The 14 Fundamental Standards of Care

This guide summarises the fundamental standards for general information purposes. It does not constitute legal advice. The regulatory framework is subject to amendment — verify all references against legislation.gov.uk and CQC's current guidance for the latest position.

Every CQC assessment of your care home traces back to the same legal foundation: the fundamental standards of care set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These 14 standards — Regulations 9, 9A, and 10 through 20A — define the minimum level of care that every registered provider must deliver. Fall below any of them and CQC can take enforcement action — from requirement notices through to criminal prosecution.

This guide covers all 14 standards with practical guidance for registered managers and owners: what each one requires, where homes most commonly breach, and what evidence to hold.

What are the fundamental standards?

The fundamental standards are the legal minimum requirements for care quality and safety that apply to all CQC-registered services in England. They were introduced under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, partly in response to the Francis Report into Mid Staffordshire NHS Foundation Trust.

They sit in Part 3, Section 2 of the Regulations ("Fundamental Standards"), which runs from Regulation 8 (a general provision, not itself a standard) through Regulation 20A. CQC's own published list — The fundamental standards of care — names 14 standards by title, from "Person-centred care" through "Display of ratings"; those titles correspond to Regulations 9, 9A, and 10 through 20A of Part 3 Section 2. Regulation 5 (fit and proper persons: directors) is a separate requirement in Section 1 of Part 3, does not appear on CQC's list, and is not one of the fundamental standards, though CQC can still act on it. A single breach of any standard is enough for CQC to take enforcement action.

The 14 fundamental standards explained

Regulation 9: Person-centred care

What it requires: Care and treatment must be appropriate, meet the person's needs, and reflect their preferences. Care plans should be based on an assessment of individual needs and developed with the person's involvement.

Most common CQC finding: Generic care plans that read identically across residents, with no evidence that the person (or their representative) contributed to planning their care.

Evidence tip: Audit five care plans at random. Each should contain specific personal preferences — not just clinical needs — and show a review signature from the resident or their representative within the last month.

Regulation 9A: Visiting and accompanying in care homes, hospitals and hospices

What it requires: Care homes must facilitate visits and must not discourage residents from taking visits out of the home, unless there are exceptional circumstances. Visits must be appropriate for the individual, reflect their care plan and preferences, and maintain safety. The regulation does not require a visit to go ahead without consent or against someone's best interests, and it does not override the Mental Capacity Act 2005, Mental Health Act 1983, or a relevant court order. This standard was inserted specifically for care homes, hospitals, and hospices — it does not apply to most other regulated activities.

Most common CQC finding: Blanket visiting restrictions applied to all residents without an individual, documented justification, or restrictions that persist after the "exceptional circumstance" that prompted them has passed.

Evidence tip: Keep your visiting policy on file with the individual, documented exceptions it allows for, and evidence that any restriction on a specific resident is reviewed regularly and tied to a care-plan reason rather than a blanket home rule.

Regulation 10: Dignity and respect

What it requires: People must be treated with dignity and respect at all times, including privacy during personal care, supporting autonomy, and due regard to protected characteristics under the Equality Act 2010.

Most common CQC finding: Staff entering rooms without knocking, personal care delivered with doors open, or care discussions held in communal areas.

Evidence tip: Run an observational dignity audit during a busy shift — not a quiet afternoon. Record findings and feed them back in supervision.

Regulation 11: Need for consent

What it requires: Care must only be provided with the consent of the relevant person. Where someone lacks capacity for a specific decision, the provider must act in accordance with the Mental Capacity Act 2005.

Most common CQC finding: Missing or poorly documented capacity assessments. Homes often have a single blanket assessment rather than decision-specific assessments as the MCA requires.

Evidence tip: For each resident subject to any restriction — bed rails, door sensors, covert medication — check that a decision-specific capacity assessment and best interests decision is on file and has been reviewed.

Regulation 12: Safe care and treatment

What it requires: Care and treatment must be provided in a safe way, including assessing risks, proper medicines management, and maintaining infection control standards.

Most common CQC finding: Medication errors — gaps in MAR charts, incorrect fridge temperatures for medicines, and missing PRN protocols. See our medication management guide for detail on this area.

Evidence tip: Conduct monthly medicines audits covering MAR chart accuracy, controlled drugs registers, fridge temperatures, and PRN protocols. Document findings and actions.

Regulation 13: Safeguarding service users from abuse and improper treatment

What it requires: Systems must prevent abuse — physical, psychological, financial, and neglect. Staff must recognise abuse and know how to raise safeguarding concerns.

Most common CQC finding: Staff unable to articulate the types of abuse or describe the referral pathway to the local authority. Training recorded as complete but with no competency testing.

Evidence tip: Ask three staff members at random what they would do if they suspected abuse. If they cannot describe the steps — including external reporting — your training approach needs revisiting.

