CQC Overview: Who Are They, What They Do, and Their Powers

The Care Quality Commission (CQC) is the independent regulator of health and social care services in England. Their role is critical in ensuring that people receive safe, effective, compassionate, and high-quality care. Whether you operate a care home, domiciliary care service, GP practice, or NHS trust, CQC compliance is non-negotiable.

Understanding CQC readiness, mock inspections, and enforcement actions is essential for providers who want to maintain compliance, improve their ratings, and avoid regulatory breaches. This blog will provide an in-depth overview of the CQC, their responsibilities, enforcement powers, and how care providers can prepare for inspections to ensure they meet the required standards under the Single Assessment Framework.

Who Is the CQC?

The Care Quality Commission was established in 2009 under the Health and Social Care Act 2008. It regulates health and social care services in England, including care homes, hospitals, dental practices, and GP surgeries. The CQC ensures that these services provide care that is safe, effective, and meets the required standards.

The Single Assessment Framework

The CQC has transitioned to a Single Assessment Framework (SAF), which streamlines its approach to regulation and inspection. This framework focuses on:

• Quality Statements – Replacing Key Lines of Enquiry (KLOEs) with topic-based statements aligned with regulations.
• Evidence Categories – Using structured sources of evidence to assess compliance and performance.
• Scoring System – Providing greater transparency on how services are rated and improving consistency in assessments.

CQC Scoring System

Under the Single Assessment Framework, the CQC uses a scoring system to determine service ratings. The system evaluates evidence from inspections, statutory notifications, and provider information submissions. The key elements include:

• 0 Points – No evidence of meeting the required standard.
• 1 Point – Limited assurance that the standard is being met.
• 2 Points – The service is meeting the standard but with areas needing improvement.
• 3 Points – Good assurance that the standard is met.
• 4 Points – Excellent assurance and strong evidence of high-quality service.

Each quality statement is scored, and the overall rating is calculated based on these individual scores. Ratings are assigned as:

• Outstanding (Score: 80% or more)
• Good (Score: 60-79%)
• Requires Improvement (Score: 40-59%)
• Inadequate (Score: Below 40%)

Fundamental Standards of Care

The CQC ensures that providers meet Fundamental Standards of Care, which include:

• Person-Centered Care – Services must be tailored to meet individual needs and preferences.
• Dignity and Respect – People must be treated with dignity and respect at all times.
• Consent – Care and treatment should only be provided with valid consent.
• Safety – Services must be delivered in a safe way, minimizing risks of harm.
• Safeguarding from Abuse – People should be protected from any form of abuse or neglect.
• Food and Drink – People must receive appropriate nutrition and hydration.
• Premises and Equipment – The environment must be clean, safe, and well-maintained.
• Complaints Handling – A robust system should be in place for handling complaints.
• Good Governance – Services must have effective governance and auditing procedures.
• Staffing – There must be sufficient, well-trained staff to meet people’s needs.
• Duty of Candour – Providers must be open and honest about mistakes and incidents.
• Fit and Proper Staff – Staff should be competent and properly vetted.

What Does the CQC Do?

The CQC’s primary role is to monitor, inspect, and regulate services to ensure compliance with fundamental standards. Their key functions include:

1. Registration of Providers

All health and social care providers must register with the CQC to operate legally. During the registration process, providers must demonstrate that they meet the necessary requirements and agree to abide by the fundamental standards of care.

2. Inspections and Ratings

The CQC conducts regular inspections to assess the quality of care provided. These inspections result in ratings that range from:

• Outstanding
• Good
• Requires Improvement
• Inadequate

3. Enforcement Actions

If a provider fails to meet the necessary standards, the CQC has the power to take enforcement actions, including issuing warning notices, fines, or even shutting down a service.

4. Factual Accuracy Responses

After an inspection, providers receive a draft report and can submit a factual accuracy response to challenge inaccuracies or provide additional context. This process ensures that the final report accurately reflects the provider’s performance.

5. Notices of Proposal (NOP) and Notices of Decision (NOD)

• Notice of Proposal (NOP): If the CQC intends to take enforcement action, they issue an NOP detailing the proposed steps and giving the provider a chance to respond.
• Notice of Decision (NOD): If the CQC decides to proceed with enforcement after considering the provider’s response, they issue an NOD. Providers can appeal the decision.

6. First-Tier Tribunal Appeals

If a provider disagrees with an NOD, they can appeal to the First-Tier Tribunal (Health, Education, and Social Care Chamber). This independent body reviews CQC decisions and can overturn or amend them if necessary.

Statutory Notifications

CQC requires providers to submit Statutory Notifications for certain events that may impact care quality. These include:

• Serious Injuries – Any incident resulting in severe harm.
• Allegations of Abuse – Safeguarding concerns affecting people using the service.
• Deaths of Service Users – Any death occurring while receiving regulated care.
• Outbreaks of Infectious Diseases – Such as COVID-19 or norovirus.
• Significant Events Affecting the Service – Such as major equipment failures or staffing crises.

Failure to submit these notifications can result in enforcement action and impact a provider’s CQC rating.

Conclusion

CQC compliance is essential for all health and social care providers. Understanding the Single Assessment Framework, Fundamental Standards of Care, the CQC Scoring System, statutory notifications, and enforcement processes helps providers remain compliant and deliver high-quality care. Regular mock inspections and a culture of continuous improvement are key to maintaining compliance and ensuring service users receive the best care possible.

For support with CQC readiness, mock inspections, and compliance audits, get in touch with our expert consultancy team today.