3. Mrs X complains on behalf of staff at the hospice, about the attitude and behaviour of a CQC Inspector, during an inspection.
4. Mrs X says the conduct of the Inspector has affected staff confidence.
5. By bringing the complaint to us, Mrs X (on behalf of staff at the hospice) is seeking service improvements; namely, changes to how investigations are conducted.
6. In December 2023, an inspector from the CQC, accompanied by a specialist advisor, conducted a two-day inspection at the hospice.
7. During the inspection, Mrs X stated that the inspector’s attitude and behaviour was ‘unprofessional’ and ‘rude’. She described the two-day inspection as ‘traumatic’ leaving staff feeling fearful of future inspections.
8. During the first day of the inspection, Mrs X reported that the inspector conducted interviews with staff, who found her approach ‘aggressive’ and frequently interrupted them.
9. The inspector did not accommodate requests from staff, for time to ‘address their nervousness’ or to seek clarification.
10. Mrs X stated that the interview style was intentionally aimed at ‘demoralizing and disempowering’ leaving three members of staff feeling as though they had let the organisation down.
11. On day two of the inspection, Mrs X stated that the inspector’s approach shifted ‘from firing questions and making staff feel anxious, to then being completely different’.
12. Mrs X said she was ‘reduced to tears’ during the closing feedback session with the inspector, who suggested the possibility of a ‘requires improvement’ rating. In her view, the CQC values were not upheld nor demonstrated by the inspector, and the experience had had, a lasting impact on staff.
13. Mrs X lodged a complaint with the CQC on behalf of the hospice, including statements from three members of staff, who had been interviewed by the inspector.
14. The CQC provided its response on 15 July 2024, following its investigation into Mrs X’s concerns and concluded that it ‘partially upheld’ the complaint.
17. During an inspection, CQC inspectors evaluate the service on several key areas, including safety, effectiveness, responsiveness, and leadership. The results of these inspections can impact a care provider’s reputation and operations.
18. During the site visit, the inspector speaks with people using the service and their visitors, staff, volunteers and visiting professionals to assess all of the key questions. They also review relevant records and inspect the layout, safety, cleanliness and suitability of the premises, facilities and equipment. At the end of the inspection, the CQC will provide feedback on what they have seen and give the service provider the opportunity to comment before publishing a final report.
The CQC’s Response – It’s findings
19. ‘On day one of the two-day inspection visit [the Inspector’s] approach to speaking with staff, to gather evidence in relation to the key questions, was through a ‘question after question’ style which may have made staff feel uncomfortable. This resulted in them feeling like they had been interrogated which increased their anxiety and caused upset. Upon being informed of the negative impact their approach was having, [the Inspector] adjusted their approach for day two of the site visit.’
20. ‘It is evident that due to receiving a high volume of information from your team during the onsite inspection, in such a short time period, that this is likely to have resulted in [the Inspector] asking for information that had already been provided, especially in relation to concerns about medicines, funding and safeguarding and MCA training. Additionally, the format of the referenced data returned following the inspection made it difficult for [the Inspector] to identify specific documents and resulted in a repeat request being made in some instances.’
21. ‘The outcome of this review will be shared with the staff involved to reflect on and learn from your experience. On behalf of [the Inspector] and the CQC, we offer our apologies for the impact on your team and wish to assure you that this was not in any way intended.’
22. It is important to note, that, as part of our consideration of this complaint, we can only consider if the CQC conducted a though investigation in line with our expectations.
23. It may be helpful at this point to say more about our approach to complaints such as this one.
24. Essentially, the purpose of a CQC inspection is to ensure that the service being provided is of a safe and suitable standard. It is important the CQC forms an independent judgement and, although it must take account of what the service provider tells it, it cannot be unduly influenced by this. Instead, the CQC must form its own judgement after viewing all available evidence in the round.
25. Unfortunately, the nature of this process may bring CQC into conflict with the service provider, particularly if the two parties have differing views on the standard of service being provided. Equally, some of the questions the CQC ask may appear intrusive, particularly if they are questions the service provider was not expecting to be asked. In our experience, this can sometimes lead to one, or both, parties, finding the inspection challenging. This is unfortunate but cannot always be avoided.
26. In situations like this, it is often difficult for us to take a robust view on how the inspection was conducted. This is because we were not present and therefore cannot always take an independent view on what was said (and/or how it was said). We also recognise that differences on this matter often stem from perception on how the exchanges happened or should have happened. This does not mean we put more weight on one account than the other. It simply means that we sometimes find it difficult to make a firm judgement either way.
27. When the CQC investigates complaints about its own conduct, including concerns about inspectors’ behaviour during inspections, it follows a structured process to ensure fairness and transparency.
28. The CQC outlined what it had undertaken, as part of its investigation process. It confirmed that the investigator:
• Read all correspondence in relation to Mrs X’s complaint • Reviewed the inspection plan, inspector’s notes for the site visit on 6 and 7 December 2023, and CQC factual accuracy response • Liaised with and interviewed the inspector for this inspection • Liaised with and interviewed the specialist advisor who attended the inspection visit • Liaised with and interviewed the Operations Manager (the inspector’s line manager) • Reviewed its policies and procedures on Code of Conduct policy (24 October 2023) • Reviewed the document ‘Our Values’ https://www.cqc.org.uk/about-us/our-purpose-role/who-we-are • Reviewed Core Service Framework Guiding Hospice Inspections in 2023.
