type of application that you're making so it and whether you're an existing provider or whether you're a new provider so if your application is dependent um it is dependent on a commercial transaction taking place i advise really that the completion of sale is subject to cqc registration and in addition i would say give an extra few weeks just to cover off any hiccups that may that may happen during the process so once you've submitted your application cqc will send you um an email to say that it's hopefully passed the initial check sometimes they send you an email to ask you to um put an extra dot above an eye or cross a tee off or resign the date the date and things like that there's some niggly bits that can come back but they're quite good actually at guiding you through what the bits that you need to to amend um so once you've had that email i suggest you take a very deep breath uh grab a large gin and tonic and wait for gnt for cqc to contact you um but use this time really to look at all the systems you've got in place make sure your service is ready for registration that it's ready for inspection and that you're really clear about your your processes paperwork documentation that people are ready so cqc registration who is involved there's there's a variety of people it can be three people or it can be the same person um so often smaller services it's the same person is both the provider the nominating of joanne and the registered manager but one of the key questions you'll be asked as a new provider and manager is that how will you actually have oversight of the quality of your service what systems and processes are you going to have in place to make sure that you have an effective audit communication and service development at both manager and provider level that there are really clear layers of governance in place you will be asked about your business plan and the financial sustainability of your service you may be asked how you intend to grow and secure your space within the marketplace and develop relationships with commissioners and funding authorities so you need to have answers for those you know in your mind and a strategy for that you may also be asked about threats to your business and you need to think about these as you formulate your business plan so what's your competition and what are any potential threats so top tips really is firstly making sure that you know which regulated activity you're applying for and that it's the most appropriate one for your service by using the scope of registration document secondly check double check and triple check the application um as i said they can be returned for the most minor of errors so it's it's better to spend the time making sure your application is is watertight before you press that send button um apply for the manager's dbs in good time as as i said you can't progress the application until that dbs number is obtained for the registered manager uh choose the roles carefully and who's going to have responsibility for which area how you're going to have oversight and governance of that so be very clear about your vision and values your mission statement what it is you're really passionate about and what what helps you to stand out above above the other services locally and lastly have a very good knowledge of cqc the regulations and the key lines of inquiry and really what a good service would look like so that you can make sure that you mirror um you mirror that thank you very much there's my contact details some references okay so in this part of the webinar i will be looking at the fit and person's requirement which relates to your decision over who you're going to select for a manager or nominated individual registering with a criminal conviction and challenging a proposal or decision to refuse your registration if you receive one from the cqc and so the fit and proper persons requirement is a test used by the cqc when considering an application for registration to determine whether a person is fit and proper to carry out their role there are three separate tests one for directors one for nominated individuals and one for managers and these are set out in regulations five to seven of the health and social care act 2008 regulations 2014. once you're registered you also have to be mindful of regulation 19 which sets out the fit and proper persons requirement for employees so as a provider it's your responsibility to ensure that you only employ fit and proper staff who are able to provide safe care and treatment appropriate to their role and and to enable them to carry out the regulated activity so let's have a look at the fit and proper person's criteria for a nominated individual manager regulations six and seven set out that a person is not fit to manage or supervise the management of any regulated activity unless they're of good character they have the necessary uh qualification qualification skills and experience to manage the uh regular regulated activity and they are able to do so by reason of their health there's a fourth requirement as well that they're able to provide information and documents uh to the cqc which confirms their suitability with that criteria so when looking at whether someone is of good character in line with the fit and proper person's requirement the legislation directs you to look at whether the person trying to register has been convicted of an offense or whether the person has been erased removed or struck off um from a professional register such as the general medical council or the national periphery council for example um but cqc are looking for someone who can demonstrate that they're honest trustworthy reliable respectful and those two things may depending on the circumstances point to the opposite characteristics however having a conviction is not necessarily a bar to registration provided that you are open and honest with the cqc if you're a provider and you're looking at whether you can employ someone as a manager with a conviction you need to ensure that you carry out full investigation into the circumstances of the conviction you should record the outcome of that investigation in writing with detailed reasons for your decision and if you choose to employ that person you then need to consider whether it would be appropriate to carry out a risk assessment or any other action and perhaps a period of shadowing before that person is allowed to work on their own if you're a manager trying to register then you might want to consider providing a reflective statement to the cqc at the time of applying this could include full details um of the conviction any relevant circumstances and mitigation and it should also demonstrate