Duty of Candour in Care Homes: Requirements, Examples, and How to Comply

This guide is for general information only and does not constitute legal advice. Duty of candour involves legal obligations with potential criminal liability — always seek independent legal advice for specific situations. References are current as of the last reviewed date above; check legislation.gov.uk and CQC's guidance for the latest position.

Duty of candour is one of the most misunderstood obligations in adult social care. Many registered managers know the phrase but are unclear on exactly when it applies, what they must do, and how quickly. The consequences of getting it wrong are serious — CQC has used duty of candour failures as grounds for enforcement action, warning notices, and conditions on registration.

The Legal Framework

Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 establishes the statutory duty of candour for all CQC-registered providers, including care homes with and without nursing. It was introduced following the Francis Report (2013) into failings at Mid Staffordshire NHS Foundation Trust.

The statutory duty is triggered when a notifiable safety incident occurs. There is also a broader professional duty to be honest when things go wrong, but this guide focuses on the statutory requirements — those carrying specific legal timelines and obligations.

What Is a Notifiable Safety Incident?

Regulation 20(6) defines this as any unintended or unexpected incident during provision of a regulated activity that, in the reasonable opinion of a health care professional, appears to have resulted in:

Death relating to the incident rather than the natural course of illness
Severe harm — permanent injury or permanent lessening of bodily, sensory, motor, physiologic, or intellectual functions
Moderate harm — requiring a moderate increase in treatment, such as hospital admission, unplanned surgery, or a prolonged episode of care
Prolonged psychological harm — lasting at least 28 continuous days

In care homes, the most common triggers include: a fall resulting in a fracture requiring hospital treatment, a medication error causing adverse reaction requiring medical intervention, development of a grade 3 or 4 pressure ulcer that was potentially avoidable, a safeguarding incident causing harm, or an unexpected death where care delivery may have contributed.

The duty is triggered by the outcome, not the incident type. A fall with no injury does not trigger Regulation 20. The same fall resulting in a hip fracture does.

The Timeline

Step 1: Verbal Notification — As Soon As Reasonably Practicable

Contact the relevant person (the resident, or if they lack capacity, their representative) and:

Explain that an incident has occurred, with a factual account to the extent known
Offer an apology — Regulation 20(4) requires the word "sorry" specifically
Explain that an investigation will follow
Confirm a written follow-up will be sent

"As soon as reasonably practicable" means within 1-2 working days. CQC has criticised homes that delayed beyond this without justification.

Step 2: Written Notification — Within 10 Working Days

Provide a written account containing:

Facts as currently understood (can be preliminary if investigation is ongoing)
Details of further investigation to be carried out
An apology — again, the word "sorry" must appear
Actions taken or to be taken
Any support available to the person affected

Step 3: Investigation and Follow-Up

Complete a thorough investigation — typically within 4-8 weeks. If findings differ from the initial written notification, provide an updated written account. Keep the relevant person informed throughout.

Recording Requirements

Regulation 20(5) requires a written record of each notifiable safety incident, including:

The incident itself
Verbal notification: date, who was told, what was said
Written notification: date sent and a copy
Investigation: findings, actions, outcome
Further communications with the relevant person

Retain these in the person's care record. A separate duty of candour log — a register of all notifiable incidents and corresponding actions — is not legally required but strongly recommended for governance oversight.

For background on how CQC assessments are structured, see our complete guide to CQC compliance for small care homes.

The Criminal Offence

Regulation 20(7) creates a criminal offence where a provider provides information they know to be false or misleading with the intention of deceiving the relevant person. This is separate from procedural failures — it applies to deliberate dishonesty: covering up what happened, falsifying records, or providing a misleading account. On conviction, an unlimited fine applies. Individual directors or managers who consented to or connived in the offence can also be prosecuted.

CQC Enforcement

CQC treats duty of candour failures seriously. Common findings in enforcement actions include:

No written notification despite a notifiable incident occurring
Delayed notification — families contacted weeks later rather than promptly
Apology missing or inadequate — "sorry" not used, or buried in defensive language
No investigation completed after the notification
No record of the verbal notification

CQC can issue requirement notices under Section 29A of the Health and Social Care Act 2008, warning notices under Section 29, conditions on registration, or prosecution for the criminal offence of intentional concealment.

Practical Steps for Care Home Managers

Build duty of candour into your incident process. When an incident occurs: provide immediate clinical response, then within 24 hours the registered manager assesses whether the outcome meets the notifiable threshold. If yes, initiate verbal notification immediately, then written notification within 10 working days, then complete the investigation.

Train staff to recognise triggers. Care staff witness incidents first. They need to understand that fractures, hospital admissions, serious medication reactions, and significant pressure ulcers require immediate escalation — not just for incident reporting, but because they may trigger legal obligations. Include this in induction and annual mandatory training.

Separate the apology from the investigation. The apology is for the fact that an incident caused harm. It is not an admission of fault — section 2 of the Compensation Act 2006 confirms this. The verbal notification says: "We are sorry this happened. Here is what we know. We are investigating and will share findings in writing."

Personalise notifications. CQC has noted in inspection reports that generic, template-like notifications suggest box-ticking rather than genuine openness. Every notification must address the specific incident and person.

For guidance on how complaints can reveal incidents triggering the duty, see our guide to care home complaints procedures.

Compliance Checklist

Duty of candour is about honesty when something goes wrong. Homes that approach it promptly, openly, and with genuine concern consistently fare well in CQC assessments. Those that avoid difficult conversations or treat it as paperwork do not.