Seabrooke Manor Limited, R (on the application of) v The Care Quality Commission

A specialist regulator’s evaluative rating will be unlawful only where it rests on an irrational assessment, material error of fact, or procedural unfairness. The court should exercise particular caution before substituting its own assessment where public safety is engaged.

Best-practice guidance on covert medication may inform a regulator’s assessment without creating a mandatory requirement that all information appear in one document. The relevant question is whether the records and systems provide sufficient, reliable information to administer medicines safely.

Ratings may properly reflect cumulative evidence concerning medication systems, time-sensitive medicines, PRN protocols and governance. Later improvements do not retrospectively alter the position at the inspection date.

Seabrooke Manor Limited operated a care home regulated by the Care Quality Commission. Following an unannounced inspection, the CQC rated the service Requires Improvement for the safe and well-led key questions and gave the service the same overall rating.

The claimant sought judicial review, alleging that the CQC’s covert-medication guidance was irrational and went beyond NICE guidance, that the safe and well-led ratings were irrational and based on material factual errors, and that the overall rating could not stand. The claimant also sought substitution of Good ratings.

The central issues were whether the CQC had acted unlawfully in evaluating the evidence available at the inspection and whether the court could replace the regulator’s expert assessment.

1. Grounds 1–4 dismissed. The CQC’s guidance on covert administration of medicines was non-statutory best-practice guidance. It did not require every relevant detail to be contained in one care plan and was not inconsistent with the NICE guidance. It rationally supported proper, detailed recording of how covert medicines were to be administered.
2. The CQC was entitled to assess the records collectively and to make an evaluative judgment about whether the medication system was sufficiently robust. The evidence included incomplete instructions for covert medicines, absence of adequate review information, incorrect directions, weaknesses in time-sensitive medication systems and inadequately individualised PRN protocols. Those matters rationally supported a Requires Improvement rating for the safe key question.
3. The CQC was also entitled to consider governance evidence under the well-led key question. Repeated audits had failed to identify medication and care-record deficiencies, and the evidence showed discrepancies between policies and practice. The well-led rating was not an automatic consequence of the safe rating but was an independent, evidence-based evaluation. Concerns about communication with relatives were an additional factor.
4. The CQC was entitled to judge the service on the information available at the inspection and through the factual accuracy process. Later amendments and improvements did not retrospectively remove the deficiencies identified. No material error of fact satisfying the requirements in E v Secretary of State for the Home Department was established.
5. The reasons in the inspection report and factual accuracy response were intelligible and adequate. The later witness evidence elucidated, rather than replaced, the reasons already given and did not offend the principles in R v City of Westminster ex p Ermakov or R (Wallpott) v WHSSC. The process, including the factual accuracy check, was procedurally fair.
6. With the safe and well-led ratings upheld, the overall Requires Improvement rating also stood. Even if a rating had been quashed, the court would not have substituted its own Good rating; the appropriate remedy would have been reconsideration by the expert regulator.