July 13, 2017

CQC report on the state of adult social care – what do the findings show?

Social care - CQC report

The headlines from the 'The state of adult social care services report' are:

  • 2% of services are rated Outstanding
  • 77% are rated Good
  • 19% are rated Requires Improvement
  • 2% are rated Inadequate

There is some regional variation in the standard of care, with more Inadequate and Requires Improvement Services in the North West, Yorkshire and the Humber than elsewhere. The East of England tops the overall social care ratings by region with the South West in third place. The South West can however boast 3% of services being rated Outstanding which is only matched by the South East.

Areas of focus for CQC

Commitment to improvement

There is significant focus in the report on the Requires Improvement rating and concerns around services who failed to improve or got worse after re-inspection.

  • 38% of services rated Requires Improvement retained that rating and 5% went down to a rating of Inadequate
  • Of the 1,830 services that were originally rated Good, only 1% improved to Outstanding and 26% had deteriorated after re-inspection
  • However, 81% of services rated Inadequate improved their rating following re-inspections, suggesting that Inadequate services had worked harder to improve than those with a Requires Improvement rating.

Medicines and staffing

Of the five key questions, Safe has the poorest overall rating, with only 0.5% of services achieving Outstanding. Poor ratings in Safe are indicative that the inspectors are still concerned about systems and processes for the management and administration of medicines and determining staffing levels.


This was the best rated key question with 92% good and 3% outstanding.


Of the four types of services included in the report, nursing homes had 3% of services rated overall as Inadequate and only 1% Outstanding. Larger residential and nursing homes (50+ beds) were more likely to be rated Inadequate than medium and small services.  This was attributed to smaller homes being better able to demonstrate responsiveness to people’s needs and being able to deliver person centred care.


24% of services had a Requires Improvement or Inadequate Rating for the Well-Led key question, the second worst overall rating after Safe. Findings in the report demonstrate the benefits of having a committed and consistent registered manager, which filters through to staff and the care being provided to service users.

What can providers learn?

Going forward CQC will be continuing to inspect homes within the Safe, Effective, Caring, Responsive and Well-Led framework. From November 2017 the new Key Lines of Enquiry, amended as a result of the first phase of their consultation, will be adopted and providers should ensure they are familiar with the changes.  Please see our recent blog on these changes here.

We encourage providers to review the characteristics of Good and Outstanding ratings, in order to understand what inspectors will be looking for.

There will  be less tolerance for providers who fail to take heed of advice and concerns highlighted in past inspections with an overall clampdown on complacency. There will be particular focus on services who fail to improve from a Requires Improvement rating.

It is evident that leaders, which includes both owners and managers, will continue to be under the spotlight. It is CQC’s view that the Well-Led question has a direct impact on the other key questions and inspectors are looking to the management team to inspire a positive culture among staff which will in turn drive high standards of care.

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