Many care homes fall short of the requirements of Regulation 17, often unknowingly, leading to lower ratings.
Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is a cornerstone of quality care in England. It mandates that care homes establish and maintain robust systems for good governance, impacting their Care Quality Commission (CQC) ratings significantly.
This report delves into Regulation 17's requirements, its influence on CQC ratings, and how care homes can use technology and data to ensure compliance and enhance the quality of care they provide.
[You can download a PDF version of the report here: Regulation 17: Good Governance and its Impact on CQC Ratings for Care Homes]
Understanding Regulation 17
Regulation 17 emphasises the importance of proactive and continuous improvement in care homes. It requires providers to implement systems and processes that not only monitor current practices but also identify potential risks and areas for improvement. This proactive approach helps prevent incidents and ensures that care homes are consistently striving to provide the best possible care for their residents.
At its core, Regulation 17 requires care providers to:
- Assess, monitor, and improve the quality and safety of services, including the quality of the experience of people receiving those services.
- Assess, monitor and mitigate risks relating to the health, safety, and welfare of service users and others who may be at risk.
- Maintain secure, accurate, complete, and contemporaneous records for each service user, including care and treatment provided and decisions made.
- Maintain other necessary records related to persons employed and the management of the regulated activity.
- Seek and act on feedback from relevant persons to continually evaluate and improve services.
- Evaluate and improve practices related to information processing.
Key Components of Regulation 17
Regulation 17 encompasses several key components that contribute to effective governance and high-quality care in care homes:
Leadership and Culture
Strong leadership is fundamental to creating a culture of openness, learning, and continuous improvement within a care home. Leaders must foster an environment where staff feel valued, empowered, and supported to deliver the best possible care. Research has shown that a resident-centred culture, where staff perceive regulations as tools to enhance care rather than burdens, can significantly improve care practices and resident well-being.
Risk Management
Care providers are required to have robust systems in place to identify, assess, and manage risks effectively. This includes:
- Establishing clear procedures for incident reporting and investigation.
- Analysing incidents to identify root causes and implement preventative measures.
- Regularly reviewing and updating risk assessments to reflect changes in the care environment.
- Developing strategies to minimise the likelihood and impact of potential risks on residents and staff.
Engagement and Involvement
The CQC emphasises the importance of actively involving residents, their families, and staff in decision-making processes. Care homes should have mechanisms in place to:
- Gather feedback through surveys, suggestion boxes, resident meetings, and informal conversations.
- Actively seek the views and preferences of residents and their families regarding their care.
- Involve staff in the development and implementation of policies and procedures.
- Create a culture where residents and staff feel comfortable raising concerns and providing feedback.
Information Sharing and Collaboration
Regulation 17 requires care homes to share relevant information with other organisations and individuals involved in the care of residents. This includes:
- Sharing information with safeguarding boards and coroners when necessary.
- Collaborating with healthcare professionals, social workers, and other agencies to ensure coordinated and holistic care.
- Communicating effectively with residents and their families about their care and any changes to their care plans.
Record Keeping and Information Management
Maintaining accurate, complete, and secure records is a critical aspect of Regulation 17. Care homes must ensure that:
- Individual care records are kept up-to-date and include all relevant information about the resident's care and treatment.
- Records are legible, indelible, and stored securely to protect confidentiality.
- Decisions made about a resident's care, including discussions with the resident, their family, and healthcare professionals, are documented clearly.
- Consent records and advance decisions to refuse treatment are readily accessible.
- Records are created, stored, and destroyed in line with data protection legislation and guidance.
Regulation 17 and CQC Ratings
CQC inspectors evaluate care homes against five key questions, with Regulation 17 directly contributing to the "well-led" question. Inspectors assess how well the leadership and governance of the service ensure the delivery of high-quality, person-centred care. Compliance with Regulation 17, by promoting good governance, ultimately leads to better care and improved well-being for residents.
It is important to acknowledge that while regulatory oversight is crucial for maintaining quality standards, it can also place pressure on care home staff, potentially leading to increased workload and job dissatisfaction. Care providers need to find ways to balance the demands of compliance with the well-being and support of their staff.
Consequences of Non-Compliance
Failing to meet the requirements of Regulation 17 can have serious consequences for care homes. The CQC has a range of enforcement actions at its disposal, including:
- Warning notices: These require the provider to make specific improvements within a set timeframe.
- Fines: Financial penalties can be imposed for non-compliance.
- Conditions on registration: Restrictions may be placed on the care home's operation, such as limiting the number of residents or the types of services provided.
- Suspension of registration: This prevents the care home from operating for a specified period.
- Cancellation of registration: This is the most serious action, removing the care home's license to operate.
Furthermore, the CQC can prosecute for a breach of Regulation 17 if a provider fails to submit a report when requested. Non-compliance can also damage the care home's reputation, erode trust with residents and their families, and make it difficult to attract and retain staff.
Technologies for Evidencing Compliance
Technology plays an increasingly important role in supporting care homes to evidence their compliance with Regulation 17. Several technologies can be utilised to streamline processes, improve record-keeping, and enhance the quality of care:
- Digital Nurse Call Systems: This technology allows care providers to track and monitor carer visits and care delivery, ensuring that residents receive the care they need and that carers are meeting their obligations.
