Assessing quality and performance

To support the transparency and consistency of our judgements, we have introduced a scoring framework into our assessments.

Where appropriate, we’ll continue to describe the quality of care using our 4 ratings: outstanding, good, requires improvement, or inadequate.

When we assess evidence, we assign a score for each quality statement that we’re assessing. Ratings will be based on building up scores from quality statements to an overall rating.

Some types of services are exempt from CQC's legal duty to provide a rating. Read our guidance for non-rated services.

Scoring

Using scoring as part of our assessments will help us be clearer and more consistent about how we’ve reached a judgement on the quality of care in a service. The score will indicate a more detailed position within the rating scale. This will help us to see if quality or performance is moving up or down within a rating.

For example, for a rating of good, the score will tell us if this is either:

• in the upper threshold, nearing outstanding
• in the lower threshold, nearer to requires improvement.

Similarly, for a rating of requires improvement, the score would tell us if it was either:

• in the upper threshold, nearing good
• in the lower threshold, nearer to inadequate.

Our quality statements clearly describe the standards of care that people should expect.

How we assess and score quality statements

To assess a specific quality statement, we will consider the evidence we have in each relevant evidence category. This will vary depending on the type of service or organisation. For example, the evidence we will collect for GP practices will be different to what we’ll have available to us in an assessment of a home care service. 

Evidence could be information that we either:

• already have, for example from statutory notifications
• actively look for, for example from an on-site inspection

We give a score for each quality statement that we’ve assessed. The score will be on a scale of 1 to 4. 

1   =   Evidence shows significant shortfalls
2   =   Evidence shows some shortfalls
3   =   Evidence shows a good standard
4   =   Evidence shows an exceptional standard

Inspectors will use professional judgement to assign the score, based on the evidence categories they have looked at for each quality statement.

As we have moved away from assessing at a single point in time, we aim to assess different areas of the framework on an ongoing basis. This means we can update scores for different quality statements at different times.

How we calculate key question scores

We then use the quality statement score to give us an updated view of quality at key question level.

Again, we calculate a percentage score. We divide the total by the maximum possible score. This is the number of quality statements under the key question multiplied by the highest score for each statement, which is 4. This gives a percentage score for the key question.

At key question level, we translate this percentage into a rating rather than a score, using these thresholds:

25 to 38% = inadequate
39 to 62% = requires improvement
63 to 87% = good
88% and above = outstanding

By using the following rules, we can make sure any areas of poor quality are not hidden:

• If the key question score is within the good range, but one or more of the quality statement scores is 1, the rating is limited to requires improvement.
• If the key question score is within the outstanding range, but one or more of the quality statement scores is 1 or 2, the rating is limited to good.

Our judgements go through quality assurance processes.

For services that have not previously been inspected or rated, we will need to assess all quality statements in a key question before we publish the rating. For newly registered services, we’ll usually assess all quality statements within 12 months.

How we aggregate ratings using the rating principles

Overall location ratings are produced on the basis of the following principles:

1. The 5 key questions are all equally important and are weighted equally when aggregating.
2. At least 2 of the 5 key questions would normally need to be rated as outstanding and 3 key questions rated as good before an aggregated rating of outstanding can be awarded.
3. There are a number of ratings combinations that will lead to a rating of good. The overall rating will normally be good if there are no key question ratings of inadequate and no more than one key question rating of requires improvement.
4. If 2 or more of the key questions are rated as requires improvement, then the overall rating will normally be requires improvement.
5. If 2 or more of the key questions are rated as inadequate, then the overall rating will normally be inadequate.