Regulation 14: Meeting nutritional and hydration needs

What it requires: Residents must receive adequate nutrition and hydration, with support to eat and drink where needed. Specialist dietary needs must be met.

Most common CQC finding: Fluid intake charts left incomplete or filled in retrospectively at shift end. Weight loss not escalated or linked back to care plan reviews.

Evidence tip: Cross-reference MUST scores with food and fluid records. Where a resident is at nutritional risk, there should be a clear chain from assessment to dietary plan to monitoring to escalation.

Regulation 15: Premises and equipment

What it requires: Premises must be clean, suitable, properly maintained, and fit for purpose. Equipment must be safe to use and available when needed.

Most common CQC finding: Overdue maintenance tasks, unaddressed ligature risks, and missing calibration records for clinical equipment like weighing scales and blood pressure monitors.

Evidence tip: Keep a live maintenance log with completion dates — not just a list of requests. Track equipment calibration centrally, not through individual staff memory.

Regulation 16: Receiving and acting on complaints

What it requires: An accessible complaints system must be in place. Complaints can be made in any form (including verbal), must be investigated, and must result in proportionate action.

Most common CQC finding: Complaints logged but with no documented outcome, no evidence of learning, and no follow-up with the complainant. Our complaints procedure guide covers the full process.

Evidence tip: For each complaint in the last 12 months, check the file contains: the complaint, the investigation, the written response, and what changed as a result. CQC looks for the learning cycle, not just the paperwork.

Regulation 17: Good governance

What it requires: Systems and processes must assess, monitor, and improve care quality and safety. Records must be accurate, complete, and contemporaneous. Risks must be identified and mitigated.

Most common CQC finding: Audits that identify issues but show no follow-up action — creating a paper trail that proves the provider knew about problems and did nothing. This is worse than having no audit at all.

Evidence tip: Every audit should feed into an action plan with named owners and deadlines. Review completion at governance meetings. For a broader view, see our CQC compliance guide.

Regulation 18: Staffing

What it requires: Sufficient numbers of suitably qualified, competent, and experienced staff must be deployed. Staff must receive appropriate training, supervision, and appraisal.

Most common CQC finding: No dependency assessment tool used to determine staffing levels. Rota gaps filled with agency staff who have not received a local induction.

Evidence tip: Use a recognised dependency tool, keep the calculation on file, and update it when occupancy changes. Ensure agency staff complete a documented induction before working unsupervised.

Regulation 19: Fit and proper persons employed

What it requires: Staff must be of good character, have "the qualifications, competence, skills and experience which are necessary for the work to be performed by them", and be able by reason of health, after reasonable adjustments, to perform the tasks intrinsic to the work. Recruitment procedures must be established and operated effectively, and the Schedule 3 information must be available for each person employed — proof of identity, evidence of conduct in previous employment, qualification evidence, a full employment history with gaps explained, health information, and a criminal record certificate where one is required for the post. One carve-out applies: Regulation 19(3) is now expressly "[s]ubject to paragraph (3A)", and Regulation 19(3A) — inserted with effect from 15 January 2024 by S.I. 2023/1404 — provides that "[u]nless regulation 4, 6 or 7 applies, where the person so employed is a volunteer, paragraph (3) does not require the information specified in paragraph 7 of Schedule 3 to be made available." Paragraph 7 is the full employment history with explained gaps, so you do not need it for volunteers (Regulation 19(7) defines a volunteer as "a person employed under arrangements to provide their services voluntarily"). Every other Schedule 3 item still applies to them. Right-to-work checks are a separate duty under immigration law rather than a Schedule 3 item, but belong on the file too.

Most common CQC finding: Incomplete recruitment files — missing second references, unexplored employment gaps, or DBS checks not received before the person started.

Evidence tip: Create a recruitment checklist based on Schedule 3 of the Regulations. Do not permit a start date until every item is ticked. Audit five files quarterly.

Regulation 20: Duty of candour

What it requires: When a notifiable safety incident occurs, the provider must notify the relevant person in person as soon as reasonably practicable, include an apology (Regulation 20(7) defines "apology" as "an expression of sorrow or regret" — no particular form of words is prescribed), advise what further enquiries are appropriate, and follow up in writing. Failing to comply with Regulation 20(2)(a) or 20(3) — which includes giving an account that is not, to the best of your knowledge, true — is a criminal offence under Regulation 22(1), punishable on summary conviction by a fine not exceeding level 4 on the standard scale (Regulation 23(5)).

Most common CQC finding: The in-person notification happens, but the written follow-up is missed or incomplete. Regulation 20 sets no deadline in days for the written notification — set an internal target and evidence that you met it. Our duty of candour guide covers the full sequence and recording requirements.

