What Happens When a Service User or Their Support Network Raises a Concern With CQC?

When a service user, family member, friend or advocate is worried about the care someone is receiving, they may decide to contact the Care Quality Commission (CQC). For care providers, receiving notification that concerns have been raised with the regulator can understandably feel serious. However, a concern being reported to CQC does not automatically mean that a provider has breached regulations, nor does every concern result in an inspection or enforcement action.

Understanding what happens next is important for both people receiving care and the organisations providing it.

Does CQC investigate individual complaints?

CQC’s role is different from that of a complaints service or ombudsman. Although people can tell CQC about poor care, the regulator generally does not investigate or resolve individual complaints on a person’s behalf. Instead, information provided by service users, relatives, advocates, staff and members of the public can be used as intelligence about the quality and safety of a regulated service. CQC considers this information alongside other evidence it holds about the provider.

This distinction is important. Someone contacting CQC about their experience does not necessarily begin a formal regulatory investigation into the provider. The information becomes part of the wider picture CQC uses when deciding whether there may be a risk to people using the service and whether regulatory action is required.

Where somebody wants their individual complaint resolved, they would normally be expected to use the provider’s complaints procedure first. Depending on the circumstances and how the care is funded, there may subsequently be routes to an appropriate ombudsman or other body if the complaint remains unresolved.

What does CQC do with the information?

What happens next depends heavily on the nature and seriousness of the concern. CQC can review the information alongside other intelligence it holds about the service, including previous inspection findings, information supplied by the provider, safeguarding concerns, feedback from other people and information received from partner organisations.

A single concern may provide important information, but several reports identifying similar issues can potentially indicate a wider pattern. For example, repeated concerns involving missed visits, medication errors, inadequate staffing, poor moving and handling practices or failures to respond to safeguarding issues may suggest a systemic problem rather than an isolated incident.

CQC will consider whether the information indicates that people may be experiencing, or be at risk of experiencing, unsafe or poor-quality care. The regulator can then determine what response is proportionate to the level of risk identified.

Will CQC contact the care provider?

It may. Depending on the circumstances, CQC can contact a provider seeking information or assurance about an issue that has been brought to its attention. The provider may be asked to explain what happened, what action it has taken and how it is ensuring people remain safe.

This is where good governance becomes particularly important. Providers should be able to demonstrate that concerns and complaints are recorded properly, investigated objectively and followed by appropriate action. Relevant care records, incident reports, staff statements, audits, risk assessments and evidence of communication with the person or their representative may all help establish what happened and how the organisation responded.

A strong response should not simply attempt to prove that the complainant is wrong. Even where a provider disputes aspects of an allegation, it should consider whether the complaint identifies an opportunity to improve the service.

Can a complaint trigger an inspection?

Information supplied to CQC can contribute to a decision to inspect or otherwise assess a service, particularly where the regulator believes there may be a significant risk to people. That does not mean every complaint will trigger an inspection. CQC’s response will depend on the information it receives, the seriousness of the allegations, the evidence available and what else is known about the service.

Where concerns suggest an immediate risk of harm, the regulatory response can be considerably more urgent. CQC also works with other organisations, including local authorities and safeguarding teams, where concerns fall within their responsibilities.

If CQC subsequently identifies breaches of regulations, it has a range of regulatory and enforcement powers available. The action taken will depend on the circumstances and seriousness of the findings.

Complaints can reveal more than the original incident

For providers, one of the most important lessons is that the regulatory significance of a complaint may extend beyond the event that prompted it. Imagine, for example, that a relative complains that a care worker failed to administer medication correctly. The immediate issue is the medication incident, but reviewing it properly may raise wider questions. Was the member of staff appropriately trained? Had their competency been assessed? Were the medication records accurate? Had similar errors happened previously? Were those incidents identified through audits? If problems had previously been identified, what action had managers taken?

What initially appears to be one complaint can therefore expose weaknesses in governance, training, auditing or oversight.

The reverse is also true. A provider with comprehensive records, effective audits, clear investigation processes and evidence that it learns from incidents is in a much stronger position to demonstrate that an isolated problem does not represent the overall quality of the service.

What should providers do when someone complains?

The strongest approach begins long before CQC becomes involved. Providers should have an accessible complaints process and create a culture in which people feel able to raise concerns without worrying that doing so will affect their care.

Complaints should be acknowledged, investigated and responded to within appropriate timescales. Where something has gone wrong, providers should be open about it, take appropriate action and consider whether their duty of candour obligations apply.

It is equally important to look beyond the individual complaint. Managers should ask whether the issue could affect anyone else receiving the service and whether audits, supervision, training, care plans or risk assessments need to change as a result.

Evidence matters. If improvements are made following a complaint, providers should be able to demonstrate what changed, when it changed, who was responsible and how they subsequently checked that the improvement was effective.

Should providers be worried when someone contacts CQC?

Providers should take any regulatory concern seriously, but contact from CQC should not automatically be interpreted as evidence that enforcement action is coming.

People receiving care and their families have every right to raise concerns about the quality or safety of a service. A well-run provider should expect scrutiny and be capable of demonstrating how it manages complaints, investigates incidents and learns when things go wrong.

Trying to discourage someone from contacting CQC, treating them differently because they have complained or becoming defensive about legitimate concerns can create considerably greater problems.

The better question for a provider is not simply, “How do we defend this complaint?” It is: “Can we demonstrate that we understand what happened, that the person is safe and that we have responded appropriately?”

That distinction is fundamental to good governance.

When concerns indicate immediate danger

Where someone believes a person is in immediate danger or requires urgent medical assistance, contacting CQC should not replace emergency action. Emergency services or the relevant safeguarding authority should be contacted where appropriate.

Concerns involving abuse or neglect may also need to be referred through local safeguarding procedures. CQC can receive information about these issues, but it operates as part of a wider health and social care system and is not a substitute for emergency services, local authority safeguarding teams or the police.

The bigger picture

Complaints are sometimes viewed by providers primarily as a reputational risk. In reality, they are also an important source of information about how a service is performing.

A complaint may ultimately prove to be based on a misunderstanding, may identify an isolated mistake or may expose a much wider problem. What matters from a regulatory perspective is how effectively the provider recognises risk, protects people, investigates concerns and learns from what happened.

For care businesses, that means complaints management should never sit in isolation as an administrative exercise. It is part of safeguarding, quality assurance, governance and continuous improvement – and when CQC receives information about a service, the provider’s ability to demonstrate those systems can become just as important as the original concern itself.

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