- Digital Care Records: These provide a centralised and secure platform for storing and managing service user information, improving accuracy, accessibility, and efficiency.
- Mobile Apps for Carers: These enable real-time recording and updating of client information, facilitating communication and collaboration between care professionals.
- Digital Care Plans: These offer a comprehensive overview of individual care needs, ensuring that all care professionals involved are aware of the resident's requirements and preferences.
- Geo-location Services: These monitor the location of carers and critical equipment during shifts, ensuring that they are where they should be and providing evidence of care delivery.
- Sensor-Based Monitoring: This technology allows care providers to track the movement of service users within the care home, providing insights into their activity levels and potential risks.
In addition to these specific technologies, compliance software and dashboards offer centralised platforms for managing all compliance-related activities.
This can include:
- Policy and procedure management: Ensuring that all policies are up-to-date, accessible, and followed consistently.
- Incident and risk management: Capturing, tracking, and investigating incidents to identify trends and implement preventative measures.
- Auditing and document control: Conducting internal audits, managing findings, and maintaining version control for all documents.
- Training and competency management: Tracking staff training and ensuring that all staff members have the necessary skills and knowledge.
- Feedback collection and analysis: Gathering feedback from residents, families, and staff to identify areas for improvement.
The CQC itself encourages the use of technology and data to drive improvement in care services.
Using Data to Drive Service Improvements
The effective use of data is essential for driving service improvements and demonstrating compliance with Regulation 17. By collecting and analyzing data, care homes can gain valuable insights into their performance, identify areas for improvement, and make informed decisions about their services.
Care homes can use data to:
- Identify trends and patterns: Analyse data on incidents, complaints, and feedback to identify recurring issues and areas where improvements are needed.
- Monitor key performance indicators (KPIs): Track progress against quality and safety targets, such as medication errors, falls, and infections.
- Personalise care: Gather data on individual needs and preferences to tailor care plans and ensure that residents receive person-centred care.
- Measure the effectiveness of interventions: Evaluate the impact of changes and improvements on service user outcomes, such as resident satisfaction, health outcomes, and quality of life.
- Improve efficiency: Analyse data on staffing, resource utilisation, and operational processes to identify areas for optimisation and cost savings.
Data analysis can also be used to identify outlier practice, where a team's performance deviates significantly from the norm. This can help to identify areas where additional training or support may be needed. Furthermore, data can be used to evidence dependency rates and estimate demand and capacity, ensuring that care homes have the resources and staffing levels to meet the needs of their residents.
Practical Strategies for Evidencing Good Governance:
- Develop a Comprehensive Governance Framework: This framework should clearly outline the care home's governance structure, roles and responsibilities, policies and procedures, and systems for monitoring, evaluating, and improving service quality.
- Implement Robust Risk Management Systems: Establish clear procedures for identifying, assessing, and managing risks. This includes regular risk assessments, incident reporting and investigation, and the development of preventative measures.
- Prioritise Feedback and Engagement: Actively seek feedback from residents, families, and staff through surveys, meetings, suggestion boxes, and informal conversations. Analyse this feedback, identify trends, and take action to address concerns and improve services.
- Maintain Meticulous Records: Ensure all records are accurate, complete, up-to-date, and stored securely. Use a consistent format and ensure records are legible and easily accessible to authorised personnel.
- Use Data to Drive Improvement: Collect and analyse data on incidents, complaints, feedback, and key performance indicators to identify areas for improvement and measure the effectiveness of interventions.
- Promote a Culture of Transparency and Continuous Learning: Encourage open communication, staff involvement in decision-making, and learning from mistakes. Provide opportunities for professional development and create a culture where staff feel comfortable raising concerns.
- Document Everything: Maintain clear and comprehensive documentation of all governance processes, including policies, procedures, risk assessments, audits, feedback mechanisms, and actions taken in response to feedback or incidents
- Prepare for CQC Inspections: Familiarise yourself with the CQC's inspection framework and key lines of enquiry. Be prepared to demonstrate how your governance systems contribute to the delivery of high-quality, person-centred care.
Regulation 17 is not just a set of rules but a framework for continuous improvement in care homes. By embracing the principles of good governance, actively engaging with residents and staff, and utilising technology and data to drive service improvements, care providers can ensure they meet the requirements of this regulation and achieve positive CQC ratings.
This, in turn, leads to better care, improved resident outcomes, and a more sustainable and reputable care home.
Arquella
Arquella offers a suite of technology solutions designed to help care homes meet the requirements of Regulation 17 and demonstrate good governance to the CQC.
Here's how each of our solutions contributes:
Arquella Connect: This serves as the central platform, integrating data from various sources and providing valuable insights into care delivery and resident well-being.
It helps care homes to:
- Monitor Service Quality and Safety: Connect gathers data from other systems, such as Arquella Call, Sense and Move to provide a comprehensive overview of resident activity, incidents, and care provision. This allows care homes to identify trends, monitor key performance indicators, and proactively address potential risks.
