New Framework, New Era? CQC Changes Explained

Helen Fuller, Managing Director & Founder of Care 4 Quality considers how the new CQC Single Assessment Framework will impact your Care Home


The Care Quality Commission (CQC) announced a new strategy which will bring all health and social care providers under one single framework to provide more consistency across services.

As such, care providers will be expected to implement certain changes in the context of CQC’s four new areas of focus, as outlined in its publication A new strategy for the changing world of health and socialcare’ 

·         People and communities: Regulation that’s driven by people’s needs and experiences, focusing on what’s important to people and communities when they access, use and move between services.

·         Smarter regulation: Smarter, more dynamic and flexible regulation that provides up-to-date and high-quality information and ratings, easier ways of working with us and a more proportionate response.

·         Safety through learning: Regulating for stronger safety cultures across health and care, prioritising learning and improvement and collaborating to value everyone’s perspectives.

·         Accelerating improvement: Enabling health and care services and local systems to access support to help improve the quality of care where it’s needed most.

Inspection format

The current timetable of on-site inspections will be replaced by frequent monitoring and engagement calls to assess risk. These are known as Direct Monitoring Activity (DMA) calls.

These phone calls are based on a set of questions with a focus around the key lines of enquiry (KLOEs).

Questions will be asked around:

·         The continued relevance of the registered service user bands, checking that the service is providing the regulated activity appropriately.

·         Mental Capacity Act (MCA), consent, best interests and Liberty Protection Safeguards.

·         Risk management and safeguarding people.

·         Care planning.

·         Safe staffing.

·         Medication.

·         Infection control.

·         Activities and lifestyle choices.

·         Stakeholder feedback.

·         Governance and provider oversight.

Inspectors will also ask service-specific questions around any other intelligence that they have received from third parties, such as the local authority.

CQC will inform you of the outcomes of the call. If your service is identified as ‘very high risk’, you will receive further engagement calls and can also expect on-site inspection activity.

Key lines of enquiry

The current service frameworks will be replaced by a single framework, which will be used across all providers from initial registration application. The aim is to simplify the process and provide a coherent and joined-up service history.

The key questions will remain, but the KLOEs will be replaced by ‘I’ statements. This will help the regulation to be driven by people’s needs and their experiences of the health and care service.

These ‘I’ statements will be underpinned by ‘We’ statements. These statements outline the expectations of how providers are meeting the ‘I’ statements. They are quality indicators and there will be between four and 10 ‘We’ statements beneath each ‘I’ statement.

Evidence will then be reviewed under one of six to ascertain if the quality statements are being met.


There will be no change to the current rating categories; however, there is the possibility of CQC having the ability to change a service’s rating without an on-site inspection, based on the findings and information gathered during a remote monitoring call.


There will be increased focus on information gathering from care providers’ partners and stakeholders and you may be asked for contact details of relatives and staff as part of the remote monitoring process.

Evidence categories

The evidence categories recently went to consultation, and it is proposed that each service type will be asked to provide a list of evidence under each of the five key questions and topics (Safe, Effective, Caring, Responsive and Well-led).

Evidence will fall under one of six categories:

1.       People’s experiences.

2.       Feedback from staff and leaders.

3.       Feedback from partner organisations and stakeholders.

4.       Observations.

5.       Processes.

6.       Outcomes.


A score will be made against each of the six evidence categories, which will then be calculated and will determine a rating for the care service.


What can care home providers do to prepare?

1.       Work with your care team and staff. Share information about the strategy with them as it becomes available. Add it as an item to your team meeting agendas, share the CQC resources with them, and make quality and compliance a cultural value in your care facility.

2.       Join CQC’s Citizen Lab. This gives you the opportunity to have early access to what CQC is thinking, as well as share your opinion on the upcoming changes.

3.       Keep your CQC presentation/Personal Information Record up to date. This will save you time in the long run as it will be requested!

4.       Look at the DMA questions for care providers. Start to gather evidence and write your answers before the call.

5.       Keep a record of innovation and creativity within your care service. Make sure you can evidence the impact on people and the wider facility.

6.       Reach out to other services. Are you part of leadership forums and healthcare groups in your area? Networking and sharing information and best practices helps to drive innovation and improvement across services.

7.       Make sure your audits are up to date and clearly reflect any changes made/actions taken in response to audit findings.

8.       Survey people who use your service, including friends, family and visiting professionals – how do you utilise this feedback?

9.       Treat external stakeholders and the local authority in the same way as you do the CQC – they will be asked for feedback.

10.   Ensure your evidence is well organised. Think about the new evidence categories and how you will present this to CQC.

11.   Consider implementing a compliance software system. Electronic systems and processes can save a significant amount of time.

12.   Involve people who use your service and their families as much as possible in your service’s development. Consider asking people who use services to join interview panels.

13.   Remember, CQC is looking at how care providers work together within systems to help achieve shared care goals, so:

·         Increase your understanding and awareness of the care system you belong to.

·         Identify local healthcare themes and trends.

·         Consider the pressure points in secondary care – is there any way you can support with this?

·         Look out for any initiatives in your area with which you could join forces to support the ongoing national aims of reduction in health inequalities, reducing hospital admissions due to Urinary Tract Infection, and early detection of pressure damage which could lead to tissue breakdown.

Need expert advice? Call us now, we’ll be glad to help you!