CQC Single Assessment Framework: What Care Homes Must Do Now

What Changed?

The CQC Single Assessment Framework replaces the previous inspection methodology with a continuous, evidence-based approach. Instead of periodic inspections with advance notice, the CQC now monitors providers continuously using data from multiple sources including staff surveys, complaints data, and local authority intelligence.

The Five Key Questions (Unchanged)

The framework still assesses providers against five key questions, but the evidence requirements have changed significantly:

1. Safe: People are protected from abuse and avoidable harm
2. Effective: Care achieves good outcomes and is evidence-based
3. Caring: Staff treat people with compassion and respect
4. Responsive: Services are organised to meet people's needs
5. Well-led: Leadership and governance drive continuous improvement

Quality Statements

Each key question now contains specific quality statements that providers must demonstrate. For example, under "Safe":

• Learning culture — how you learn from incidents and near-misses
• Safe systems, pathways and transitions — how you manage care transitions
• Safeguarding — how you prevent and respond to abuse
• Involving people to manage risks — how you balance safety with autonomy
• Safe environments — how you maintain physical safety
• Safe and effective staffing — how you ensure adequate, competent staff
• Infection prevention and control — how you manage infection risks
• Medicines optimisation — how you manage medications safely

Evidence Categories

The CQC now collects evidence from six categories:

• People's experience: Feedback from people using services and their families
• Feedback from staff and leaders: Staff surveys, whistleblowing data
• Feedback from partners: Local authority, NHS, and other stakeholder views
• Observation: What inspectors see during visits
• Processes: Your policies, procedures, and governance documents
• Outcomes: Measurable results of care delivery

What You Must Do Now

1. Build a continuous evidence portfolio — Don't wait for inspections. Maintain living documents that demonstrate compliance against each quality statement.
2. Implement real-time incident logging — The CQC expects you to demonstrate learning from every incident, complaint, and near-miss.
3. Collect ongoing feedback — Regular surveys from residents, families, and staff. Document how you act on feedback.
4. Maintain staff training records — Every staff member's training must be current and documented. Gaps are immediately flagged.
5. Document governance meetings — Minutes showing discussion of quality, safety, and improvement actions.
6. Track outcomes data — Falls rates, medication errors, hospital admissions, pressure ulcers. Show trends and improvement actions.

Cost of Getting It Wrong

• Fixed penalty notice: £1,250 - £4,000
• Prosecution: unlimited fine
• "Inadequate" rating: special measures, potential closure
• Occupancy drop after poor rating: 20-40% (average £85,000 revenue loss)
• Staff recruitment difficulty after poor rating: 3x harder to hire