Regulatory bodies across the United Kingdom are tasked with inspecting and regulating care services. In England this is the Care Quality Commission, Wales this is the Care Inspectorate Wales, In Scotland this is the Care Inspectorate and in Ireland this is the Regulation and Quality Improvement Authority. They all have the same goal which is ensuring high standards of care and ensuring the wellbeing of people being supported.

Despite their role within the care sector, there is a heightened anxiety amongst Registered Managers and care teams when the inspector comes knocking. I reached out to some Registered Managers in two social care forums to ask about the emotions they felt at their last inspection and responses included anxiety, stress, fear, and pressure. 100% of respondents stated that they have heightened emotions when they know an inspector is coming.

Work needs to be done to build the relationship between the inspectorates and the care providers as they should work in collaboration and there shouldn’t be a fear factor involved, but that is a subject for another day.

In this week’s blog, I am going to focus on how we can manage our emotions, however I want to reassure you that heightened emotions are normal, and you are not alone. Inspections have the ability to highlight the positive impact you are having as a leader but also the ability to shine a spotlight on where you are falling short. If, however we can manage our emotions, we have the ability to create a smoother inspection process and reduce the impact on our mental wellbeing.

Let’s look at the emotions that came out of the forums, and how we can manage these:

Anxiety was the most common word used by most Registered Managers who completed the poll but many did not know why. It got me thinking about why our workforce should be subjected to this feeling, the longer term impact this has on someone and what we can do to prevent this going forward.

Many providers told me that when they know an inspector is due in advance, their levels of stress heightened because they needed to ensure they had everything in place in preparation. Many told me that this feeling left them feeling physically and emotionally drained.

We have a workforce who are worried about the outcome, pre inspection and post inspection. It is natural that we often jump to worst case scenario but this is not good for our mental health. Some of the worries including poor inspection results, what their managers will think about them and their suitability to the role but also what happens if they get a poor outcome and the impact this will have on their role, the relationships with local authorities and families and the wider impact on recruitment and retention.

Not only as Registered Managers having to manage their own emotions, but they are also having to manage the feelings within their staff team who are also, often anxious about having to speak to an inspector.

Post inspection, I heard how managers spend time reflecting and during this many said they often think of things they should have mentioned and forgot which manifests into a culture of self-blame

So how can we manage these emotions?

Understanding the source is key, and luckily for many of us working on the frontline, we know the cause is the inspector and the impact a negative inspection can have so we have a good base to create the foundations and build on this to ensure we are managing our emotions.

We know the common emotions (anxiety, stress, fear, and pressure), and the first step we need to take is to talk to your line manager or someone you trust about how you are feeling.

Remember this feeling is normal and you are not alone.

Here are some practical tips:

• If have been given notice of a pending inspection that write everything down that you are worried about, so that you can then address one by one. Even if you are not due an inspection, but know that your emotions are heightened, this could be an exercise you can do now.
• Ensure you have the inspectorate as part of your team meetings, so you can talk to your team about the role they play, reassure them that inspections are routine and there is nothing to worry about. Encourage open and honest communication so you are address these. Through up-skilling our team, we can reduce the worries they have.
• Look into training sessions and workshops for yourself or your team so that you/them feel empowered
• InvictIQ’s audIT on Cloud has a planning and governance module that can support pre-inspection planning.
• Familiarise yourself with the inspectorate’s standards and any guidelines.
• Check your documentation is in order and fool proof so anyone picking them up can make sense of them. It may be that you have multiple systems in place, and if this is the case, make sure you link one to another where possible. One of the benefits of having all your audits and evidence in one place is that it removes this cross references, and audIT on Cloud does just that, as well as removing paper and excel documents.
• Conduct internal audits, so you can highlight shortcomings and address these.
• Manage self-care routines such as taking regular breaks, engage in stress relieving activities, seek support from your line manager.
• Seek support from an external consultant to audit your service. A fresh pair of eyes can help spot things you may have overlooked. Organisations such as Fulcrum Care and Care Improvement Associates who have teams that do this for a living but there are also independent consultants such as Paula Cashmore and Karen Ritson who can bring hands on experience and expertise to the table.
• Adopt your opinion of inspections being negative into positive and see them as an opportunity for growth and improvement and not a threat.
• Use a mock inspection toolkit to stimulate the experience of a CQC inspector. This not only makes you prepared but will also help your team become familiar with the process and can help reduce anxieties.
• Check your inspectorate’s website for any events they are hosting.
• Check what events are being hosted by your local care associations and services like The Caring View who host regular events and podcasts to up-skill and support knowledge and skills.
• Devise a protocol for what happens when an inspection happens and communicate this with your team so everyone knows the process.
• Network with other registered managers in your local area and nationwide. Facebook has some great groups for this.
• Prepare mentally with things such as breathing and relaxation techniques and cognitive reframing.
• Do your homework – look at recent inspection reports from other providers, what did they do really well that you can implement, and what did they not do well that you can double check you have in place. Often things like medication plans, recruitment processes, mental capacity assessments and risk assessments are the downfall.

The biggest bit of advice though that I can give is that a single inspection does not define the quality of care you are your team are providing. It is a snapshot of that particular time and a chance to learn and improve. Heightened emotions are natural and you cannot determine the outcome of an inspection, but you can control the learning that comes from it.