The Care Quality Commission (CQC) inspects all registered care services in England to ensure they meet fundamental standards of quality and safety. For care home managers, an inspection can feel daunting—but with proper preparation, it becomes an opportunity to demonstrate the quality care you deliver every day.
This checklist is based on the CQC's guidance for adult social care providers and covers all five key questions that inspectors assess: Safe, Effective, Caring, Responsive, and Well-led.
Important Note
CQC inspections can be announced or unannounced. While this checklist helps with preparation, the best approach is to maintain these standards continuously rather than preparing only when an inspection is expected.
Domain 1: Safe
The Safe domain assesses whether people are protected from abuse and avoidable harm. According to Regulation 12 of the Health and Social Care Act 2008, care must be provided in a safe way for service users.
Safeguarding
- Safeguarding policy is up to date and accessible to all staff
- All staff have completed safeguarding training (Level 2 minimum for care staff)
- Staff can articulate the signs of abuse and the reporting process
- Local Authority safeguarding contact details are displayed
- Records of safeguarding concerns are complete with actions and outcomes
Risk Assessments
- All residents have current risk assessments (falls, pressure ulcers, nutrition, moving & handling)
- Risk assessments are reviewed at least monthly or after significant changes
- Mitigation measures are clearly documented and being followed
- Environmental risk assessments are current (fire, legionella, COSHH)
Medication Management
- MAR charts are completed accurately with no gaps or unexplained omissions
- Controlled drugs register is accurate with running balances checked
- PRN protocols are in place with clear criteria for administration
- Medication competency assessments are current for all administering staff
- Medication storage is secure and temperature-monitored
- Medication errors are reported, investigated, and learned from
Infection Prevention and Control
- IPC policy reflects current UKHSA guidance
- Hand hygiene facilities are accessible and well-stocked
- PPE is available and used appropriately
- Cleaning schedules are documented and followed
- Outbreak management plan is in place and tested
Incident Management
- All incidents are recorded promptly with full details
- Root cause analysis is completed for serious incidents
- Duty of Candour requirements are met (informing affected persons)
- Statutory notifications to CQC are submitted within required timeframes
- Learning from incidents is shared with staff and embedded in practice
Staffing
- Staffing levels are sufficient to meet residents' needs safely
- Dependency tool is used to determine staffing requirements
- Agency staff receive appropriate induction and supervision
- DBS checks are current for all staff with resident contact
Domain 2: Effective
The Effective domain examines whether care achieves good outcomes and is based on best available evidence. Regulation 9 requires that care is appropriate, meets needs, and reflects preferences.
Assessment and Care Planning
- Pre-admission assessments are comprehensive and identify all needs
- Care plans are person-centred with clear goals and interventions
- Care plans are reviewed monthly or when needs change
- Residents and families are involved in care planning
- Daily care records reflect the care plan and show continuity
Nutrition and Hydration
- MUST screening is completed on admission and monthly thereafter
- Food and fluid charts are maintained where clinically indicated
- Dietary requirements and preferences are documented and followed
- Weight monitoring is regular with action taken for significant changes
- SALT recommendations are documented and followed
Staff Training and Competence
- Training matrix shows all mandatory training is current
- Staff have received training relevant to residents' conditions (e.g., dementia, diabetes)
- Supervision and appraisals are conducted regularly and documented
- New staff complete comprehensive induction programme
- Care Certificate is completed within 12 weeks for new care staff
Multi-Disciplinary Working
- Healthcare professional visits are documented with outcomes
- Referrals to specialists are made promptly when needed
- Hospital discharge information is obtained and acted upon
- GP reviews are scheduled and outcomes documented
Domain 3: Caring
The Caring domain looks at whether staff treat people with compassion, kindness, dignity and respect. This is assessed primarily through observation and conversations rather than documentation.
Dignity and Respect
- Staff knock before entering rooms and wait for response
- Personal care is provided in private with doors closed
- Residents are addressed by their preferred name
- Conversations are not overheard by others (confidentiality)
- Residents' appearance is well-maintained and they are appropriately dressed
Involvement in Care
- Residents are offered meaningful choices throughout the day
- Families are kept informed and involved appropriately
- Advocacy services are offered where needed
- Resident and family feedback is sought and acted upon
Emotional Support
- Staff respond promptly and compassionately to distress
- End of life care plans include emotional and spiritual needs
- Bereavement support is available to families
Domain 4: Responsive
The Responsive domain examines whether services are organised to meet people's individual needs. This includes how complaints are handled and how the service adapts to changing needs.
Person-Centred Care
- Life history and preferences are documented and known by staff
- Daily routines respect individual preferences (wake times, meals)
- Activities programme is varied and based on residents' interests
- One-to-one activities are available for those who prefer them
- Cultural and religious needs are met
Complaints Management
- Complaints procedure is accessible and understood by residents and families
- Complaints are acknowledged within required timescales
- Investigation and response is thorough and documented
- Learning from complaints is embedded in practice
- Information about LGSCO is provided if complaint unresolved
End of Life Care
- Advance care planning discussions are offered and documented
- DNACPR decisions are properly documented with capacity assessment
- Staff are trained in end of life care
- Anticipatory medications are in place where appropriate
Domain 5: Well-led
The Well-led domain assesses leadership, management, and governance. This is often the determining factor between Good and Outstanding ratings.
Leadership and Culture
- Registered manager is in day-to-day charge (or clear interim arrangements)
- Clear vision and values that staff can articulate
- Open culture where staff feel able to raise concerns
- Whistleblowing policy is in place and known by staff
- Staff morale is positive and turnover is monitored
Governance
- Quality assurance audits are conducted regularly (medication, care plans, infection control)
- Audit findings lead to documented action plans with follow-up
- Key performance indicators are monitored (falls, pressure ulcers, infections)
- Policies are current, reviewed regularly, and accessible
- CQC registration details are accurate and displayed
Continuous Improvement
- Service improvement plan is in place with measurable objectives
- Resident and staff surveys are conducted with actions from feedback
- Benchmarking against similar services is undertaken
- Best practice guidance is followed (NICE, Skills for Care)
- Previous CQC recommendations have been actioned
Partnerships
- Positive relationships with commissioners and local authority
- Links with community services (GP, pharmacy, community nursing)
- Engagement with sector networks and learning opportunities
Inspection Day Tips
- Brief your team: Ensure all staff know an inspection may happen and understand what to expect. Remind them to be honest and helpful with inspectors.
- Prepare key documents: Have these readily accessible: Statement of Purpose, resident list, staff rota, training matrix, complaints log, accident/incident records, and medication audit results.
- Welcome the inspector: Offer them a space to work, introduce key staff, and provide access to residents and records as requested.
- Be transparent: If there are known issues, share what you're doing to address them. Inspectors value honesty and evidence of improvement work.
- Facilitate conversations: Help inspectors speak with residents and families, but don't coach responses or hover during conversations.
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