Preparing for CQC assessment: Safeguarding adults - resource for directors of adult social services

The Health and Care Act 2022 put the Care Quality Commission's (CQC) assurance of local authorities on a statutory footing. The new duty on the CQC to assess local authorities’ delivery of their adult social care (ASC) duties under Part 1 of the Care Act 2014 came into effect on 1 April 2023. The CQC has introduced a regime for assessing local authority adult social care services. This is based on the overarching framework, which was updated in July 2023.

Linked to this new duty is a power for the Secretary of State to intervene where, following assessment under the new duty, it is considered that a local authority is failing to meet their duties.

Within the CQC framework for assessment, the third of the four themes is about safety and safeguarding.

This resource aims to bring together existing tools that have been developed for audit, review and assurance to support sector led improvement in safeguarding adults. These can assist councils in preparing for CQC assurance and can be used following assessment to support subsequent improvement activity. Additionally, it includes tools that have been developed which include sections covering theme three, alongside the other themes.

The CQC regime is based on statutory requirements in the Care and Support Statutory Guidance regarding safeguarding adults, and local authorities are the lead agency for safeguarding adults. In preparing for assessment, the director of adult social services (DASS) requires evidence of compliance with statutory requirements.

These tools assist in providing evidence of:

• effective safeguarding processes
• operational delivery
• strategic safeguarding leadership.

For this resource, we have worked with the Association of Directors of Adult Social Services (ADASS) Safeguarding Adults Policy Network, the National Networks of Safeguarding Adults Boards Chairs and Managers, and the Principal Social Worker (PSW) network, NHSE Safeguarding Adults National Network (SANN) to collate resources for audit, review and assurance regarding safeguarding adults’ responsibilities. This resource was first published in 2022 and has been updated in 2024; and it includes and collates tools that have been developed locally, regionally and nationally.

The London Voices Network of People with Lived Experience shared views on what was important to them, as did Think Local Act Personal (TLAP), for the first version of this resource. This resource should be seen as evolving; it is not comprehensive, having been reliant on partners to submit relevant tools and new tools continue to be developed as the assessment regime roles out. The inclusion of resources does not imply particular endorsement and it is hoped further work and tools will be available and reviewed in future.

The first part of theme three of the CQC assessment framework includes two elements: the first is ‘Safe systems, pathways and transitions’ and the second is ‘safeguarding.’

The resources are clustered into four sections:

• the first area focuses on safeguarding practice, pathways, activity and outcomes
• The second area focuses on leadership and the effectiveness of Safeguarding Adult Boards, including how peer challenges can identify areas for development of safeguarding functions
• The third section focuses on the voices of people with lived experience – at both operational and strategic levels, as this is a cross cutting priority for the CQC assurance process
• The fourth section signposts to generic resources that have been developed to support preparation for inspection that include sections on theme three and safeguarding responsibilities alongside the other themes.

These resources mainly focus on ‘safeguarding’ operationally and strategically. They may also provide support for evidencing ‘safe systems’ in theme three as well as ‘leadership’ in the fourth theme of the CQC assessment framework, as the local authority has a unique leadership role for local safeguarding arrangements through the Safeguarding Adults Board.

CQC reference best practice and guidance for safeguarding adults in their framework; these are core documents and include:

• Care and support statutory guidance, Chapter 14: Care Act: GOV.UK
• Revisiting safeguarding practice: GOV.UK
• Safeguarding Adults Reviews under the Care Act, implementation support: SCIE
• Making safeguarding personal: ADASS
• Mental Capacity Act 2005 code of practice: GOV.UK
• NHS Digital Safeguarding Adults Collection - see detailed metrics
• Survey of Adult Carers (SACE), Adult Social Care Survey (ASCS) - see detailed metrics

This resource aims to build on this list and provide examples relevant to different areas of safeguarding adults’ duties and responsibilities.

Practice

Understanding and describing the effectiveness of safeguarding practice is central to evidencing the delivery of Care Act 2014 duties regarding safeguarding adults by local authorities.

Revisiting safeguarding practice by the Chief Social Worker for England provides guidelines on practice and states that:

It is important that senior leaders use this document as part of a process to assure themselves of the quality and responsiveness of their adult safeguarding work.”

Safeguarding practice should be strengths-based, as evidenced by the Making Safeguarding Personal approach.

Guidelines on Strengths-based approach: Practice Framework and Practice Handbook emphasise that:

Strong leadership that supports and enables the change to occur, by behaving in a way aligned with the strengths-based practice themselves, is the best way to cultivate and reinforce a culture that is relationship based and strengths- based. Strong leadership will take actions that promote the importance of strengths-based ethos.”

The Adult Principal Social Worker (PSW) Network and resources are hosted by Research in Practice (RIP) which assures social work and professional practice developments, following priorities agreed with the Chief Social Worker for England (Adults). The DASS should consult with their PSW on the current tools that are available and accessible through PSW networks to support analysis and improvement in safeguarding adults’ practice.

