# Health and social care, Level 5: running a registered service

*Registration, governance, notifications and being personally accountable.*

## Production summary

- Modules to record: 2
- Total script: 944 words, about 6 minutes of finished audio
- Voices: Amara (host) and Nadia (practice educator)
- Level: Level 5, registered and aspiring registered managers

## Accreditation wording that must appear in the description

- **The CPD Certification Service** (planned): Application scheduled.
- **Skills for Care knowledge sets and the Care Certificate standards** (aligned): Mapped by us to published Skills for Care material. This is our own mapping and implies no endorsement or assurance by Skills for Care.

> Do not upgrade any of these words in a description or a thumbnail. Aligned is not accredited, and planned is not approved.


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## What you sign up to, what you must report, and how you know

**Runtime** about 3 minutes. **Words** 495. **Starts at** 00:00 in the full course recording.

### Learning outcomes to state on camera

- Describe the personal accountability that registration carries
- Identify notifiable events and act within the required timescales
- Design governance that gives early warning
- Apply the duty of candour fully and promptly

### Script


`[CUE 1]` *Registration as personal accountability alongside the provider's.*

**AMARA**  [00:00]
Registration. What am I actually taking on that I would not have as a deputy?

**NADIA**  [00:06]
Personal accountability. You are named on the register, assessed as a fit person, and enforcement action can be taken against you as an individual, not only against the company.

**AMARA**  [00:17]
So if a member of staff does something wrong at three in the morning while I am asleep, that is on me?

**NADIA**  [00:26]
Not the act itself. What is on you is whether the systems that should have made it less likely were there and working. Recruitment, induction, supervision, staffing levels, the culture that decides whether somebody feels able to raise a concern.


`[CUE 2]` *Notification categories with the separate safeguarding and police duties shown.*

**AMARA**  [00:42]
And if I genuinely did not know?

**NADIA**  [00:45]
That is the answer that helps you least. Not knowing is itself evidence about the governance you were responsible for building. A manager who knew and acted is in a far stronger position than one who did not know.

**AMARA**  [01:00]
Notifications. Give me the ones people get wrong.

**NADIA**  [01:04]
Two errors dominate. The first is thinking that telling the local authority safeguarding team means the regulator has been told. It does not. They are separate duties and you owe both.


`[CUE 3]` *Governance pack redesigned from reassurance to early warning.*

**AMARA**  [01:16]
And the second?

**NADIA**  [01:17]
Waiting until you know what happened. People want to notify a complete story. The duty is to notify without delay, not to notify once comfortable, and failing to notify is a breach in itself. Providers have been prosecuted for the failure to notify rather than for the incident.

**AMARA**  [01:36]
What if I am not sure it qualifies?

**NADIA**  [01:40]
Notify. An unnecessary notification costs you nothing at all. A missing one is a regulatory failure with your name against it.


`[CUE 4]` *Turnover and agency use as leading indicators ahead of quality decline.*

**AMARA**  [01:48]
Governance. I have a monthly pack that says everything is fine.

**NADIA**  [01:52]
Then it is decoration. Governance exists to tell you the things you would least like to hear, early, while they are still cheap. If your pack has never ruined your morning, it is not working.

**AMARA**  [02:06]
Which numbers matter most?

**NADIA**  [02:08]
Turnover and agency use, above all, watched as trends. A service losing experienced staff has already begun to fall in quality whatever this month's audit says, because the people who knew the residents have gone and nobody has replaced that knowledge.


`[CUE 5]` *Duty of candour sequence: tell, apologise, explain next steps, confirm in writing.*

**AMARA**  [02:24]
Something has gone wrong. The family do not know. The instinct is to wait for the investigation to conclude.

**NADIA**  [02:32]
Understandable, and a breach of regulation 20. The duty of candour requires you to tell them as soon as reasonably practicable, face to face, to apologise, to say what enquiries follow, and to confirm it in writing.

**AMARA**  [02:47]
Is the apology an admission of liability?

**NADIA**  [02:50]
No, and the regulations state that explicitly. It is the most commonly cited reason for delay and it has no legal basis.

