How to Run a Care Home Audit for CQC

An audit only earns its keep when it changes something. Plenty of care homes run audits that tick a box, file a score, and move on — and inspectors can spot that pattern in minutes. A clean audit with no actions, no trend, and no follow-up is not evidence of good governance. It is evidence that the audit is decorative.

This guide is about running audits that do the opposite: ones that find real gaps, generate actions that get closed, and build the trail CQC reads as a service that knows itself. It is written for the registered manager of a small home who does the audits themselves or oversees a small team.

Why audits sit at the heart of CQC compliance

Internal audit is not a free-standing nicety. It is how you meet the good governance requirement in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 requires providers to operate systems or processes that, among other things, "assess, monitor and improve the quality and safety of the services" and "assess, monitor and mitigate the risks relating to the health, safety and welfare of service users." A structured audit programme is the most direct way to evidence that you are doing exactly this.

That framing matters. An audit is not paperwork you produce for an inspector — it is the mechanism by which you run a safe service, and the inspector wants to see it working. Under the assessment framework, your audit findings feed the Well-Led key question, and specific audits feed others: a medication audit evidences Safe, an infection control audit evidences Safe and Effective, a care plan audit evidences Effective and Responsive.

What to audit, and how often

There is no single mandated list, but the audits CQC expects to see in a residential or nursing home cluster into these areas:

Audit	Typical frequency	Key question it evidences
Medication (MAR charts, storage, controlled drugs)	Monthly	Safe
Infection prevention and control	Monthly	Safe, Effective
Care plans and risk assessments	Monthly (rolling sample)	Effective, Responsive
Health and safety / environment	Monthly	Safe
Accidents, incidents and falls (trend analysis)	Monthly	Safe, Well-Led
Staffing, training and supervision	Quarterly	Safe, Well-Led
Complaints and feedback	Quarterly	Responsive, Well-Led
Mealtime / nutrition and hydration	Quarterly	Effective, Caring

Frequency should reflect risk, not habit. A home with a recent medication error should audit medication more often until the trend is stable. A home with no falls in six months can audit a representative sample rather than every record. The judgement — and the rationale for it — is itself evidence of good governance.

For a complete schedule mapped to your home, our audit schedule guide breaks down what to run when, and the free Care Home Audit Schedule Generator builds a tailored programme you can adapt.

The structure of an audit that works

A useful audit has five parts, and the last two are where most homes fall short.

1. Scope — what you are checking, against which standard or policy. "Medication audit against our medicines policy and NICE managing medicines guidance."
2. Method — how you checked. Sample size, records reviewed, observations made. "20 MAR charts reviewed across two units; CD register reconciled against stock."
3. Findings — what you found, with specifics. Not "medication generally well managed" but "18 of 20 MAR charts complete; 2 gaps on the night shift on the dementia unit; CD register balanced."
4. Actions — what you will do, who owns it, and by when. This is the part that turns a score into governance.
5. Verification — confirmation, at the next audit, that the action worked. The loop that closes.

The single biggest difference between an audit that reassures an inspector and one that worries them is whether actions get closed and verified. An audit that finds the same gap three months running, with an action logged each time and never resolved, is worse than no audit — it shows you can see the problem and cannot fix it.

Turning findings into evidence

CQC values the trail from gap to action to verified improvement more than a clean score. Concretely, that means:

• Log every action with an owner and a deadline. A finding with no owner is a finding nobody fixes.
• Track actions to completion in one place — not scattered across audit forms. A single action tracker that pulls from every audit lets you (and an inspector) see the whole picture.
• Show the trend. Three months of medication-audit scores moving from, say, 88% to 94% to 98% tells a story a single snapshot cannot. Trends are what demonstrate ongoing monitoring.

• Feed the findings upward. Your audit results should appear in your governance meeting minutes and, when requested, your Provider Information Return. If your audits and your PIR tell different stories, that inconsistency is a finding.

Who should do the audit

In a small home the registered manager often runs most audits, and that is acceptable — but a degree of separation strengthens the evidence. Where you can, have someone other than the person responsible for an area audit it: a senior carer audits care plans the manager wrote, a visiting manager from a sister home audits yours. Peer or cross-site auditing is a recognised way to reduce the "marking your own homework" risk and is a strong Well-Led signal.

Common audit mistakes

1. Auditing for a score, not for findings. A 100% audit with no observations usually means the audit was not rigorous, not that the home is flawless.
2. No closed-loop actions. Findings without owners and deadlines do not get fixed.
3. No trend analysis. A single snapshot proves nothing about whether the service is improving.
4. Auditing everything at the same shallow depth. Risk should drive frequency and rigour.
5. Keeping audits in a folder nobody reads. Audits that never reach the governance meeting are not part of how the home is run.

Building an audit programme you will actually maintain

The homes that struggle with audits are usually the ones treating each audit as a separate event. The homes that do it well have a single rolling programme: a calendar of what is due each month, a standard template per audit type, and one action tracker that everything feeds into. That structure is what InspectReady is built around — scheduled audits with action tracking that connects findings to evidence and to your Quality Statements, so the trail is there when the inspector asks.

To start building your programme, the free Care Home Audit Schedule Generator produces a tailored schedule in a few minutes, and the CQC Readiness Self-Assessment shows you where your evidence is strongest and weakest before your next assessment.

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This is general guidance based on the published Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and CQC guidance current at the date above. Regulatory requirements can change — always check the current guidance on cqc.org.uk and the regulations on legislation.gov.uk for your specific situation. Not legal advice.

Sources

• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 17 — good governance
• CQC — regulations for service providers