Executive summary
From 1 April 2019, CQC changed how our website shows the ‘regulatory history’ of locations where health and care services are carried out. For registration applications completed from that date, where there is a change of ownership or address at an existing location (service), the ‘regulatory history’ of that previous location (its last rating and inspection report) will continue to be displayed against the new location. If the previous location was not inspected, no history will be displayed against the new location. We will not apply this retrospectively to applications completed before 1 April 2019.
This has several advantages, including:
- Where the overall responsibility for a location is unchanged (for example, a change of legal entity for business purposes or a location moves address), continuing the history makes it clear that the provider continues to be accountable for the quality of a service.
- Where a location is acquired by a new provider, they are considered to ‘inherit’ the previous location history (rating and report). Although the rating was not awarded to them, they will have full knowledge of the history and are responsible for maintaining and improving the service, including addressing any issues from the last inspection.
This guidance sets out when we will continue the regulatory history of a location, what information will be displayed and how providers can tell us of any issues.
Guidance
1. Why did CQC make this change?
Previously, when a provider made a change to their registration that affected a location (such as a change of legal entity, purchase, acquisition, merger, or certain address changes), the previous history and ratings were not shown against the new location. Where we established a connection between a predecessor (previous) and successor (new) location, we linked them on our website, with text directing the reader to the old and new location profile page.
In 'Our next phase of regulation consultation in 2017', we proposed that a location’s regulatory history remains visible when its ownership changes. We would continue to show the previous inspection report and ratings against the new location website record, and maintain the history within the CQC register. Our consultation response confirmed that we would do this.
Note: Although ‘locations’ are often referred to as ‘services’, the term ‘location’ (as defined in our ‘What is a location?’ guidance) will be used in this document. We will use the terms ‘predecessor’ and ‘successor’ to refer to the previous and new provider and/or location.
2. What are the benefits of CQC doing this?
Continuing a location’s regulatory history will ensure:
Better visibility of this information for the public and people choosing services.
- That ratings for locations previously rated good and outstanding can continue to be displayed. This will enable improved web searches by rating (for example if someone searches for ‘good services near me’).
- That ratings for locations previously rated as requires improvement or inadequate are not lost and will continue to be be displayed when there is a change to the registered provider or a location moves address. This means that providers can be held accountable for making improvements where they are needed.
- That we can be more effective and efficient when scheduling the next inspection after a registration change, enabling us to take a proportionate, risk-based approach based on our last assessment of the location and the type of registration change that took place.
3. When will CQC continue the regulatory history?
Regulatory history (ratings and reports) will only be continued at location/service level, and where at least one of the same regulated activities is being continued.
CQC will always continue the regulatory history when the following registration changes affect locations:
- A location moves premises: a provider varies their registration because they start providing an existing service (regulated activity) from new premises.
- Changes to provider legal entity: a new registration happens as a result of a legal entity currently registered with CQC changing their business structure – for example, from an individual provider or partnership to a limited company.
- Location taken over by new provider: a location is sold to, or taken over by, a new provider. This applies to both NHS and non-NHS, and includes mergers.
We will also continue the previous regulatory history where a provider re-opens a location they had previously removed from their registration.
The regulatory history will be continued regardless of whether a location was operating when the legal entity or address changed, or when it was taken over by a new provider.
Occasionally two or more locations may merge to form a new location. We cannot display multiple histories against a new location, but will normally continue the history of one predecessor location.
Where all the predecessors are rated the same:
- if one of the predecessor registered managers continues to manage the new location, we will normally continue their previous location history
- if no predecessor registered manager is managing the new location, we will normally continue the history of the most recently inspected location.
Should multiple predecessor locations ever have different ratings we will normally continue the history of the lowest rated location. This protects people who use services by helping them be aware of any previous areas of concern.
4. Are there any circumstances when CQC won’t continue the history?
We will not continue a regulatory history when:
- There is no rating or report at location level to continue against the new location. This could be where a predecessor location has not yet been inspected, or for services that are only rated at provider and core service level (for example, NHS Mental Health and Community services).
- The predecessor location provides a number of different services and transfers some services to another provider but remains an active location providing other services; a history cannot be split between multiple locations.
- A location is absorbed into another existing location; in this scenario, one location is being removed and the remaining location’s rating will apply.
5. How will CQC decide whether to continue a history?
We will regularly review registration data to identify new locations meeting the criteria for continuing the history. Where information in a registration application form confirms a relationship with a predecessor location we may automatically continue the history. The certificate cover letter we send all providers will remind them that this may happen. We will not notify providers individually.
If we identify a link between locations that is not shown in an application form, we will investigate further and may decide to continue the location’s history. In this instance, we will always inform the provider in writing that the history has been continued, explaining why.
6. What continued history information will be displayed?
The most recent ratings and report published for a predecessor location will be displayed against the successor location’s profile page on CQC’s website. This will include the following, where relevant:
- overall location rating
- key question ratings
- core service ratings
- population group ratings
- judgements applied to dentist locations (ticks and crosses representing No action, Action required, Enforcement action).
Our website will show that the location has been subject to a change of registration and that the ratings were awarded to the previous provider, where applicable.
7. When will a continued regulatory history be displayed?
CQC will review data on completed registration applications every two weeks. This means that links between predecessor and successor locations will not be displayed at the point a new location first appears on the CQC website, but made retrospectively.
We expect to make the majority of links to continuing regulatory history within 30 days of a registration application being completed. However, where there is a delay between completing predecessor and successor registration applications, it may take longer.
We will carry out regular data reviews to capture any links between locations not yet identified.
8. How should providers tell CQC of any omissions?
If a history has not been displayed within 30 days of a completed registration, providers that think there is a link and that the history should be continued can tell CQC by contacting our National Customer Service Centre (NCSC) (enquiries@cqc.org.uk).
9. How should providers tell CQC of any incorrect links?
Providers that believe we have incorrectly continued a regulatory history at a location or incorrectly applied the criteria should contact our National Customer Service Centre (NCSC) (enquiries@cqc.org.uk).
Providers will need to provide the evidence to substantiate any correction requested. CQC will review the query within 28 days and tell the provider of the outcome and any action taken. If the provider is still dissatisfied with the outcome and considers that CQC has not followed due process, a member of CQC staff who was not involved in the previous review will review and respond to the concern.
Once a decision has been made to add, amend or remove a continued history, we will update the links and the website location page will be refreshed 36 hours later.
10. Does the requirement to display ratings apply?
Regulation 20A (Health and Social Care Act 2008 (Regulated Activities) Regulations 2014) applies to all providers who have received a CQC performance assessment for their regulated activities. It requires them to ensure that their rating is displayed at each location delivering a regulated service and on their website.
When a location undergoes a change of ownership, the successor provider is not legally required to display the rating awarded to the predecessor.
However, providers may choose to do so and we encourage providers to do this in order to better inform people who use their service. If a successor chooses to display the inherited rating, they must clearly show that the rating was awarded to the predecessor. Any false or misleading statements related to a rating may lead to CQC taking action.
Once CQC has made links between predecessor and successor locations to display the continued history on our website, widgets and posters that display and explain the inherited rating will be available for providers to use.