appropriate insight and reflection in respect to that conviction and why you think you're now a fit and proper person to be registered with the cqc um you might also want to consider obtaining character testimonials and these are most effective if they're from people that you've worked with in a care setting or with vulnerable people since the conviction um and particularly from the last year or so so they have to be recent and if they're from someone who worked with you in a similar role that also helps as well once the cqc have assessed your application for registration then they have the power to refuse refuse it under section 12 of the health and social care act 2008 if they're satisfied that the requirements of the regulations and any relevant legislation have not been complied with in relation to the carrying on of the regulated activity so the most common reasons for refusing an application would be if there's evidence of failing to comply with any of the regulations particularly the 2009 registration regulations and the health and social care act regulations 2014 and for example they may have identified concerns um at a registration visit over a provider's proposed policies and procedures staffing arrangements or medicines management for example and the ctc might also not be satisfied with a proposed manager or a nominated individual they may not think they're a fit and proper person to manage or supervise the regulated activities um but before refusing the application they have to issue with the notice of proposal and that's a document which outlines in detail the reasons why they're proposing to refuse you then have a period of 28 days to make written representations against that proposal and this is an opportunity for you to respond to the cqc's concerns and provide them with any additional evidence or information in support of your application it's important that you review each reason very very carefully and that you take a very careful and measured approach to your response and it's only a proposal at this point it isn't their final decision so there is still time to persuade them to to grant the registration there are of course other reasons why registration may be refused and that might relate to the cqc's registering the right support guidance document um and that's affected a lot of new learning disability uh providers we understand that documents currently under consultation so i don't propose to go into that in any great detail but we will cover that in a future webinar um after assessing the representations and everything evidence you submit they'll then have to decide whether to proceed with the refusal if they do they'll issue you with a similar document called a notice of decision and with that document you have a right of appeal against that decision to the first tier tribunal um care standards chamber and that appeal has to be made in writing within 28 days in order to sound any prospects of success with an appeal of that nature you do need to make sure that you're able to support any challenge with clear documentary evidence and at that point if you haven't already done so i would strongly suggest you get legal advice before lodging an appeal one of the unfortunate outcomes of the covert 19 pandemic is that many care homes and nursing homes may end up having to close due to the additional financial pressures that the whole pandemic has placed on already struggling social care services in recent years it's it's been reported as we all know that the demand for social care is expected to continue to rise quite significantly but with rising costs and more rigorous regulatory requirements um we have seen an increase in care home closures um in december 2019 the telegraph actually reported that there had been more than 600 care homes opens that year but there were also over 900 closures so that equated to an overall loss of over 23 000 beds which is quite significant um we expect the demand for for care home placements and home care to no doubt continue to rise in the coming years but we also hope to see an increase in applications for registration from new and existing providers wanting to register to cater for that demand but as we've seen obtaining registration with cqc is not always a straightforward easy task they have taken a more stringent approach to registrations in the last few years and that's been reflected in the increase in refusals that they're issuing and their annual report from 2018 to 2019 confirmed that they'd issued 564 registration note notices of proposals that year and that was an increase of 26.7 from the previous year so we expect the new statistics that will be released in due course we'll show a further increase on that as well so it just shows how important it is to make sure that your application is properly prepared thought out and if necessary that you obtain the right advice and support before you make that application if we have a look at some some recent case studies as by way of an example so there was a case reported a couple of years ago about an 82 year old woman who had been permitted to register as a manager of a 25 bed care home in 2010 she then got on to obtain a second role as a manager and registered again in 2014 she had a previous conviction um from 2003 for deceiving a client of 9 000 pounds in her previous role as a financial advisor and she actually served a prison sentence for it the cqc had to review the case in around 2018 because they were contacted by a whistleblower who was questioning the appropriateness of her registration and what the cqc said in a statement was that they had sought legal advice and that they were satisfied that it carried out a detailed and rigorous investigation into the circumstances of her conviction and she'd been open and honest with both the cqc and the employer about the conviction as well um and it's clear that the length of time that had passed since her conviction in 2003 to when she first obtained registration in 2010 so some seven years later had played a huge role in the cqc's decision-making process during that period there'd also been no reports that she'd received any further convictions um and there was no further evidence to suggest that any such conduct or any dishonesty had been repeated however i think if the the conviction had been a bit more recent um and she didn't have any supporting evidence from her current employer of a good character then it probably would be reasonable to assume that um the cqc may have potentially reached a different decision um but we have an example for a new provider registration we recently in the last couple of months acted for a provider of mental health crisis services for