When registered with the Care Quality Commission (CQC), providers of social care and health services are required to have a registered manager. At the HLTH Group, we specialise in the recruitment of CQC Registered Managers, so we understand the difficulties in managing your team and the potential pitfalls of not notifying the CQC.
But there are often circumstances in which this might not always be possible for a period of time. So what could the consequences be?
What the regulations say
Regulation 7 of the Health and Social Care Act 2014 stipulates that: “People who use services have their needs met because the regulated activity is managed by an appropriate person.”
The guidance goes on to describe who would be considered an “appropriate person” to act as the registered manager, including an individual who has the necessary competence, qualifications, experience and skills to manage the regulated activity, plus other qualities.
Why a service might be without a registered manager
We know that having a skilled and experienced registered manager in place is one of the key factors behind a care service being delivered to a high standard. However, many care organisations experience difficulties in recruiting suitable people to fill managerial positions from time to time.
Managers often leave services at short notice. For example, they can become sick or experience a significant change in personal circumstances which affects their ability to continue in the role.
In 2019/20, there was a vacancy rate of around 12% in management positions in regulated care services in England alone. For a sector with almost 26,000 registered locations, that’s over 3,100 providers operating without a manager.
What action the CQC can take
Back in 2013, the CQC announced a crackdown on services operating without a registered manager. This was on the back of research which revealed that a quarter of such provisions had been without a manager for two years or more.
It is an offence under the Health and Social Care Act to operate a registered service without a registered manager if the provider is required to do so. In the first instance, the CQC will write to providers informing them of the need to appoint a registered manager. Providers who fail to comply with the condition to have a registered manager could get a Fixed Penalty Notice (FPN) from the CQC.
When the CQC might not take action
The Health and Social Care Act is not entirely clear on situations in which it might be acceptable to continue without a registered manager. The Act states that it may not be appropriate to issue an FPN when there is a “reasonable excuse” for not having a registered manager.
This would generally mean that what is considered a valid reason will be at the discretion of the CQC. For example, one of the reasons stated by the regulator is when an application to be registered as a manager is still being processed by them.
The CQC will also state that services must have a registered manager in post within a “reasonable length of time”. Again, this is largely unclear in terms of the time in which the regulator considers it to take to recruit and appoint a suitable manager.
There will likely be an impact on ratings
What we do know though, and perhaps of more concern to providers, is the impact not having a registered manager will have on a service’s inspection rating.
A CQC inspection will, more often than not, consider that a service cannot be rated highly in the absence of a registered manager. This is particularly the case for the “well-led” key domain. A service which is not considered to be “well-led” is highly unlikely to receive a favourable inspection rating by the CQC.
As inspection ratings are published and must be displayed on the provider’s premises, any rating less than “good” can be damaging to reputation and to business. It will also lead to increased inspection scrutiny by the CQC themselves, who will consider the service to be “high risk”, as well as likely action being taken by local authority commissioners.