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KLOE Key Lines of Enquiry CQC - The Complete Guide

May 4, 2022
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As a home care agency, we know that the safety of your clients is a priority. The CQC agrees, and one of its five Key Lines of Enquiry (KLOEs) focuses on how your service keeps people safe. This article will discuss what the CQC Safe KLOE means for your home care agency and the common barriers to achieving a good or outstanding rating.

What are the key elements of the CQC safe KLOE?

To provide the relevant CQC KLOE evidence of how you meet requirements, you need to understand exactly what the CQC means by ‘safe’.

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The CQC says:

“By safe, we mean people are protected from abuse* and avoidable harm.”

*Abuse can be physical, sexual, mental or psychological, financial, neglect, institutional or discriminatory abuse.

So, what does this mean for your home care agency?

Every part of your service must actively protect people from abuse and harm. That means managing risks, investigating concerns and learning from mistakes. You’ll also need to show how you prevent and control infection, and ensure the safe use of medications.

The CQC Safe KLOE is broken down into six areas. Let’s take a closer look:

The CQC asks:

“How do systems, processes and practices safeguard people from abuse?”

What does this mean for you?

This part of the CQC Safe KLOE focuses on your safeguarding systems and processes and how they are communicated to staff. You need to demonstrate to the CQC that you protect the privacy and dignity of your clients and keep clients and staff safe from abuse, neglect, harassment, or discrimination. 

The CQC inspectors might ask your staff about what they understand by ‘keeping people safe’ and how they would raise a safeguarding concern. Make sure all employees are up to date with safeguarding training beforehand.

The CQC asks:

“How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?”

What does this mean for you?

Every aspect of the work that happens within a home care agency should be risk assessed in order to keep clients, employees, and other parties safe. You’ll be expected to provide CQC KLOE evidence to support your risk assessment policies. Think about the tools you use, how you record and update assessments, and how you communicate them to the relevant people. Risk assessments must also cover the use of equipment and the living environment - even in premises that you’re not responsible for.

The CQC also identifies a robust whistleblowing process as a key part of running a safe home care agency.  You should be welcoming whistleblowing and thoroughly investigate every concern raised.

The CQC asks:

“How does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?”

What does this mean for you?

As the manager of a home care agency, you’ll be responsible for staffing and rotas. Adequate staffing is vital for minimising the risk of harm to both clients and staff. You’ll need to demonstrate that you have a healthy mix of skill, experience, and competencies among employees, that staffing levels reflect the level of work required, and that employees are trained in safety processes and practices.

You should also have documentation for all employees that includes:

  • Photo ID
  • Right to work in the UK DBS check
  • Two written references*
  • Full employment history
  • Qualifications
  • Physical and mental health conditions
  • CV’s applications interview scores
  • Risk assessments (environment and health and safety)

The CQC asks:

“How does the provider ensure the proper and safe use of medicines?”

What does this mean for you?

As a home care agency, your carers might be required to administer medicines to clients or supervise clients who self-administer medicines. Medication administration is an area that carries a significant risk of harm if not done correctly. The CQC Safe KLOE expects thorough training and regular reviews to ensure that medicines are handled and administered safely, in line with prescriptions and guidance from healthcare personnel.

In their report ‘Medicines in Health and Adult Social Care’ the CQC highlighted some key areas that should be adhered to when it comes to medicine safety. These included:

  • Ensuring any information about changes to medicines is transferred soon enough and accurately.
  • Reporting incidents and near misses, and sharing the learning from them, to reduce the risk of a similar event happening again.
  • Working collaboratively with community pharmacies, who can act as partners to improve medicines safety. 
  • Having a systematic process to both receive and discharge people from their services, so that their medicines are managed safely and effectively. Referring to summary care records could support this, with input from pharmacy professionals. 
  • Creating and maintaining policies that are central to everyday practice, easy for staff to understand and readily accessible.These need to be reviewed regularly to make sure they align with best practice guidance, including NICE guidance for medicines reconciliation, patient-centred care plans and accurate recording. 

 You can read the full Medicines in Health and Adult Social Care Report, here

Implementing eMAR (electronic medication records) can really help reduce medication risk and ensure you’re in line with the CQC Safe KLOE. Birdie’s eMAR was recently cited in a CQC report, where one of our partners improved their rating in responsiveness from Good to Outstanding. 

“Medication Administration Records (MAR) contained the required information, to ensure medicines were administered safely. The service used electronic MAR charts, which staff accessed via a mobile device. The system automatically detected any medicines which had not been administered during each time period and alerted the office, so this could be addressed in real time.” Read the full CQC report.

Read more about Birdie's eMAR, here.

The CQC asks:

“How well are people protected by the prevention and control of infection?”

What does this mean for you?

Infection control and cleanliness can be a challenge when you are providing care for clients in their own homes and have little control over their immediate environment.

However, you must be able to demonstrate that you take measures to manage infection control risk as much as possible, including supporting clients with tidying and cleaning. Infection control policies must be available and followed at all times. Carers are often required to prepare food for the client during visits, so all staff must be trained and compliant with food hygiene regulations.

Read more about the CQC expectations around infection control, here.

The CQC asks:

“Are lessons learned and improvements made when things go wrong?”

What does this mean for you?

This is a key point that arises in many of the KLOEs - how your service handles incidents or complaints. The CQC wants to see that you have thought about every stage of the process: that people understand how to raise and record concerns and feel comfortable doing so, that you review and analyse incidents so you can learn from them, and that you take action as a result. You also need to have arrangements for responding to external safety alerts, inquiries, or investigations.

Barriers to achieving a good or outstanding rating in the CQC safe KLOE

  • Safeguarding is not prioritised as it should be, or the service places unnecessary restrictions on people in the name of safeguarding.

  • Safeguarding policies and procedures are not always put into practice.

  • People are fearful of reporting incidents or concerns, and there is a culture of blame.

  • All staff members are not up to date with safeguarding training.

  • Inadequate staffing levels make carers feel rushed and unable to deliver the best care.

  • The service lacks clear procedures around administering medicines to clients with reduced capacity.

  • The service doesn’t react quickly enough to safety concerns.

At Birdie, we understand that the safety of clients and staff is of paramount importance for home care agencies. The CQC Safe KLOE framework sets out the requirements for you to achieve a good or outstanding rating and can help you prepare for your inspection. 

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Birdie’s tools are closely aligned with the CQC inspection frameworks and can help you audit for your CQC Safe KLOE. We have worked hard to create a system where your whole team can record CQC KLOE evidence in one place.

Find out more about Birdie.

Have you got an upcoming CQC Inspection? Check out our resources:

Learn more about the other KLOEs: Well-Led, Effective, Responsive and Caring.

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If you've got a CQC inspection coming up, why not check out our guide to getting prepared, here.

Want to find out more about CQC inspections? Check out our blog roundup of a talk held by Deanna Westwood, Head of CQC Inspections, held earlier this year. She talks about CQC's 2021 digital strategy and how they're evolving the ESF framework in the wake of COVID-19. Or if you're looking to capture evidence that proves your business is outstanding, get some top tips here, or find out how to improve your rating, here

You might also be interested in our on-demand webinar which focuses on improving your CQC score with care management software like Birdie and our free downloadable, printable tip sheet to help improve your CQC rating. Just click here to download yours now.

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