The 13 Fundamental Standards of Care: What CQC Measures You Against

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 13 standards (Regulations 9 through 20, plus Regulation 5) 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 13 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.

Twelve apply directly to care delivery (Regulations 9-20). One — Regulation 5, fit and proper persons: directors — applies at provider level. A single breach of any standard is enough for CQC to take enforcement action.

The 13 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 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: Recruitment procedures must ensure staff are of good character, have the necessary qualifications, and that all pre-employment checks (DBS, references, right to work, health declarations) are completed before they start.

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 inform the relevant person, apologise (using the word "sorry"), investigate, and provide a written account. Providing deliberately misleading information is a criminal offence.

Most common CQC finding: The verbal notification happens, but the written follow-up within 10 working days is missed or incomplete. Our duty of candour guide covers the full timeline and recording requirements.

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

Regulation 5: Fit and proper persons — directors (provider level)

What it requires: Directors (or equivalent) must be of good character, physically and mentally fit, have the necessary qualifications, and must not have been responsible for serious misconduct or mismanagement.

Most common CQC finding: No documented fitness assessment for directors, or assessments completed at appointment but never reviewed. CQC expects ongoing assurance, not a one-off check.

Evidence tip: Conduct and record an annual fit and proper person assessment for each director covering character, health, qualifications, and competence. Include a declaration confirming no disqualification conditions apply.

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 mapping helps you organise your evidence portfolio.

Regulation	Standard	Primary Key Question
Reg 5	Fit and proper persons: directors	Well-led
Reg 9	Person-centred care	Responsive
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

How the fundamental standards relate to the 34 quality statements

The fundamental standards are the legal baseline. The 34 quality statements under the single 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 — A formal notice requiring improvements by a set date. 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 including avoidable harm (Regulation 12) and deliberately misleading information under duty of candour (Regulation 20). Can result in unlimited fines and custodial sentences.
• 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 13 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 13 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.