Making Safeguarding Personal (MSP) is a well-established strengths-based approach to safeguarding, which was embedded in the care and support statutory guidance. Understanding how to assure MSP is embedded, with effective quality assurance and oversight is key for the DASS to be satisfied staff are carrying out procedures properly and consistently to meet the needs of individuals and fulfil Care Act duties. There is a range of resources, including toolkits and case studies to support developing MSP in practice, developed by ADASS, Local Government Association (LGA) and partners on the LGA website.

Case file audit is key to ongoing learning and improvement in safeguarding practice. Some examples of case file audit tools and guidance/methodologies are offered. These have been shared by local authorities/Safeguarding Adults Boards to support others in developing audit methodologies.

The Social Care Institute of Excellence (SCIE) provides analysis, information and advice tools on strategic as well as on professional practice both for single agency and multi-agency audits.

North West ADASS region has developed a social work quality assurance tool along with an explanatory presentation, and benchmarking tool. The benchmarking tool draws on the BASW ethical framework social Wwrk and the TLAP ‘Making It real’ statements. The rationale for designing this tool was to be able to benchmark whether social work practitioners were delivering ‘Fit for purpose’ and ‘Right first time’ high quality social work services. The purpose is to support organisations with defining what “good social work” looks like, how it can be measured, and how it can be improved. The tool has been designed to be used in conjunction with and to support organisations using local social work quality assurance and practice improvement frameworks. 

Safeguarding pathways

The local authority has responsibility for responding to all concerns and undertaking or authorising enquiries under section 42, which constitutes the key safeguarding pathway. Identifying actual or potential abuse and deciding which pathway to take to address risks, whether a safeguarding enquiry or other helps to determine what action is to be taken and by whom.

The framework developed on behalf of ADASS and LGA offers support in making decisions about whether or not a reported safeguarding adults concern requires a statutory enquiry under the Section 42 (ii) duty of the Care Act 2014. Resources are available to support consistent interpretation of the statutory guidance on concerns and enquiries.

Making decisions on the duty to carry out safeguarding adults enquiries

The LGA has produced a framework to help support in making decisions about whether or not a reported safeguarding adults concern becomes a Section 42 (ii) enquiry. The ratio of concerns that become Section 42(ii) enquiries is often referred to as the ‘conversion rate’.  This can provide insight into patterns of local safeguarding activity. The Revisiting safeguarding practice by the Chief Social Worker for England (Adults) says that local authorities “should also check themselves against other like local authorities in the application of Section 42 and conversion of concerns to enquiries to ensure consistent application of the Care Act across England. This will require PSWs and DASSs across regions to work closely to develop parity of application." However, these are not performance indicators and should not be interpreted as such. Local tools have been developed to guide decision making, such as Portsmouth Safeguarding Adults Board’s ‘Quality of referrals and decision making.’

Safeguarding activity and outcomes

A starting point for a DASS is to know what the profile of safeguarding activity and practice is in their area. Understanding from both quantitative and qualitative data what happens with safeguarding concerns and conversion to statutory safeguarding enquiries. The NHS Digital Safeguarding Annual Collection (SAC) provides information for comparison on a range of safeguarding activity on an annual basis. This includes the voluntary return on Making Safeguarding Personal, which is key to evidencing that people are involved and determining the outcomes of safeguarding activity that supports them to keep themselves safe.

The SAB Manager Network has developed a toolkit which enables and supports the development of data sets and assurance tools including assurance frameworks and stories of difference as examples. This intelligence can inform emerging themes and priorities for Safeguarding Adults Boards and local authorities. See National Data Toolkit Framework

The Making Safeguarding Personal Outcomes framework report (May 2018) underlines the importance of including qualitative information in developing an understanding of the difference that safeguarding support makes for people. It offers support for developing audit questions and methodologies, including multi agency safeguarding case file audit and quality standards guidance on safeguarding audit provided by the LGA/ADASS. Case file audit can also be used to establish whether safeguarding outcomes have been met for people with lived experience.

The local authority has a statutory leadership role in the Safeguarding Adults Board (SAB). There are many local and regional tools that have been developed to look at how partner agencies provide assurance to the board that they are meeting their responsibilities for safeguarding adults, coming together to ‘check and challenge’, and reviewing the actual arrangements for working as a partnership.

Safeguarding audit tools for SABs

A range of approaches have been developed for SABs to review their effectiveness and performance at regional and local levels.

Several multi-agency assurance tools can be found on the National Network for Chairs of Adult Safeguarding Boards website and are typically used for informing SAB priorities, at challenge events for partners etc. For example:

The West Midlands Regional consortium developed a single online audit tool and platform for Care Act and Children Act Section 11: West Midlands Care Act Compliance Audit for Safeguarding Adult Boards

The London SAB developed a Safeguarding Partnership Audit Tool, which has been updated several times to ensuring that the questions and challenges are current. SAB partners respond and the information is presented back to the SAB (often in a development session), which helps inform priorities for strategic planning and improvement. For the current version email [email protected] Co-Chair, London SAB Manager’s Network

Bromley produced a survey with CQC-framed questions on BSAB Effectiveness survey which was sent to partners via MS Forms. Their other methodologies are also included on Bromley Safeguarding Adults Board strategy.

