Types of inspection: adult social care services

Comprehensive inspections

Comprehensive inspections take an in-depth and holistic view across the whole service. Inspectors look at all five key questions to consider if the service is safe, effective, caring, responsive and well-led. We give a rating of outstanding, good, requires improvement or inadequate for each key question, as well as an overall rating for the service.

We will carry out comprehensive inspections:

• where we believe there is a risk to the safety or wellbeing of people who use the service, or there has been a significant deterioration in the quality of that service
• where we believe there is a substantial improvement in quality that could increase the overall rating.

Comprehensive inspections are usually unannounced, although there are circumstances where we may let the provider know we are coming. For example, we may contact a small residential service within 48 hours of the start of our inspection to check that people are at home, or give up to a week’s notice to very complicated community services where careful planning is needed.

Focused inspections

Focused inspections are more targeted than comprehensive inspections: they are a response to specific information we have received or to follow up findings from a previous inspection. We do not look at all five key questions. However, we can expand a focused inspection into a comprehensive inspection, which does look at all five key questions, if the scope needs to be broadened in the light of new concerns.

Focused inspections:

• are structured according to the reason why they need to be conducted, including the risks or concerns raised, the timing, evidence and engagement required, and the resources they will involve, including Experts by Experience and Specialist Advisors
• always look at the well-led key question, plus any other key question that is relevant to the information that triggers it
• are smaller in scale than a comprehensive inspection
• broadly follow the same process as a comprehensive inspection
• can change an overall rating at any time, using key question ratings from the focused inspection as well as the remaining key question ratings from the last comprehensive inspection
• are normally unannounced
• may expand to a comprehensive inspection in response to findings.

Targeted inspections

• have a narrower focus than focused inspections
• are intended to assess a particular risk or concern, for example whether a Warning Notice has been met or to look at tangible concerns about specific risks to people's safety.
• do not look at an entire key question, just the KLOEs within the key question we are concerned about. Inspectors don't need to look at the well-led key question unless the concerns are under that question.
• are usually unannounced and can take place before a focused or comprehensive inspection
• will not lead to a change of ratings or the timing of the next scheduled comprehensive inspection. If we find further concerns or significant improvement during a targeted inspection, it can be expanded into a focused inspection.

Combined inspections

Some providers deliver services across both health and social care sectors, for example, mental health, community health, and care homes. These services are inspected in different ways. Where possible, we align our inspection process to minimise unnecessary burden on providers. Each service is inspected by specialist inspectors.

We report on and rate each type of service in a comparable way. We do this by using our different inspection approaches in combination. We call this a ‘combined inspection’. Overall ratings are aggregated from the ratings for all of the services that are inspected.