End of life care is perhaps one of the most challenging aspects of providing care, both emotionally as well as practically, with strict regulations and guidelines to follow. Demonstrating to the CQC that you are fully compliant with these regulations and deliver truly person-centered end of life care can be challenging. So let’s take a look at what the CQC wants to see, how you can comply with their regulations and guidance, and importantly, how to evidence this.

Inspecting end of life care

During your CQC inspection, you will be assessed on your core end of life services, including:

• specialist end of life care or palliative care services
• community-based teams caring for people approaching end of life
• bereavement services

The inspector will look at relevant reports and client records, as well as observing your team in action both on your premises and during home visits. They will also conduct interviews with service users, family members of service users and your staff, as well as looking at how you enforce quality control.

It can be time-consuming to make sure you’re ticking all the right boxes when you are busy dealing with the day to day of providing care. A mock CQC inspection from Care Skilled is a great way to help you get a comprehensive overview of how you are performing in preparation for your real CQC inspection. Our expert team of inspectors can help you identify any areas of concern and get a plan of action in place before it impacts your CQC rating.

Let’s take a closer look at some of the requirements for end of life care.

The 5 priorities of end of life care

The Leadership Alliance for the Care of Dying People sets 5 priorities for person-centric end of life care in England and Wales. These requirements should be at the heart of your care services and the CQC will be checking that you’ve taken action to deliver on these as part of their ‘Effective’ key line of enquiry (KLOE).

 The 5 priorities are as follows: 

1. When a service user may die within days or hours, it must be communicated to them clearly and a care plan set out in line with their needs and wishes. These should be reviewed regularly and revised as required.
2. Staff should communicate sensitively with the service user and with those important to them.
3. The service user and those important to them must be involved in decisions about their treatment and care.
4. People important to the service user must be listened to and have their needs respected.
5. Care must be tailored to the individual and delivered with compassion, including help with eating and drinking for as long as the service user wishes. Their comfort and dignity must be prioritised at all times. 

In Northern Ireland, the 5 priorities are based on the 2010 Living Matters Dying Matters report. Similarly, NHS Scotland has set out guidelines called Caring For People In The Last Days And Hours Of Life.

The CQC will also expect you to act in accordance with NICE guidelines for end of life care, paying particular attention to NICE QS13 (end of life care for adults) and NICE CG140 (opioids in palliative care) in your care plans. To work towards an Outstanding rating, any extra accreditations such as using the Gold Standards Framework and following Department of Health guidance will help.

At Care Skilled, we offer comprehensive audits on end of life care, alongside our mock CQC inspection services, which will help you stay up to date on the latest compliance requirements and demonstrate your commitment to client wellbeing.

Optimise care management

Putting internal policies and a clear end of life care strategy in place will help demonstrate that your care home is well-led – one of the CQC’s 5 KLOE. There should be a hierarchy of responsibility and accountability within your team, and a dedicated end of life care lead.

You will need to perform regular audits and reviews to ensure care is being delivered in line with your policies and to collect feedback from staff, service users and their families of service users. Our mock CQC inspection services provide valuable impartial insights into how well you’re meeting these requirements.

To simplify coordinating care, an electronic palliative care coordination system can help in managing care plans, your team and any external providers you work with. It will also help keep your essential records up to date and secure so you can present them as evidence that you’re meeting the CQC’s KLOE.

Supporting staff and service users

Acting with compassion, kindness, dignity and respect are the cornerstones of caregiving and will inform your overall ‘Caring’ rating. Make sure staff are fully trained in giving end of life care, including health and safety for everyone who comes into contact with the deceased person’s body in line with the ‘Safe’ KLOE. You should also ensure that staff who work alone giving end of life care at the service user’s home are fully supported and protected.

The key to supporting service users is to ensure their needs and wishes are respected, and that their care plan is regularly reviewed and updated. Pain and symptoms should be managed and DNACPR protocols followed in line with national guidance. Food and drink should be provided for as long as the person wishes, alongside help with feeding if necessary.

Make sure service users and their families are aware of out of hours services, including support following the death of a loved one and bereavement services, and that you’re monitoring service user outcomes, such as whether service users die in their preferred place of care.

You should also be monitoring waiting times, did not attend rates and service complaints. When you have a complaint, the CQC will want to see that lessons were learned and if any changes were actioned.

It’s also very important that your services are accessible to everyone. The KLOE around responsiveness includes equality requirements, such as having access to translators and being able to tailor services for vulnerable individuals such as those with dementia (see the Mental Capacity Act 2005).

A helping hand

Achieving an Outstanding rating for end of life care means being able to deliver consistently high-quality care and carrying out regular audits to ensure you’re compliant with all relevant legislation.

With over 20 years of experience providing residential and domiciliary care, we understand the challenges you’re facing and are uniquely positioned to help identify opportunities for improvement before your CQC inspection. Book a mock CQC inspection with Care Skilled and we’ll produce a full report and recommended plan of action to help you achieve and maintain an outstanding level of service for your end of life care.

Call our expert team on 0333 444 5344 or email info@careskilled.co.uk for more information.