Somerset SAB'S Effectiveness Survey is being developed for regional usage in 2024.  

Safeguarding peer reviews

Peer reviews and peer challenges of safeguarding adult services in local authorities, can be conducted at a national level (through the LGA) or regionally (through regional ADASS) or individually (locally commissioned). The outputs of these reviews and challenges include areas that are working well as well as areas for consideration or development. Tools have been developed and tested to support peer review and peer challenge in safeguarding adults; sections of these are helpful in shaping the focus of a local review or challenge according to local priorities and needs. These include:

• Standards for Safeguarding Adults, November 2017
• Adult Social Care Peer Challenge: key areas of focus - additional probes, February 2015
• Adult safeguarding standards for Safeguarding Adults Boards

See also section 5 covering peer challenge developed to support preparation for CQC assurance.

Making Safeguarding Personal – leadership and SABs

There is a wealth of information provided on MSP on the LGA website, covering key areas a DASS need to be assured of; as well as covering themes used by CQC and commissioners regarding 'safe, caring responsive and effective safeguarding arrangements'. Ensuring all partners are Making Safeguarding Personal continues to be a SAB responsibility. Resources focused on sector specific approaches are available.

A commissioner or provider table and information on ‘what good looks like’ is provided in the resources to support Making Safeguarding Personal. Local tools have been developed for providers to report quality issues, for example North Yorkshire’s Risk Notification Return.

Safeguarding Adults Reviews (SARs) and assurance of learning

The first national review of SARs 2017-19 provides briefings and key learning and all SABs were asked to audit themselves against the findings and recommendations.

A second analysis covering SARs between April 2019 and March 2023 is due to be published on this website shortly and has briefings and recommendations for SABs and others.

Many SABS have found effective use of seven minute briefings to pass on key messages to staff groups, with feedback to the SAB.

The National Network of SAB Chairs now hosts the SAR library on its National Network for Chairs of Adult Safeguarding Boards website.

People with lived experience

As part of developing this resource, representatives of the London Safeguarding Voices group were asked about their experiences. The overwhelming view was to stress how important it was for people with lived experience to be involved right at the start of developing any work, for co-production to be meaningful and not as an afterthought. 

Resources to support Making Safeguarding Personal: Early work to help SABs on how to engage and involve people was done in the Making Safeguarding Personal programme and the resource provides examples of how to achieve engagement, what to consider as no one size fits all. Examples include co-production, surveys using multi-media approaches and citizen- based approaches, working with the local Healthwatch.

Think Local Act Personal

The key organisation providing materials emphasising this is Think Local Act Personal. (TLAP). It provides general resources, not safeguarding specific (see below) and they apply to safeguarding adults work.

• Think Local Act Personal: Making it real
• The ladder of co-production
• What is co-production?
• The three Rs of social care reform 

Citizen-led approach

Some SABs follow a citizen-led approach, tapping into wider local authority involvement approaches and linking with local Healthwatch. See Leeds SAB ‘Citizen-led guidance’ including ‘Top tips for practitioners’ and short films on their YouTube channel.

Other SABs have brought together resources for community engagement, see London Borough of Sutton’s resources library.

Preparing for assurance tools

These resources have been developed to assist local authorities to prepare for CQC inspection. They cover all the four themes of the CQC assurance framework, so include sections on safeguarding adults in the context of addressing the third of the four themes.

Partners in Care and Health

CQC's new assurance framework

Adult social care assurance: A guide to the development of your adult social care assessment is designed to support councils as they prepare for CQC assessment. It is comprised of two parts. The first part provides an introduction and overview of self-assessment. While the second part is a workbook providing tools and templates which have been developed to support the self-assessment process.

There are additional resources available, including:

• presentations from our November 2023 webinar: Role of the principal social worker
• our toolkit to support councils to prepare for CQC assessment as it relates to unpaid carers
• presentations from our October 2023 webinar: Adult social care assurance: learning from the CQC pilots and the elected member perspective
• a range of resources, events, and support for portfolio holders or lead members for adult social care to help them with their roles.
• top tips for CQC assurance preparation.

Preparation for assurance peer challenges by LGA

The LGA offers Adult Social Care Peer Challenges to support councils to deliver the best services for their residents. This is primarily done through Preparation for Assurance Peer Challenges, which supports councils to deliver the best services for their residents and in turn prepare for Care Quality Commission (CQC) Assurance assessments. However, the offer is flexible to meet the individual needs of each council.

The cost of a peer challenge is £20,000.