Candour is a duty to the person harmed. Separately, many of the same events are notifiable to CQC under the registration regulations — check both routes when an incident occurs.

Evidence tip: Maintain a duty of candour log tracking each notifiable incident through in-person notification, written notification, investigation, and outcome. Review monthly at governance level.

Regulation 20A: Requirement as to display of performance assessments

What it requires: Where CQC has rated your service, the rating must be displayed at each premises and on any website you maintain, legibly and conspicuously in a place accessible to service users, together with the date it was given and (on your website) a link to where the assessment can be accessed on CQC's site.

Most common CQC finding: An out-of-date rating still displayed after a re-inspection, a rating missing from the website entirely, or a sign that is present but not legible or not placed where visitors and residents will see it.

Evidence tip: When a new rating is published, update the physical sign and the website on the same day, and keep a short log of the change with the date so you can evidence when the update was made.

How the fundamental standards map to CQC key questions

Each fundamental standard aligns primarily with one or more of CQC's five key questions. This is InspectReady's own categorisation to help you organise your evidence portfolio — CQC does not publish an official standard-to-key-question crosswalk — so treat "primary" as a starting point for your evidence folders, not a CQC-stated rule.

Regulation	Standard	Primary Key Question
Reg 9	Person-centred care	Responsive
Reg 9A	Visiting and accompanying	Caring
Reg 10	Dignity and respect	Caring
Reg 11	Need for consent	Effective
Reg 12	Safe care and treatment	Safe
Reg 13	Safeguarding	Safe
Reg 14	Nutritional and hydration needs	Effective
Reg 15	Premises and equipment	Safe
Reg 16	Complaints	Responsive
Reg 17	Good governance	Well-led
Reg 18	Staffing	Safe / Well-led
Reg 19	Fit and proper persons employed	Safe
Reg 20	Duty of candour	Well-led
Reg 20A	Display of ratings	Well-led

How the fundamental standards relate to the 34 quality statements

The fundamental standards are the legal baseline. The 34 quality statements under the assessment framework describe what good looks like above that baseline. They are connected but not the same.

Each quality statement maps to one or more fundamental standards — for example, "Safeguarding" (S3) maps to Regulation 13, and "Governance, management, and sustainability" (WL5) maps to Regulation 17. CQC uses quality statements to assess your service, but enforcement powers are triggered by breaches of the fundamental standards themselves.

Meeting the quality statements usually means you meet the underlying regulation. But you can technically satisfy the legal minimum of a regulation while falling short of the quality statement. CQC will rate you accordingly.

For a full breakdown of all 34 quality statements with evidence examples, see our quality statements guide.

CQC enforcement powers

When CQC finds a breach of a fundamental standard, it has a graduated range of enforcement tools. The response depends on the severity and immediacy of the risk.

• Requirement notice (CQC now calls this an "Action Plan request") — Used where a breach exists but people are not at immediate risk of harm. It asks the provider for a report on how and when it will comply. The most common action; published on the CQC website alongside your report.
• Warning notice — Legally binding, with a compliance date. Failure to comply leads to escalation.
• Conditions on registration — Restricting new admissions, mandating staffing ratios, or requiring specific improvements before conditions are lifted.
• Suspension or cancellation — Reserved for immediate risk to people or persistent failure to improve.
• Prosecution — For specific offences only. Regulation 22(2) covers breaches of Regulations 12, 13(1)-(4) or 14 that result in avoidable harm, exposure to significant risk of it, or loss of money or property; Regulation 22(1) covers breaches of Regulations 11, 16(3), 17(3), 20(2)(a) and (3), and 20A. The penalties are fines, not imprisonment: Regulation 23(4) makes a Regulation 22(2) offence "liable on summary conviction to … a fine", specifying no maximum level, while Regulation 23(5) caps the duty-of-candour offence at "a fine not exceeding level 4 on the standard scale".
• Fixed penalty notices — Available for certain less serious offences as an alternative to prosecution.

CQC does not always start at the bottom of this ladder. Where there is evidence of serious harm, it can move straight to urgent conditions, suspension, or prosecution.

Using the fundamental standards as your compliance framework

The 14 fundamental standards give you a fixed structure for organising compliance, regardless of how CQC changes its assessment approach. A practical starting point:

1. Map your policies to each regulation — our care home policy list shows which policies you need and where they fit.
2. Build an evidence folder per regulation containing key documents, audit results, and improvement actions.
3. Run a quarterly self-assessment against each standard, scoring honestly and documenting the rationale.
4. Track actions to completion — CQC values the trail from gap identification through action to verified improvement more than a clean audit.

Check where you stand

If you are unsure how your home measures up against the 14 fundamental standards, our free CQC Readiness Assessment walks you through each area and identifies where your evidence gaps are. It takes about 15 minutes and gives you a prioritised action list you can start working through immediately.