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Care Quality Commission [CQC]

Overview

1. The Care Quality Commission (CQC) is the regulatory body in England that oversees health and social care services.1‘Care Quality Commission’   

2. It was established in 2009 by the Health and Social Care Act 2008.2Health and Social Care Act 2008, Part 1, s1 

3. Providers of adult health and social care services must register with the CQC if they engage in regulated activities, or risk facing legal action and fines. 

Regulations

4. The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (2014 Regulations) specify the activities that are regulated under Part 1 of the 2008 Act. They also set out the requirements that apply to the way in which those activities are carried on. 

5. The 2014 Regulations are currently due to expire after 31 March 20253The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 No 2936 reg 1(6) (as amended by SI 2022 No 179

Regulated activities

6. Regulated activities relevant to the provision of supported housing are:

  1. the provision of “personal care”:4The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 No 2936 Sch 1 para 1
  2. the provision of residential  accommodation together with nursing or “personal care” eg adult care homes and nursing homes;5The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 No 2936 Sch 1 para 2 
  3. the provision of residential accommodation for someone together with treatment for drug or alcohol misuse, where acceptance by that person of such treatment is a condition of the provision of the accommodation.6The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 No 2936 Sch 1 para 3 

Implications for supported housing

7. Many supported living and extra care housing services require the provider to be registered for the regulated activity of providing ‘personal care’.

8. In some cases, supported living and extra care housing services may need to be registered for the regulated activity “Accommodation for persons requiring nursing or personal care.”

9. But providers of supported housing are not required to register with the CQC where the support offered does not fall within the definition of  “personal care”.  There is no definition of “support” in legislation. Some support activity takes the form of intensive or enhanced housing management whilst other forms of support are unrelated to “personal care” as defined in the legislation. 

10. While support is not a regulated activity, if it has been commissioned by a local authority, there may be some oversight of the service by the authority under the commissioning contract. 

 

 

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Care home

Description

1. A care home is a place where personal care and accommodation are provided together.1NHS Business Definitions – Care Home

2. People may live in a care home for short or long periods. For many people, it is their sole place of residence and so it becomes their home, although they do not legally own or rent it.

Types

3. There are two types of care home:

  1. Care home without nursing (residential care home);
  2. Care home with nursing (nursing home).

Care homes for HB purposes

4. For HB purposes a “care home” is separately defined as:2The Housing Benefit Regulations 2006/213 reg 2(1) def: “care home“; The Housing Benefit (Persons who have attained the qualifying age for state pension credit) Regulations 2006/214 reg 2(1) def: “care home“; Universal Credit Regulations 2013/376, sch 1, para 1 def: “care home“

  1. a “care home” in England;3Care Standards Act 2000 s 3 
  2. a “care home service” in Wales, which is provided wholly or mainly to persons aged 18 or over;4Regulation and Inspection of Social Care (Wales) Act 2016 part 1 and
  3. a “care home service” in Scotland.5Public Services Reform (Scotland) Act 2010 sch 12 para 2

In England 

5. In England an establishment is a “care home” if it provides accommodation, together with nursing or personal care, for any of the following persons (unless excluded by relevant law):6Care Standards Act 2000 s 3(1)-(2) 

  1. persons who are or have been ill;
  2. persons who have or have had a mental disorder;
  3. persons who are disabled or infirm; or
  4. persons who are or have been dependent on alcohol or drugs.

6. Accommodation is not a care home unless the care which it provides includes required assistance with bodily functions.7Care Standards Act 2000 s 121(9), 3(1)-(2)

In Wales

7. In Wales a “care home service” is the provision of accommodation, together with nursing or care at a place in Wales to persons because of their vulnerability or need.8Regulation and Inspection of Social Care (Wales) Act 2016 s 2(1)(a), (2); sch 1 para 1(1)

In Scotland

8. In Scotland a “care home service” is a service which provides accommodation, together with nursing, personal care or personal support, for persons by reason of their vulnerability or need; but the expression does not include:9Public Services Reform (Scotland) Act 2010 sch 12 para 2

  1. a hospital;
  2. a public, independent or grant-aided school; or
  3. a service excepted from this definition by regulations.

Regulation of care homes

9. Care homes, as defined in the relevant legislation, are regulated by:

  1. the Care Quality Commission (in England);
  2. the Care Inspectorate Wales; and
  3. the Care Inspectorate Scotland.

