• The CQC has begun a review of infection prevention and control (IPC) systems in care homes.
• A CQC Insight report was published in September 2020, which included a summary of the results so far from the review of IPC systems.
• To support the IPC review, the CQC has developed a new IPC inspection tool, with questions and prompts relevant to the current pandemic.
• The CQC will use the IPC inspection tool for the continuing IPC review and on all upcoming inspections of care homes.
Soon after the pandemic started to impact on health and social care systems in England the CQC responded by announcing a halt to inspections. The CQC wrote to all providers and stated that its primary objective during the pandemic would to be to support services. An Emergency Support Framework (ESF) was developed for inspectors as a monitoring tool to support their conversations with providers. The focus of inspectors was on the immediate risks from the pandemic while being sensitive to the pressures on providers.
With the first phase of the pandemic over, the CQC has now turned its attention to how it will regulate services in the immediate future and beyond.
The CQC states that it does not intend to return to ‘business as usual’ regarding inspections, especially with the risks relating to COVID-19 virus transmission still very present, and even increasing in some areas. Thus there will be no return at present to its usual fixed timetable of face-to-face inspections and site visits.
However, despite this, the CQC is keen to stress that it remains active in its regulatory role and in protecting the public from poor practice and low standards. It has therefore announced that, from October, it will be implementing a ‘transitional’ approach that in-volves an increase in remote monitoring of data. This will continue to support the current system of quality ratings and their publication on the CQC website. Inspectors will review the monitoring information and, using a streamlined set of key lines of enquiry (KLOES), will make judgements as before.
There are concerns, face-to-face site visits will be conducted. CQC states that in such circumstances it will use existing inspection methodologies and adapt to work with the environment concerned.
If a provider wants to contact the CQC or submit information or notifications during the pandemic it is asked to do so online or by email wherever possible. Providers are asked not to send forms by post. This is because many CQC staff are working from home during the crisis and their offices are closed in compliance with government restrictions.
Infection prevention and control (IPC) reviews
In the summer of 2020 as the COVID pandemic lockdown in England began to ease the CQC began a review of IPC systems in care homes. These were described as Provider Collaboration Reviews and not formal inspections. The aim was to drive system, regional and national learning and improvement.
Residential care was severely impacted by the virus at the height of the pandemic and IPC was identified as a vital part of managing COVID-19 risks.
A CQC Insight report was published in September which included a summary of the results so far from the review, drawing to-gether the main findings and identifying best practice. Further results will be published in due course.
The adult social care inspection IPC information gathering tool
To support the review the CQC has developed a new IPC inspection tool, with questions and prompts relevant to the current pan-demic. The CQC states that this will be used for the IPC review and on all upcoming inspections of care homes. The intention is to help inspectors to understand if there are any ‘gaps or concerns’ about infection prevention and control. Where these are identified a service can be signposted to resources that could help.
The adult social care inspection information gathering tool: infection prevention and control relates to how inspectors answer KLOE S5: How well are people protected by the prevention and control of infection?
The questions have been published to help care providers prepare for the risk of a ‘second wave’ of COVID-19 and the impact of winter pressures.
Key questions are as follows:
• Are all types of visitors prevented from catching and spreading infection?
• Are shielding and social distancing rules complied with?
• Are people admitted into the service safely?
• Does the service use PPE effectively to safeguard staff and people using services?
• Is there adequate access and take-up of testing for staff and people using services?
• Do the layout of premises, use of space and hygiene practice promote safety?
• Do staff training, practices and deployment show the service can prevent transmission of infection and/or manage outbreaks?
• Is the IPC policy up to date and implemented effectively to prevent and control infection?
Additional mandatory questions include:
• Does the service have sufficient and adequate supply of PPE that meets current demand and foreseen outbreaks?
• Are staff using PPE correctly and in accordance with current guidance?
• Has the service received external PPE training during the pandemic sourced from a Mutual Aid trainer or equivalent?
• Does the service know where to go for advice should there be an outbreak – which authorities and what their role and responsibilities are?
• Is the service participating in the testing programme that is currently provided for residents and staff members?
• Do staff in the service understand the principles of isolation, cohorting and zoning appropriately?
• Has the service implemented isolation, cohorting and zoning appropriately?
• Has the service adequately taken measures to protect clinically vulnerable groups and those at higher risk because of their protected characteristics (BAME, physical and learning disabilities)?
• Has the service got a named clinical lead as assigned by the Primary Care Network?
• What position/profession is your named clinical lead (for example, GP)?
• Do they conduct a home/ward round?
• What clinical support has been provided direct into the care home, by whom, and what has been its impact?
The full tool includes additional questions and prompts and provides guidance for inspectors on what effective IPC measures look like in practice.
• The infection prevention and control tool can be found here: https://tinyurl.com/IPCCQC
• COVID-19 Insight Issue 4 can be found at: https://tinyurl.com/CQCCOVInsight
About the author
Martin Hodgson MSc, PGCEA is a community psychiatric nurse by background, and has had a long career working as a senior manager in various health agencies, including mental health, primary and community care. Martin also has experience in information governance in health and social care.