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Challenging evidence obtained by the CQC

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There are a number of routes available for providers to challenge evidence obtained by the Care Quality Commission (CQC) and the way they apply their ratings process. It is important for providers to be aware of the options available and the prompt action they need to take if they wish to challenge evidence obtained by the CQC.

Factual accuracy check

The first step to challenging the findings of an inspection is through the factual accuracy process. Before an inspection report is published by the CQC, providers are provided with a copy of the draft report which will include their ratings. Providers are then invited to provide feedback on the factual accuracy of the report which includes challenging the accuracy and completeness of the evidence on which the ratings are based. Any factual accuracy comments that are accepted by the CQC may result in a change to one or more ratings. When a provider receives a draft report, they have ten working days to review the report and submit any factual accuracy comments to the CQC. Providers should be submitting detailed reasons to support their argument against CQC’s judgements and factual inaccuracies given that this is their only opportunity to challenge the factual content of the report.

Warning notice representations

If the CQC serve a warning notice, the provider has the opportunity to make representations about the matters in the notice before the inspection report is published. The content of the notice will be based upon evidence obtained by the CQC during their inspection(s) and it will confirm the breach(es) noted in the inspection report. Representations that are upheld and that also have an impact on ratings may result in relevant ratings being amended.

Request for a rating review

After an inspection report has been published, providers can ask for a review of the ratings. However, the only grounds for requesting a review are that the inspector did not follow the process for making ratings decisions and aggregating them. This can be difficult for a provider to establish given that the CQC will not have disclosed the underlying inspection paperwork relating to the production of the report. A review cannot be requested solely on the basis that you disagree with the judgements made by CQC. These disagreements must be dealt with before the report was published through the factual accuracy checks and any representations about a warning notice if one was served. Given the limitations of the rating review process, it is fundamental that providers challenge aspects of the inspection process that they are not happy with during and immediately after the actual inspection.

How to request a review of the rating

If you do not believe that the CQC have followed the published process properly and want to request a review of one or more of their ratings, you must notify the CQC of your intention to do so within five working days of the report being published. There will be instructions on how to submit an intention in the CQC’s covering letter which you will receive with your final inspection report. After you submit your intention via the CQC’s online webform, you will receive instructions on how to request a review. The full request for review must be submitted using the online webform within 15 working days of the report being published. Providers only have one opportunity to request a review of their inspection ratings. In the request for review form, you must say which rating(s) you want to be reviewed and all of the relevant grounds for review. If the CQC do not uphold a request for review, you cannot submit a subsequent review of the ratings from the same inspection report.

The review process

Once a request for review has been submitted, the CQC will firstly assess whether the request for a review falls within the permitted grounds as set out in the provider handbook. Your request for review will be dealt with by the CQC rating review team who will not have been involved in the original inspection and will have access to an independent reviewer. Once the CQC have reached their final decision they will send you the outcome of the review. Where a rating is changed the report and ratings will be updated on CQC’s website as soon as possible. It is important to note that following the conclusion of the review, ratings can go down as well as up. This is the final CQC process for challenging a rating. The narrow scope of the rating review process highlights the increasing importance for Providers to challenge the content of inspection reports at the factual accuracy stage.

With the limited opportunities and tight deadlines involved in challenging the CQC’s evidence, it is essential that you seek professional assistance as soon as possible. This will significantly increase your chances of obtaining the most favourable outcome. Our team have experience of successfully challenging evidence obtained by the CQC and obtaining upgraded ratings for providers.

If you do require assistance in dealing with issues you may have with the CQC including responses to notices, factual inaccuracies and ratings reviews, our dedicated team are at hand to assist you.

By regulatory defence graduate paralegal, Brea Carney-Jones