29. As part of its investigation, the CQC spoke with the inspector about her conduct during the inspection, including their approach to engaging with staff. It acknowledged that the inspector’s approach, had a negative impact on staff.
30. It was confirmed that a ‘question by question approach’ was used on day one of the investigation to ‘gather sufficient evidence’. The CQC stated that the inspector was made aware of the ‘negative impact’ through personal feedback from Mrs X, and a separate conversation with the specialist advisor, at the end of day one.
31. Under our Principles of Good Administration – getting it right – we expect organisation to take account of all relevant considerations, ignore irrelevant ones and balance evidence appropriately. For that reason, we can understand why Mrs X believes the CQC should have asked ‘supplementary questions’ to both her and her team, as part of its investigation, particularly as three members of staff had already submitted written statements supporting the complaint.
32. We cannot conclude that because of the CQC not doing so, this amounted to a failure, or that a thorough investigation was not conducted. This is because we cannot see that further questioning of these staff would have added to, or contradicted, anything they had put in writing. Unless the CQC sought to challenge the accounts provided by the staff, further interviews would likely have been unnecessary in these circumstances.
33. We have seen that the CQC noted, and reflected upon Mrs X’s comments on how the inspection made her and her staff feel. The evidence shows that the inspector took on board the feedback regarding her behaviour and consciously changed her approach on day two. This was confirmed by Mrs X who noted ‘changes’ in the inspector’s approach from ‘firing questions and making staff feel anxious, to then being completely different’.
34. The CQC also explained that it would share the outcome of its review with the staff involved to reflect on and learn from Mrs X’s experience. It would also review the learning and support resources that it provides its operations colleagues to protect their welfare and the welfare of providers following assessment and inspection
35. This is in line with our Principles of Good Administration - seeking continuous improvement under which we expect organisations to actively seek and welcome all feedback, both compliments and complaints’ and use the feedback to improve their public service delivery and performance.
36. The CQC added that, since the visit, it had reflected on learning taken from a high-profile case involving another organisation which operated a similar inspection regime. It said it developed a mandatory learning programme with the aim of assisting its assessors and inspectors to manage positive stakeholder engagement, including on inspection site visits. This includes risk assessment, identifying signs that providers/staff may be distressed and when to take appropriate action and how to relay news which might be distressing to providers and managers, as well as how to have supporting conversations once those messages have been relayed. This reinforces our view of the CQC as an organisation willing to learn from events, both internal and external.
37. We note that in Mrs X’s view, the CQC did not go far enough in providing assurance that the inspector would not be assigned to inspect the hospice in the future. Mrs X expressed that the ‘emotional toil’ of the inspection on the hospice staff was ‘considerable ‘and the prospect of experiencing it again would be ‘deeply unacceptable’.
38. We should explain that we are not a regulator and have no say on the day-to day running of the CQC. For that reason, we cannot dictate what resource the CQC should allocate to a particular inspection regime, including what personnel the CQC chooses to conduct that inspection.
39. The CQC explained that ‘Inspectors no longer have a portfolio of services to regulate. The assessor will identify when a site visit is required, and the inspector who will carry this out will be identified from a wider team, based on a variety of factors such as team resource and individual capacity.’ We would not have expected the CQC to have said more.
40. Have looked at matters carefully, we cannot say with enough certainty that the CQC inspector acted inappropriately. Although we can see, Mrs X, and her staff, found the inspection difficult and upsetting, we cannot say with enough certainty, that this was the result of maladministration. Whilst we acknowledge that the CQC recognised the inspection had a negative impact, this does not provide evidence that the inspector acted improperly.
41. Although we have seen nothing to suggest the CQC’s intended its inspection to cause distress, we appreciate how intimidating Mrs X, and her staff, found this experience. She told us they felt ‘interrogated’ by the inspector’s conduct which left them feeling anxious and fearful of future inspections.
42. In summary, we have decided to take no further action on this complaint. This is because the CQC conducted a thorough investigation into the concerns raised in reaching its decision and outlined the additional actions taken. We would not have expected the CQC to have done anything more.
43. We recognise this is unlikely to be the outcome Mrs X was looking for from her complaint. We hope we have clearly explained our decision and we thank Mrs X for bringing the concerns to our attention. We wish Mrs X and the staff at the hospice well for the future.
1. We have carefully considered Mrs X’s complaint about the Care Quality Commission (CQC) on behalf of staff at the hospice. We were sorry to learn of the events which led to Mrs X’s complaint, and how staff were left feeling after the inspection.
2. Having looked carefully at the evidence, we have not identified any failings in the circumstances which led to Mrs X approaching us. For that reason, although we recognise how difficult the situation has been for Mrs X and staff at the hospice we have decided to take no further action on this complaint. We will explain the reasons below in more detail.