Care homes and benefit entitlement

Housing Benefit

10. People who are liable to make payments in respect of a care home are not normally eligible for HB. This applies to individuals of working age or pension age.10The Housing Benefit Regulations 2006/213 reg 9(1)(k); 9(4)(a); The Housing Benefit (Persons who have attained the qualifying age for state pension credit) Regulations 2006/214 reg 9(1)(k); 9(4)(a)

11. In the first instance the distinction between a “care home” and “exempt accommodation” for HB purposes may be difficult to determine for individuals with high care needs. 

12. For a benefit decision-maker it is normally whether or not the accommodation is registered that determines the matter.

Universal Credit

13. For UC claimants payments in respect of a care home are excluded from being rent payments for UC calculation purposes.11Universal Credit Regulations 2013/376, sch 1, para 3(d)

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Exempt accommodation [SA1]

1. Residents in “exempt accommodation” are protected from the various schemes of rent restriction that have been introduced into the HB scheme since 2nd January 1996. 

2. This does not mean that the Council will meet unreasonable amounts or unreasonable increases in the rent of such accommodation. It must, however, consider the various tests and safeguards found in the updated version of the pre-January 1996 rules.1A – The restriction on unreasonable payments for working-age claimants is now found in Housing Benefit Regulations 2006/213 , reg 13 as inserted by Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217, sch 3, para 5(2)
B – The restriction on unreasonable payments for non-working-age claimants is now found in Housing Benefit (Persons who have attained the qualifying age for state pension credit) Regulations 2006/214 reg 13 as inserted by Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217, sch 3, para 5(2)
C – The restrictions on rent increases for working-age claimants is now found in Housing Benefit Regulations 2006/213 , reg 13ZA as inserted by Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217, sch 3, para 5(3)
D – The restriction on unreasonable payments for non-working-age claimants is now found in Housing Benefit (Persons who have attained the qualifying age for state pension credit) Regulations 2006/214 reg 13ZA as inserted by Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217, sch 3, para 5(3)

Definition

3. This section describes the conditions that must be met for a dwelling to be designated “exempt accommodation”.

The landlord

4. The landlord must have a particular legal status. Exempt accommodation means accommodation which is “provided by”:3Universal Credit Regulations 2013/376 sch 1 para 1 def: exempt accommodation,  Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217 sch 3 para 4(10) def: exempt accommodation para b

  1. a housing association;
  2. a registered charity;
  3. voluntary organisation; or 
  4. a non-metropolitan county council in England. 

Provision of care, support or supervision

5. The identified landlord or a person acting on its behalf must also provide the resident with care, support or supervision.2Universal Credit Regulations 2013/376 sch 1 para 1 def: exempt accommodation,  Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217 sch 3 para 4(10) def: exempt accommodation para b 

Resettlement places

6. The term exempt accommodation also includes accommodation (a resettlement place) that was in receipt of a Resettlement Grant. 4Housing Benefit and Council Tax Benefit (Consequential Provisions) Regulations 2006/217 sch 3 para 4(10) def: “exempt accommodation” para a (These were formerly nationally run resettlement units that provided temporary accommodation for homeless people that were transferred to local providers).

Purpose of the “exempt accommodation” definition

Exclusion from UC help with housing costs

7. For working age claimants “exempt accommodation” is also a category of specified accommodation. Consequently, working age UC claimants living in exempt accommodation are not entitled to UC help with their housing costs.5Welfare Reform Act 2012, s 11, Universal Credit Regulations 2013/376, sch 1 paras 2, 3(h), 3A Help with their housing costs is provided by the HB scheme and may be paid direct to the landlord on request.

Exemption from the main HB rent restriction rules

8. The “exempt accommodation” definition provides HB claimants with exemption from the main HB rent restriction schemes that have been introduced from January 1996 ie.: 

  1. the local reference rent rules; and 
  2. the local housing allowance rules. 

HB excluded from the benefit cap calculation

9. A limit is set on the total amount of welfare benefits many working-age claimants can receive. This limit is known as the benefit cap. 

10. Working age claimants in receipt of HB living in exempt accommodation do not have their weekly HB award included in the calculation of the benefit cap. They potentially get a higher amount of total benefit income.6Welfare Reform Act 2012, s96, 96A, 97; Housing Benefit Regulations 2006/213, 75A, 75C(2)(a), 75H(2)

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