Navigating the care home landscape

A Healthcare M&A Solicitor’s brief guide on the Care Quality Commission (‘CQC’) to running a care home in the UK.

The desire to open or buy care homes is on the rise. Driven by the passion of assisting others, whilst running a business where individuals (most of the time vulnerable and elderly in nature) are solely reliant on the care and support they receive, is no easy task and comes with many challenges. Before even opening your doors to residents, a clear understanding of the complex regulatory landscape is necessary and crucial to the success and continuation of your company. This article aims to briefly discuss key legal and regulatory considerations of running a care home within the UK and the requirements you must fulfil and continue to satisfy throughout.

Navigating the ever-evolving landscape of the UK care home regulations can feel like you are walking a tightrope, especially when you are also juggling resident needs, staffing challenges as well as budget constraints. Regardless of whether you are new the care home business or a seasoned care home operator, complying with Care Quality Commission standards will form a major part of your day to day running. This guide aims to guide you through the regulatory landscape, ensuring your care home not only thrives but also delivers exceptional care whilst adhering to the highest standards.

Registration with the Care Quality Commission (“CQC”): Who are they?

The CQC is an independent regulator of health and adult social care in England, ensuring that the services provided to people are safe, effective, compassionate and of high-quality. They have the ability to monitor, inspect and regulate the services provided and regularly publish their findings on their website. They also have powers to take action against care home providers who provide poor care services, facilities and/or are unsafe assisting in regulating the industry across the board. The CQC can also provide a wealth of information and guidance for providers which might be helpful within your specific sector, including but not limited to further information on the regulations, how to register, what incidents you must notify them of and what they look out for when carrying out inspections.

Registration not only applies to all care homes, but a range of healthcare providers such as hospitals, dentists and mental health services, regardless of size or type. If you provide or intend to provide, health or adult social care services within England, it is a legal requirement under the Health and Social Care Act 2008 to register with CQC. Operating a care home without the CQC registration is illegal.

The registration process, whilst meticulous, is essential for legal compliance and demonstrating your commitment to quality care within the healthcare industry.

If you are in Wales however, you would be required to register with the Care Inspectorate Wales (“CIW”) and not the CQC. For more information on how to register to provide a care service in Wales with CIW, please visit their website at https://www.careinspectorate.wales/register-provide-service.

CQC: Who can apply and how to register?

Most individuals or entities who provide health or social care services can apply for registration, including sole traders, partnerships and organisations and whoever is responsible for operating the home (i.e., the care provider) will hold the registration in their name. As a condition to their application, some providers will require a registered member. In all cases, an individual must be designated as the registered manager, who is responsible for the day-to-day responsibility of these services which is fundamental in providing positive outcomes for the people using the service as well as ensuring the care home will continue to uphold regulations. Appointed managers must also satisfy the CQC of their fitness and suitability in meeting various requirements of running the care home, for the application to be successful.

In order to register, an application must be completed (online) in full and submitted to the CQC including but not limited to the following, providing details:

  • of the applicant;
  • of the ‘regulated activities’ (see below for further information) you are applying for; and
  • the places at which or from which, those activities will be provided (the CQC call these “locations”).

Regulated Activities

There are 14 activities which fall within the scope of regulated activities as set out with Schedule 1 of the Health and Social Care Act 2008 (the “Act”).

The Act describes a regulated activity as “an activity involving, or connected with, the provision of health or social care”.

If you carry on any of the 14 activities listed (and in most cases you may be required to register for multiple activities) in Schedule 1, you must register, unless an exception or exemption applies.

Each regulated activity requires a separate registration.

Website: https://www.cqc.org.uk/guidance-regulation/providers/scope-registration-regulated-activities

CQC: How long it will take to apply?

According to the CQC website, completing the registration application could take as much as 7 to 8 hours, although preparation for submitting the same may take several weeks. A bulk of the preparation may consist of:

  • obtaining your CQC-countersigned Disclosure and Barring Service (“DBS”) number, forming part of the application. If this is not countersigned by CQC, this will invalidate the application. The recommendation is to request for this as soon as possible as in some cases, receiving this can take up to 8 weeks;
  • your Statement of Purpose – this is where you describe what you do, where you do it and who you do it for. This should also include details about your business, aims and objectives, locations and information on your registered managers;
  • supporting documents requested by CQC – this is dependent on which type of service you are registering to provide (i.e., adult social care residential services, supported living, GP or independent consulting doctor etc.); and
  • ensuring the premises is ready.

Helpful links

For more information, please visit their website at www.cqc.co.uk.

Depending on the type of activities you are intending to provide, you may also be required to obtain licences for that activity, for example, for the possession and/or supply of stock medicines with the Home Office Controlled Drugs Licensing System.  

Maintaining compliance with the CQC – What can you do?

Maintaining compliance with the CQC Regulations is crucial to any healthcare provider and there is a wealth of guidance and information available to providers and managers to assist them in meeting the regulations, which can be found on the CQC website.

Two regulations that apply to all registered persons (providers and managers) registered with the CQC that carry on regulated activities:

  • Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (Part 3)
  • Care Quality Commission (Registration) Regulations 2009 (Part 4)

Under section 23 of the Health and Social Care Act 2008, the CQC are required to produce guidance which assists providers in complying with the regulations formed under this Act. The CQC will continue to refer to the guidance in deciding whether a provider or manager has met or meets the requirements of the regulations.

It is therefore the responsibility of providers and managers to reach and consider the guidance in respect of the regulated activities they specifically provide (see above ‘Regulated Activities’ box for more information), as this will assist you in understanding what is required to meet the regulations. The CQC are clear in their role which involves providing the guidance but does not extend to telling providers or managers what they must do to deliver those services. How the regulations are met is down to the provider and manager in following the guidance provided. The CQC have confirmed if the guidance is not followed, they will ask providers and managers to provide evidence of their approach to satisfy they are following the regulations.

It is important to note that the guidance (link below) includes specific information relating to the different types of activities and services provided and recognised quality standards. The CQC also expect providers and managers to take into account other nationally recognised guidance specific to the services they provide, such as the Department of Health, NHS England and National Institute for Health and Care Excellence for instance. Failure to meet the requirements of the regulations, may result in prosecution being brought by the CQC. The types of offences and enforcement action are not covered by this article.

CQC Guidance: https://www.cqc.org.uk/guidance-providers/regulations-enforcement/regulations-service-providers-managers-relevant-guidance

Legal and financial assistance – how can we help?

It is always worth considering seeking legal and financial assistance when starting your journey of setting up your care home, especially if your experience in those business matters is limited. A solicitor who specialises in business acquisitions (and even better, one who specialises in care home businesses) can guide you through the process, contracts and legal aspects of the transaction. A financial advisor on the other hand, can assist with financial planning and funding aspects. If this is something you are considering and also require assistance with making an application to the CQC, our specialist corporate care home team will be able to provide you with the advice you require about the legal aspects of starting up a care home business. Please contact us to speak to a member of our Corporate Team.

Emma Docking
Solicitor, Corporate
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This reflects the law and market position at the date of publication and is written as a general guide. It does not contain definitive legal advice, which should be sought in relation to a specific matter.

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