- Improved Record Keeping: Arquella Connect integrates with leading digital care record providers, such as Nourish, Person Centred Software and Care Vision, to streamline processes and promote a resident-centred approach to care.
Arquella Call: This is a digital, wireless nurse call system that enhances communication and response times.
It supports Regulation 17 by:
- Improving Resident Safety: Arquella Call ensures that residents can quickly and easily call for assistance, improving response times and reducing the risk of incidents.
- Enhancing Staff Efficiency: The call-to-mobile alerts and intuitive interface allow staff to respond to calls promptly and effectively, improving workflow and freeing up time for direct resident care.
- Evidencing Care Provision: Call provides detailed call logs and incident reports, which can be used to demonstrate responsiveness to resident needs and compliance with CQC standards.
Arquella Sense: This fall detection system uses sensors to identify potential falls and alert caregivers in real-time.
It contributes to Regulation 17 by:
- Mitigating Risks: Arquella Sense helps to prevent falls and minimise the risk of injuries to residents.
- Improving Resident Safety: The real-time alerts ensure that falls are responded to quickly, reducing the potential for serious harm.
- Evidencing Risk Management: Sense provides data on falls and near misses with fall analysis, which can be used to demonstrate proactive risk management strategies.
Arquella Move: This movement tracking system monitors staff, resident and equipment activity and location within the care home.
It supports Regulation 17 by:
- Enhancing Staff Efficiency: Move automates attendance monitoring and provides real-time location data, allowing staff to respond to resident needs more quickly.
- Improving Resident Safety: The system can be used to identify residents who may be at risk of wandering or leaving the care home unsupervised.
- Evidencing Care Provision: Move provides data on resident activity and staff interactions, which can be used to demonstrate that care is being delivered effectively.
By integrating these technologies into your care home, Arquella provides a comprehensive solution that supports you in meeting the requirements of Regulation 17 and evidencing good governance to the CQC. This can lead to improved resident safety, enhanced staff efficiency, and higher CQC ratings.
If you would like to get more information on how you can bring Arquella's technologies into your care home, please get in touch.
Works cited
- Regulation 17: Good governance - Care Quality Commission, accessed on January 31, 2025, https://www.cqc.org.uk/guidance-providers/regulations/regulation-17-good-governance
- CQC Compliance Software | Achieve Regulatory Excellence - Radar Healthcare, accessed on January 31, 2025, https://radarhealthcare.com/product/cqc-compliance-software/
- Regulation 17: Good Governance: In-depth | Croner-i, accessed on January 31, 2025, https://app.croneri.co.uk/topics/regulation-17-good-governance/indepth?product=134
- Regulation 17: Good Governance | Croner-i, accessed on January 31, 2025, https://app.croneri.co.uk/care-standards/cqc-fundamental-standards-england/regulation-17-good-governance
- The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, accessed on January 31, 2025, https://www.legislation.gov.uk/ukdsi/2014/9780111117613/regulation/17
- CQC Regulation 17: Everything You Need to Know - The Access Group, accessed on January 31, 2025, https://www.theaccessgroup.com/en-gb/blog/hsc-cqc-regulation-17-everything-you-need-to-know/
- Regulation and Mindful Resident Care in Nursing Homes - PMC, accessed on January 31, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC2918733/
- Our ratings and scores - Care Quality Commission, accessed on January 31, 2025, https://www.cqc.org.uk/about-us/how-we-do-our-job/ratings
- CQC Ratings: Everything you need to know | Birdie Blog, accessed on January 31, 2025, https://www.birdie.care/blog/cqc-ratings
- What are the 5 CQC Standards? - Radar Healthcare, accessed on January 31, 2025, https://radarhealthcare.com/news-blogs/what-are-the-5-cqc-standards/
- How we reach a rating - Care Quality Commission, accessed on January 31, 2025, https://www.cqc.org.uk/guidance-regulation/providers/assessment/assessing-quality-and-performance/reach-rating
- The Financial Implications of Non-Compliance in Healthcare - Supplemental Health Care, accessed on January 31, 2025, https://shccares.com/blog/general/the-financial-implications-of-non-compliance-in-healthcare/
- How to use Technology to improve CQC Ratings - Human Services, accessed on January 31, 2025, https://humanservices.org.uk/2023/02/28/how-to-use-technology-to-improve-cqc-ratings/
- Driving improvement through technology - Care Quality Commission, accessed on January 31, 2025, https://www.cqc.org.uk/publications/themed-work/driving-improvement-through-technology
- The data-driven approach: Innovating care home management, accessed on January 31, 2025, https://www.caremanagementmatters.co.uk/article/the-data-driven-approach-innovating-care-home-management/
- Senior care centres should use data analytics to prioritise patient-centred care | Viewpoint, accessed on January 31, 2025, https://www.chiefhealthcareexecutive.com/view/senior-care-centers-should-use-data-analytics-to-prioritize-patient-centered-care-viewpoint
- Using data to drive service improvement: false dawns and a promised land? - PMC, accessed on January 31, 2025, https://pmc.ncbi.nlm.nih.gov/articles/PMC9345228/
Comments