Targeted Quality Statement Audits

Targeted Quality Statement Audits

The landscape of regulation in England’s health and social care sector is in a state of constant evolution. For providers, the shift from the Care Quality Commission’s (CQC) familiar Key Lines of Enquiry (KLOEs) to a new single assessment framework, underpinned by Quality Statements, represents a significant change in how quality is measured and demonstrated. While this transition may seem daunting, it offers a powerful opportunity to refine and refocus quality assurance efforts. Instead of viewing compliance as a monolithic task, providers can adopt a more agile and effective approach: the targeted quality statement audit.

This strategic method moves beyond broad, superficial checks, empowering services to conduct deep, meaningful reviews of specific areas. By focusing resources where they are most needed, providers can not only prepare for CQC assessments with confidence but also foster a genuine culture of continuous improvement that has a tangible impact on the lives of the people they support. This article will explore the structure of the new framework and provide a practical guide to designing and implementing targeted audits that drive real change.

Understanding the CQC’s New Framework and Quality Statements

The CQC’s new single assessment framework is designed to be more streamlined, consistent, and easier to understand for both providers and the public. At its heart, it retains the five key questions that everyone is familiar with: Are services Safe, Effective, Caring, Responsive, and Well-led? However, the mechanism for assessing these domains has changed. The 300+ KLOEs and prompts have been replaced by 34 concise Quality Statements.

Each Quality Statement is a clear, high-level declaration of what constitutes good care. They are expressed as “we statements,” which providers are expected to evidence through their everyday practice. For example, under the ‘Safe’ key question, one Quality Statement is: “We work with people to understand what is important to them in their lives and to understand and manage risks that may arise from their care and support.”

These “we statements” are directly linked to corresponding “I statements,” which articulate the same standard from the perspective of a person using the service (e.g., “I feel safe and am supported to understand and manage any risks”). This dual perspective ensures that the focus remains firmly on the lived experience of care.

For providers, the task is to gather and present compelling evidence that demonstrates they are consistently meeting the standards set out in these “we statements.” The CQC has defined six specific categories of evidence it will collect and assess:

1. People’s Experience: Direct feedback from individuals using the service and their families.
2. Feedback from Staff and Leaders: Input from everyone working within the service.
3. Feedback from Partners: Information from other organisations and professionals involved in care.
4. Observation: Direct observation of care delivery and interactions.
5. Processes: Review of policies, procedures, care plans, and other documentation.
6. Outcomes: Data and evidence showing the results and impact of the care provided.

Understanding this structure is the first step toward building an effective internal audit system. The Quality Statements provide the ‘what,’ and the evidence categories provide the ‘how.‘

The ‘Why’ of Self-Auditing with Quality Statements

With the move to a more continuous model of assessment, where the CQC can gather evidence at any time, the importance of proactive self-auditing has never been greater. Waiting for an inspection to identify areas for improvement is a reactive stance that can leave providers vulnerable. A robust internal audit programme, built around the Quality Statements, offers numerous strategic advantages.

Firstly, it serves as the ultimate preparation tool. By regularly testing your systems and practices against the very same standards the CQC will use, you can identify and address potential gaps long before they become compliance issues. This builds a strong evidence portfolio and allows you to articulate your quality with confidence.

Secondly, and more importantly, it fosters a culture of continuous improvement. Auditing should not be a tick-box exercise performed by a single manager; it should be a dynamic process that involves the entire team. When staff are engaged in reviewing practice, discussing what works well, and brainstorming solutions for challenges, quality assurance becomes an embedded, collaborative value rather than a top-down mandate.

Finally, self-auditing allows for a targeted approach. Rather than attempting to review everything at once, which can be overwhelming and inefficient, services can focus their efforts on specific Quality Statements. This prioritisation can be guided by various factors, such as findings from a previous inspection, analysis of internal data (like incidents, complaints, or compliments), staff feedback highlighting a particular challenge, or known high-risk areas within the service. This targeted methodology ensures that time and resources are invested where they will have the most significant impact on the quality and safety of care.

How to Conduct a Targeted Quality Statement Audit

Conducting a successful targeted audit involves a systematic process of planning, evidence gathering, and analysis. Let’s break down the practical steps, using the CQC’s six evidence categories as our framework.

Step 1: Select Your Target Quality Statement

Choose one or two Quality Statements to focus on for your audit cycle. For instance, you might select “Involving People to Manage Risks” from the ‘Safe’ domain if you’ve recently had a few minor incidents, or “Supporting People to Live Healthier Lives” from the ‘Effective’ domain based on resident feedback.

Step 2: Plan Your Evidence Gathering

For your chosen statement, brainstorm how you can collect information across the six evidence categories. Your audit tool or checklist should have sections dedicated to each.

• People’s Experience: How will you capture their voice? This could involve short, focused surveys, discussions during resident meetings, one-on-one conversations with individuals and their families, or reviewing recent compliments and complaints related to the topic. The questions should be direct: “Do you feel involved in decisions about your safety? Can you give me an example?”
• Feedback from Staff and Leaders: How will you engage the team? Use team meetings to discuss the Quality Statement. Conduct brief, informal interviews with staff during their shifts. Look at supervision records for relevant discussions. Ask them: “How do we support residents to take positive risks? What are the barriers?”
• Feedback from Partners: Who can provide an external perspective? Consider reaching out to a GP, district nurse, or social worker who regularly works with your service. A short phone call or email asking for their observations on how you manage risk or promote health can provide invaluable evidence.
• Observation: This is about seeing your service in action. Plan a “walkaround” with the Quality Statement in mind. Observe staff interactions with residents. Are they having conversations about choices and risks? Look at the environment. Does it support independence while being safe? Observe a mealtime or an activity to see how health is promoted.
• Processes: This is your paper trail. Gather the relevant documents. For risk management, this would be care plans, risk assessments (including positive risk-taking), incident reports, and associated policies. Ensure they are person-centred, up-to-date, and show evidence of review.
• Outcomes: How do you know you’re making a difference? This involves looking at the results. Can you show a reduction in falls after implementing a new risk management strategy? Can you demonstrate through care plan reviews that residents have achieved personal health goals? This category connects your actions to their impact.

Step 3: Analyse and Action Plan

Once you’ve gathered your evidence, analyse it critically. A simple RAG (Red, Amber, Green) rating can be effective. Green means you have strong evidence of meeting the statement. Amber indicates some inconsistencies or areas for improvement. Red signifies a significant gap.

For every Amber or Red finding, a clear, time-bound action plan is essential. This plan should detail the specific action needed, who is responsible for leading it, and a deadline for completion. This transforms the audit from a simple assessment into a tool for driving tangible improvements.

Moving from Audit to Improvement

The true value of a targeted audit is realised when it becomes part of a continuous cycle of improvement, not a one-off event. Closing the loop is crucial. The findings and action plans should be shared and discussed with the wider team. This transparency promotes accountability and collective ownership of quality.

Regularly review progress against your action plan in management and team meetings. Celebrate successes when an Amber area turns Green. Use the findings as a basis for training and development. For example, if an audit reveals that staff are risk-averse, this could trigger a training session on positive risk-taking.

By embedding this ‘Plan-Do-Check-Act’ cycle into your governance systems, you move from reactively fixing problems to proactively building a more resilient, high-quality service. Targeted Quality Statement audits become the engine of this process, providing the focus, evidence, and insight needed to navigate the CQC’s new framework and, most importantly, deliver the best possible outcomes for the people you care for.