young people um and they'd received a notice of proposal to receive to refuse their registration the reasons for that refusal related to concerns about the location of the premises and the layout as well and we assisted them with making representations against the proposal and what we did was clarify that the purpose of the service and why the specific location was chosen which i think had caused a bit of confusion um and we also detailed the steps taken by the provider to address the issues with the internal layout and they work together with the cqc to do that and as a result the cqc granted the registration quite shortly after so that that gives you two examples of a provider and a manager obtaining registration it's clear that ctc's registration process can be can be quite complex and it depends on the certain circumstances of a particular application uh but it can also be time consuming as as helen pointed out earlier and over the last few years as i've mentioned the cqc have increasingly be taking action to refuse applications more and more ultimately the key to being successful with a registration application is preparation um it's also important that you need to make sure that you are open and honest with the cqc during the registration process as well as any employer if you're a manager particularly whether circumstances which could potentially result in the refusal of your registration such as a conviction i think being upfront with the cqc and working together with them or providing any information that's pertinent to your application is only likely to to increase your chances of obtaining registration in the long run if you've received a proposal to refuse your registration based on your compliance with the regulations then you need to carefully consider whether you accept or dispute those reasons because that will inform your approach to any challenge if you dispute any of the reasons provided then you need to make robust submissions to challenge those reasons and you must have supporting documentation um and you must also reference any applicable legislation guidance or case law and that's relevant to your circumstances if you accept any of the reasons provided then you need to consider how you can rectify or address those concerns as quickly as possible where they can be addressed before the deadline for your challenge or your appeal then it's important to give documentary evidence to demonstrate that you've addressed those concerns if you're not able to do that then maybe consider putting together a detailed action plan outlining how you can address those those issues and provide realistic time frames as to when those will be completed but overall i think it's vital that you clarify any misunderstandings um during the registration process to avoid a potential refusal and that you provide them with reassurances about any concerns particularly before any final decision is made and i think that takes us um to the question sean if if we've had any yeah thank you thank you um first is what are your thoughts on personal care in supported living services and cqc making services dormant as they do not feel pc is being delivered despite prompting in supervision of personal care medication administration not being considered as personal occurred you need to read that again yeah if you could please what are your thoughts on personal care in supported living services and cqc making services dormant as they do not feel personal care is being delivered despite prompting and supervision of personal care medication administration not being considered as personal care i i i don't is that i mean helen might think i don't know if that's questioning whether it should be registered for the regulated activity of personal care um or not is that your understanding of it helen yeah i mean i would certainly say if you're providing any sort of personal care um as as described in the scope of registration document i think that's the key document to keep going back to um and if you must make sure you have an active security registration if anything you're providing fits that scope of registration so i would go back to cqc if they're saying make it making it dormant making the service dormant they'd go back to the cqc without why you think you're providing that regulated activity currently yeah and they they can't they can take enforcement action against you if they think um you know you you're registered when you don't need to be so it's important that you it is about clarifying any misunderstandings with the cqc you need to give them as much information as possible so that they understand the position fully um otherwise there will be there will be these misunderstandings um okay thank you another question during the application can one switch registered manager if so how does this affect the application did you read it again or you got that no that's that's fine should i um so certainly it would delay the application slightly but what i would suggest in this case is that you contact cqc and explain the situation using the reference number that they gave you when you submitted the original application and take guidance from them and obviously make sure that the the new managers registration forms are fully prepared and ready to be sent off as soon as you make contact with cqc yeah okay thank you the only the only thing i would add there though sean sorry is that sometimes if um with an application if they think it's a substantial change to the to the application they may make you start from scratch and submit it again but i would hope in those sorts of circumstances if you've got quite far along and it's just a case of changing the manager that you would hope that if you had to start again and submit the application that you would be able to maybe skip skip a few stages okay thank you question for you i think helen perhaps is there a fee for registration so to see if you see they have an annual fee that's payable um once you're registered and that does actually cover the initial cost of your registration and ongoing fees okay um right but they they there is an annual fee okay thank you another question can i register more than one nominated individual yes you can and that the secrecy are very clear on this that you must make sure that each nominated individual has a clear role and responsibility and it's very clear which regulations they are going to be responsible for um so you need to have have collective oversight of how you're going to have true governance of your service okay um another question what do you see as challenges in taking on a service rated as inadequate and being in administration i'm not sure which of you would feel