The framework, in one paragraph #
CQC's published assessment framework is made up of five key questions, safe, effective, caring, responsive and well-led, with a set of quality statements under each. Quality statements are written as commitments, and for each one CQC says which evidence categories it will focus on. The evidence itself is sorted into six categories.
That is the whole structure, and it matters for your admin because it tells you what a request will look like when it arrives: not "send us everything about medicines", but a specific kind of evidence against a specific statement.
If your evidence folder is still indexed by the older key lines of enquiry, it will not line up with the way evidence is now asked for. That is an indexing problem rather than a quality problem, but it is the sort of indexing problem that turns a fifteen minute request into an afternoon.
The six categories, and what each one costs to keep up #
| Evidence category | Where a small service usually gets it | What that costs monthly |
|---|---|---|
| People's experience of health and care services | Surveys, reviews, complaints, compliments, what people say on a visit | Collecting it, then reading it into something that can be shown |
| Feedback from staff and leaders | Supervisions, appraisals, team meetings, surveys, exit conversations | Chasing the ones that are due, and recording that they happened |
| Feedback from partners | Commissioners, district nurses, GPs, safeguarding teams, families | Remembering to ask, and keeping a record of the answer |
| Observation | Spot checks, competency checks, observed practice on a run | Scheduling them, and the write up afterwards |
| Processes | Policies, care plans, risk assessments, recruitment files, audits | The monthly audit cycle, and version control on every document |
| Outcomes | What actually changed for people, incidents, falls, hospital admissions | Pulling it out of notes and incident records into a readable form |
The number of categories CQC needs to consider, and the number of sources it collects, vary with the type of service and the level of the assessment. A small domiciliary agency is not being asked for the same spread as a local authority.
Which of this runs on rules, and which does not #
Look at the third column. Almost all of it is triggered by a date passing or by something being absent, which is the textbook shape of rule based work.
Runs on rules
- A supervision that was due last month and has not been recorded
- A spot check that has not happened for a named carer since a given date
- An audit in the monthly cycle that has not been completed
- A care plan review whose date has passed
- A policy whose review date has passed, still showing as current
- A visit with no note attached, which is a hole in the evidence before it is anything else
None of those require anyone to think. They require somebody to notice.
Needs a person
- Reading feedback and deciding what it means
- Judging whether an observed visit was good practice
- Deciding what to do about a pattern in incidents
- Writing the bit of an audit that says what you are going to change
Every one of those is judgement, and judgement is the thing CQC is actually assessing.
A service that automated its way out of thinking about its own evidence would deserve exactly what it got.
Two things that sit alongside this #
Regulation 17 requires providers to have effective governance including assurance and auditing systems, and to securely maintain accurate, complete and detailed records for each person using the service.
Separately, registered providers must notify CQC about certain changes, events and incidents, including deaths, serious injuries, allegations of abuse, police involvement and the absence of a registered individual for 28 days or more. Knowing that a notifiable event has occurred is judgement. Knowing that a notification was started and never finished is bookkeeping.
What providers actually say about the burden #
The Homecare Association published a report on CQC's regulation of homecare in England on 30 August 2024. Its headline finding was about coverage rather than paperwork.
60%
Of homecare providers unrated or holding severely outdated ratings
Homecare Association, 30 August 2024
23%
Unrated
Homecare Association, 30 August 2024
37%
Severely outdated ratings
Homecare Association, 30 August 2024
The free text answers providers gave alongside it are the part worth reading if you run a service. One answer was three words long.
Sheer duplication of work.
Another said the amount of complicated forms needed simply to move office was the problem. A third said that keeping up with what CQC is telling providers is highly burdensome and time consuming.
That is a trade body reporting its own members, so it is an interested party, and we would say the same about any supplier survey. But duplication is a specific, checkable complaint rather than a general grumble, and duplication is the exact thing that a rule can catch.
The line that does not move #
Everything above is about the paperwork around care. Care records and anything else about a person's health are special category data under UK GDPR, your service remains the controller for them, and processing that is likely to result in a high risk needs a data protection impact assessment before it starts. Check that with the ICO rather than with a consultancy.
If you want to size the noticing problem before you talk to anybody, the free tools count repeated jobs and the hours they take, using your own numbers rather than ours.