What Do CQC Look For? A Checklist for Care Homes

CQC assesses care homes against five key questions — Safe, Effective, Caring, Responsive, and Well-Led — using the single assessment framework introduced in November 2023. Under each question sit quality statements describing what good care looks like, and CQC gathers evidence across six categories to make judgements.

This guide distils what CQC actually focuses on during care home assessments into a practical checklist you can use today.

The five key questions at a glance

Key Question	What CQC is asking	What trips homes up
Safe	Are people protected from abuse and avoidable harm?	Medication errors, missing risk assessments, gaps in safeguarding knowledge
Effective	Does care achieve good outcomes?	Generic care plans, missing capacity assessments, outdated training
Caring	Are people treated with compassion and dignity?	Task-focused care delivery, lack of resident involvement, privacy breaches
Responsive	Are services organised around people's needs?	Poor complaints handling, no evidence of personalisation, rigid routines
Well-Led	Is leadership effective and does the service learn?	Audits without actions, no governance structure, no evidence of improvement

For a full breakdown of all 34 quality statements under these questions, see our quality statements guide.

How CQC gathers evidence

CQC does not just read your files. They gather evidence from six categories, and a strong assessment relies on consistency across all of them:

1. People's experience — What residents and families say about the care
2. Staff feedback — What your team reports about working conditions, support, and culture
3. Partner feedback — What GPs, pharmacists, local authorities, and other professionals say
4. Observation — What assessors see during visits (environment, interactions, mealtimes)
5. Processes — Your policies, audits, care plans, risk assessments, and governance documents
6. Outcomes and data — Measurable results: incidents, infection rates, complaints trends, staffing data

The most common mistake is over-relying on process evidence (policies and audits) while neglecting people's experience and outcomes data. CQC weights the lived experience of residents heavily.

What CQC look for: the practical checklist

Safe

• Monthly medication audits completed with action plans and evidence of follow-up
• MAR charts fully signed with no unexplained gaps
• PRN protocols in place for every as-required medication
• Controlled drugs register checks at every shift handover
• Individual risk assessments (falls, nutrition, skin integrity, moving and handling) current and reviewed after incidents
• Environmental risk assessments current (fire, legionella, COSHH)
• Safeguarding lead identified; all staff can name them and describe the referral process
• Safeguarding training current for all staff with evidence of competency testing
• Incident and accident log up to date with investigation and learning documented
• Statutory notifications submitted to CQC without delay under Regulation 18 of the CQC (Registration) Regulations 2009
• Staffing levels assessed using a dependency tool, with rota evidence matching assessed needs
• IPC audit programme running monthly (hand hygiene, environmental cleanliness, PPE)

Effective

• Care plans personalised, based on thorough assessment, reviewed monthly or after significant change
• Resident and/or family involvement in care plan reviews documented
• Decision-specific mental capacity assessments on file where restrictions apply
• Best-interest decisions documented with evidence of consultation
• DoLS applications submitted where appropriate, with a status tracker
• Staff training matrix at 100% mandatory compliance
• Care Certificate completed for staff new to care
• Supervision records (6-8 weekly minimum) and annual appraisals on file
• Evidence of evidence-based practice (NICE guidelines referenced in care plans where relevant)

Caring

• Staff can describe individual residents' needs, preferences, and what matters to them
• Observation shows respectful interactions — knocking before entering, maintaining privacy during personal care
• Residents have choice over daily routines (meals, activities, getting up, going to bed)
• Residents and families are involved in decisions about their care
• Accessible information provided in appropriate formats

Responsive

• Complaints policy displayed and included in welcome packs
• Complaints log captures verbal and written complaints, with investigation, written response, and outcome
• Evidence of practice changes resulting from complaints
• Individualised activity plans based on assessed interests
• Admission assessments completed thoroughly within 48 hours
• Escalation route to the Local Government and Social Care Ombudsman clearly stated in complaints materials

Well-Led

• Monthly audit programme consistently completed for 6+ months
• Every audit generates an action plan with named owners, deadlines, and evidence of completion
• Governance meetings held regularly (at least quarterly) with minutes showing discussion of audit findings, incidents, complaints, and staffing
• Nominated individual oversight documented (visit reports, provider-level assurance)
• Service improvement plan in place and actively maintained
• Staff meetings where CQC findings, audit results, and improvement plans are discussed
• Feedback sought from residents, families, and staff (surveys, meetings) with evidence of response
• Policies current, version-controlled, and reviewed within 12 months

The most common CQC findings in care homes

Based on published inspection reports, these are the areas where homes most frequently receive enforcement action:

1. Regulation 12 — Safe care and treatment. Medication management failures account for the largest share. Incomplete MAR charts, missing PRN protocols, and poor fridge temperature monitoring are the most cited.

2. Regulation 17 — Good governance. Audits completed but with no action follow-up. This is worse than having no audit — it proves you identified problems and did nothing.

3. Regulation 18 — Staffing. No dependency assessment tool used. Agency staff not inducted. Training not current.

4. Regulation 11 — Consent. Blanket capacity assessments instead of decision-specific ones. Best-interest decisions not documented.

For the full list of regulations and what each requires, see our fundamental standards guide.

How to use this checklist

Work through each section honestly. For every item you cannot tick:

1. Identify the gap — What is missing or incomplete?
2. Assign an owner — Who will fix it and by when?
3. Evidence the fix — What will demonstrate the gap has been closed?
4. Re-check — Come back in 4 weeks and verify it is embedded, not just done once.

Our free CQC Readiness Assessment automates this process — it walks you through each quality statement and produces a prioritised action list. The Evidence Gap Checker identifies specific documentation gaps. Both take about 15 minutes and give you a clear picture of where you stand.

For a comprehensive guide to building and maintaining your compliance framework, see our CQC compliance guide for small care homes.