best to answer that do you want me to yeah um the biggest challenge is is if it's rated inadequate it's in special measures so you you're most likely going to have um a restriction on admissions um if you're taking over the existing registration then that will just continue to any enforcement action that's in place um any restrictions on admissions like i say or any conditions on the registration are going to remain in place if you're doing a brand new provider registration then they'll be aware that you are taking over an adequate rated service and there may still be you your your up your registration may be granted subject to the same same restrictions until they're satisfied that you've been able to to bring it out of special measures um so you need you need to be willing and able to to challenge any enforcement and work with any restrictions or conditions that are in place already when you take over it okay thank you could i just add something very short that i think um for somebody taking over an adequate service i i would suggest that the due diligence that you carry out as part of that purchase is extremely thorough so as as much information as you can glean about exactly why this service is is where it's at i think that puts you in a much better position um moving forward okay thank you laura if i receive a proposal to refuse my registration is it not better to withdraw my application and start again um no not not normally but it depends on the individual circumstances of the case you need to look at the reasons why the cqc are proposing to refuse your registration first of all so the refusal might have been proposed due to a misunderstanding during the application or interview process which which can be rectified by giving further information or evidence on that point um or there may be compliance concerns that can be easily rectified in a short period of time and if you start from scratch then you're having to go through submitting the application passing the initial text undertaking the fit person interview and it's a much longer process as helen uh explained before so um you've also got to be mindful that it'll be on your registration record as well if you've been refused before and it wasn't challenged so it's usually better to challenge the refusal where you can and then if you're successful your registration will be granted in a much shorter period of time okay is there a difference to an application when an existing registered manager is then changed to a joint registration with a new manager i think that would just be adding an additional manager so it would i don't if that wouldn't affect the if the existing the existing manager was already registered their registration would remain unchanged you're just applying for an an additional manager and i think they would just look at whether they think given the size of the the the company or the care home or whatever you're registering whether a second manager was needed i think okay and how long does an appeal take um i think from from start to finish so from when when you lodge the appeal to a final hearing it's probably likely to take somewhere between two to six months but it really depends on the amount of issues in a particular case and and how long it's needed for the entire timetable but at the moment it's likely to be affected further as well because of of everything and that's happened during the pandemic and it'll depend on the tribunal availability although they are holding video hearings at the moment um but i would suggest you you you really need to seek legal advice at the point of of when you're looking at lodging and appeal because they can be quite costly and so you need to consider whether you have any prospects of success in in pursuing that appeal um and the tribunal have quite wide ranging powers in relation to costs as well so you don't want to end up having to to pay the cqc's legal costs as well when somebody's asked a similar question in relation to the registration process how long on average does the registration process take helen mentioned that before didn't you yes so normally it's it's between 12 and 15 weeks however at the moment any applications going in currently are there being held for five weeks um initially before they're allocated to a registration inspector um it is different if you're applying um under covid a covert registration that can be quicker so but there's some details on the 60 website about special special code 19 applications okay another question that's just come in if an existing provider takes on an inadequate rated service is the rating carried over to the new provider um i i can answer that um i think with the um we've got the continuing regulatory histories now haven't we so i i haven't seen it working in full force but i think if if you're taking on from an old provider there will be a link on your new um provider profile of a link to the previous providers website so you'll be able to see that but you will have um an inspection um you will have an inspection helen is it within the first six to twelve months i think the first inspection so you're unlikely to have any rating on your profile at first um until you have that first inspection but there will probably be a link to the previous provider and that you'll see that that that was inadequate okay great thank you both i think that's all of the questions um that we've had um i just want to finish by um telling you about some um additional webinars that we've got coming up there we go on the 13th of august we have sophie maloney who's a solicitor at stevenson's and specializes in quarter protection health and welfare issues alongside robert york from swift management services and they're talking about non-resuscitation clauses where a patient lacks mental capacity to consent to the importance of consultation so and the importance of consultation so that's a that's an interesting one and on the 27th of august laura returns with ed watkinson of watkinson consulting to talk about the importance of challenging the cqc after inspection and injunctions and finally just a reminder um our co-hosts of these webinars are the great british care awards and you can nominate for the great british curry awards now by visiting the great british queer awards website and i did post uh the details of that on the uh the chat area if you view your great british care awards nominations and that will take you to their website so thank you very much everybody uh once again i'm sorry for the technical problems at the start of this webinar but i'm really pleased that so many of you were able to join us and thank you for your patience so that's now the end of this webinar thank you