**AMARA**  [02:58]
And the cost of waiting?

**NADIA**  [03:00]
A family who later learn you knew for three weeks will not believe another word from you, and they will be right not to. Candour is the rule, and it is also the only version of this that leaves a relationship standing afterwards.

### Sources for the on screen credit

- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulations 17 and 20, legislation.gov.uk
- Care Quality Commission (Registration) Regulations 2009, notifications, legislation.gov.uk
- Regulation 20: duty of candour guidance, Care Quality Commission
- Registered manager guidance, Skills for Care

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## Inspection, business continuity and holding a workforce together

**Runtime** about 3 minutes. **Words** 449. **Starts at** 03:18 in the full course recording.

### Learning outcomes to state on camera

- Prepare for inspection without theatre
- Build a continuity plan that works at three in the morning
- Address turnover at its actual causes
- Understand the money well enough to protect the care

### Script


`[CUE 1]` *Two weeks of tidying against two weeks of fixing, and what an inspector sees.*

**AMARA**  [03:18]
Inspection is coming. What do I do in the fortnight before?

**NADIA**  [03:22]
Less than you think, and none of it tidying. Every service tidies. It is visible, it is recognised instantly, and it burns two weeks you could have spent fixing something.

**AMARA**  [03:34]
Then what is the actual preparation?

**NADIA**  [03:36]
Be able to answer one question honestly. What are the three things about this service that keep you awake, and what have you done about each in the last month?


`[CUE 2]` *The five domains, with well led shown capping the overall rating.*

**AMARA**  [03:48]
That feels like handing over ammunition.

**NADIA**  [03:51]
It is the opposite. A manager who names their weaknesses and can show action is demonstrating the thing being assessed, which is whether the service is well led. A manager who says everything is fine is telling an experienced inspector that they do not know their own service.

**AMARA**  [04:10]
And well led matters more than the rest?

**NADIA**  [04:13]
It is the domain that most often caps the overall rating, because if leadership cannot see problems, nothing else is reliable.


`[CUE 3]` *Continuity plan contents that work at 3am, on paper.*

**AMARA**  [04:22]
Business continuity. We have a plan.

**NADIA**  [04:24]
Has anybody opened it? Most plans describe escalating to a director, which is not a plan, it is a phone call.

**AMARA**  [04:32]
What should be in it?

**NADIA**  [04:34]
The mundane specifics. Which staff can walk in when the roads close. Where the emergency lighting is. How the fridge medicines stay cold in a power cut. Which residents cannot be moved. And every number on paper, because the system holding your numbers is the thing that has failed.


`[CUE 4]` *Turnover causes ranked, first line manager dominant.*

**AMARA**  [04:54]
Turnover next. We cannot recruit.

**NADIA**  [04:56]
You probably can recruit. You cannot retain, and recruiting harder into a service people leave is just a more expensive version of the same problem.

**AMARA**  [05:06]
So why do they go?

**NADIA**  [05:08]
Consistently: no real induction, rotas too late to arrange a life around, feeling unsafe because it is short, no route upwards, and the first line manager. That last one dominates everything else.


`[CUE 5]` *Permanent post cost against a year of agency cover for the same hours.*

**AMARA**  [05:21]
Our exit interviews do not say that.

**NADIA**  [05:24]
Who conducts them? If it is the manager they are leaving, you are getting a polite fiction. Have somebody else do it, and ask what would have made them stay rather than why they are going. You will get a different and far more useful answer.

**AMARA**  [05:42]
Last one. The provider says no to a permanent post and yes to agency.

**NADIA**  [05:48]
Then make the argument in their language. Work out what that post costs filled, and what the same hours cost through an agency across a year. Almost always the agency is more expensive.

**AMARA**  [06:01]
And that changes the conversation.

**NADIA**  [06:03]
It changes it from a manager asking for more staff, which sounds like a cost, into a manager proposing a saving that happens to improve continuity of care. Same request, and the second one gets approved.

### Sources for the on screen credit

- How CQC monitors, inspects and regulates adult social care services, Care Quality Commission
- Business continuity management for care providers, Skills for Care
- The state of the adult social care sector and workforce, Skills for Care
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 17, legislation.gov.uk

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