In simple terms, instead of looking at evidence and scoring Yes or No for adequacy, an inspector has to look at 6 defined aspects and score them from 1 to 4 to justify their decision.

The scoring adds some nuance, but it is still the Inspector's judgement, the same as before.

4 = Evidence shows an exceptional standard
3 = Evidence shows a good standard
2 = Evidence shows some shortfalls
1 = Evidence shows significant shortfalls

Don't waste time trying to understand the scoring system

• The scoring system and aggregation of points is a toolkit designed to assist inspectors.
• It reflects a professional opinion, it is subjective and dependent entirely on the inspector.
• Understanding the methodology used is unnecessary and adds no benefit.

Improved scores are only achieved through robust processes and evidence from your governance system and ensuring that this aligns with the Quality Statements.

The best time to tackle scores and ratings is at an actual inspection or assessment by engaging with the inspector on how they arrived at the rating.

 What you need to know

1. Each Quality Statement receives a score based on the evidence available
2. These are aggregated to arrive at a score for the Domain Question
3. The scores are aggregated again to arrive at an Overall score

What you don’t need to know:-

There are aggregation rules with sub-rules on how everything is added up and weighted. You cannot predict this accurately, and the inspector has leeway to change this depending on their findings and judgement.

The formulas are not fixed:-

Aggregation: “If we identify concerns during an assessment, we will use our professional judgement to decide whether to depart from applying our ratings principles”

Weighting: “We can adjust the following principles for combinations where it is not appropriate to treat ratings equally”

Old ratings are redundant

The old ratings are not like-for-like, you cannot compare them to new ratings as they are measured completely differently

What this means is that a Provider rated as Good might still be Good, but they may well fall short on the new standards, as the focus has changed more towards external feedback from the old site inspections and internal evidence.

In very simple terms, this is all you need to know:-

1. Each Quality Statement has 6 types of Evidence
2. The inspector scores each of the evidence  types
3. Adding up these scores gives a total score for each Quality Statement
4. Adding up Quality Statement scores now give you a total score for the Key Question/Domain

(By adding up we mean a method of calculating and aggregating is used to arrive at an "average")

Preparation time

If you are not already familiar with the Regulations, the average time you need to reserve to study all the content, including Best Practice and Regulations, can vary between 5 hours for the simpler statements to 15 days for the more complex statements.

As an example, Safeguarding lists 16 “Additional legislation” and 27 documents on “Best Practice Guidance”. The CQC states “We expect providers to be aware of and follow the following best practice guidance”, where some documents are more than a hundred pages; making the total reading list in the region of some 3,000 pages on this single Quality Statement.

The theory: What the CQC expects

1. Read Quality Statements, the Regulations, and Best Practice
2. Draft your Policies
3. Create your processes
4. Train all your staff
5. Monitor and improve

The challenge: Implementing everything

Quality Statements
Familiarising yourself with all 34 Quality Statements is relatively easy and will probably take 1 to 2 days to read and absorb.
Reading every related Regulation and Best Practice could take between 2 to 6 months if done as a full-time activity, working on this continuously every working day.

Policies
The CQC lists a limited number of core policies they require at initial registration, but once trading commences, each inspector exercises their own judgement at local level for any other policy they deem relevant. Preparing for every eventuality would entail researching and drafting hundreds of policies, and could take 3 to 6 months at the minimum as a full-time activity.

Processes and Training
Writing bespoke processes for every scenario from all these documents would be another arduous task and could take 6 months to 1 year depending on the Provider type, and training each member of staff could take another 6 months to a year.

The Practice: What Providers usually do

Smaller Providers will generally ignore the official documents altogether and subscribe to a Policies Library service, which gives them access to hundreds of policies containing a standard process.
Their entire governance system will be based on the document library, only referring to the Regulations and Best Practice documents as needed

Complex and Enterprise Providers with greater financial resources, have the advantage of being able to engage specialised staff, and devote resources to bespoke documents, processes, and governance systems.

The Regulatory System does not differentiate between smaller and complex or enterprise Providers.

Where an Inspector is familiar with the Provider Type, they will make appropriate adjustments to what can be reasonably expected from an SME. However, it is not uncommon to find an Inspector with a hospital inspection background asking for the same level or Corporate Governance from a sole trader with just 2 members of staff.

The Ratings have not changed, but the way these are determined has changed.

Providers will still be rated as Outstanding; Good; Requires Improvement; or Inadequate. However, during the transition period there will be a mix of old and new, until eventually all Providers have been assessed at a Full Inspection under the new rules.

Comparing and Benchmarking

You can only benchmark ratings when they are like-for-like and use the same core measurement criteria.
Inspections during the roll-out stage are a “holding measure” until a Full Inspection is carried out. During this phased approach you will see KLOE based ratings combined with some elements from the new SAF, resulting in a hybrid rating system.

Provider comparison may not be like-for-like. We have identified 5 types of variations that result in hybrid ratings, which will have little statistical or benchmarking value.

Old ratings which used KLOEs as the criteria

Reliability of Ratings

Benchmarking and comparing Providers is only reliable when each of them have been rated in a full SAF based inspection. Even then, there is likely to a be a level of uncertainty where ratings are based on remote interviews versus an actual site inspection.

Partial Inspection produces a hybrid rating

An example of a Partial Inspection is a telephone review of a Provider who was previously rated as Good under the old system. A single or a small number of Evidence Categories such as Equity of Access are reviewed and scored, and all other un-inspected categories are automatically scored as Good on the basis of the previous inspection under the KLOE criteria, which may now be several years out of date. The statistics will incorrectly imply this being a recent Full Inspection.

Targetted selection are based on the inspector's judgement. This might be routine or based on new information they have received or where they feel additional reviews are necessary

• Every sector is inspected differently
• Cannot compare inter-sector ratings as each uses a different scoring criteria
• Cannot always compare Providers in the same sector if categories have been added by inspector
• Consistent comparable rating only achieved when all 204 checks applied equally to all providers

 Sub-Frameworks are tailored to each Sector
This table displays how the number of Key Evidence Categories vary for each Sector

 Key Evidence Categories

For each sector, a set of Evidence Categories are prioritised as "Key Evidence Categories" which will be checked at the next inspection, the rest are not checked but can be added at the inspector's option.

The Key Evidence Categories are different for each Sector

Illustration of variation in Inspection for SAFE

GP Practices Vs Residential Care

 Variation in Inspections for Safeguarding

Key Evidence Categories vary for every Sector