Complaint Record Form

Use this form to record complaints formally. A written record is essential for CQC Regulation 16 compliance — it ensures complaints are tracked, investigated, and responded to within appropriate timescales.

Complaint Categories

Classifying complaints helps identify patterns and areas for improvement. The following categories cover the most common complaints in care homes:

Quality of Care

Inadequate personal care or hygiene support
Delay in responding to call bells or requests for assistance
Inappropriate or insufficient care planning
Failure to follow agreed care plans
Lack of meaningful activities or stimulation

Staff Conduct

Rude, dismissive, or unprofessional behaviour
Failure to treat residents with dignity and respect
Breaches of confidentiality
Inappropriate use of restraint
Staff under the influence of alcohol or drugs

Environment and Facilities

Poor cleanliness or hygiene standards
Unpleasant odours or unclean communal areas
Maintenance issues not addressed promptly
Inadequate heating or ventilation
Safety concerns — trip hazards, broken equipment

Food and Nutrition

Poor quality or insufficient meals
Dietary requirements not met
Lack of choice at mealtimes
Meals served cold or at wrong times
Inadequate support with eating and drinking

Communication

Not being kept informed about care or changes
Difficulty contacting managers or senior staff
Lack of transparency about fees or charges
Not informed about incidents involving their relative
Complaints not acknowledged or responded to

Medication

Medication errors or missed doses
Delays in administering pain relief
Changes to medication without consultation
Side effects not monitored or reported
Administration of covert medication without proper authorisation

Complaint Record

Complete this form when a complaint is received. All fields should be filled in as fully as possible. Print this page for a paper version, or complete digitally and print for your records.

Complainant Details

Full Name

Relationship to Resident (if applicable)

Address

Telephone Number

Email Address (if applicable)

Resident Details (if complaint on behalf of a resident)

Resident Full Name

Room Number / Unit

Complaint Details

Date of Incident / Issue

Location (if relevant)

Category of Complaint

Full Description of the Complaint

Names of Staff Involved (if known)

Witnesses (names and contact details)

Desired Outcome

What Resolution Are You Seeking?

Have You Raised This Before? (when and with whom)

Office Use Only

Date Received

Received By

Complaint Reference Number

Assigned Investigator

Best Practice for Recording Complaints

Record the complaint as soon as it is received — include the date and time
Use the complainant's own words — do not paraphrase or summarise
Assign a unique reference number for tracking the complaint through to resolution
Acknowledge the complaint within 3 working days (CQC Regulation 16)
Keep the complainant informed of progress at agreed intervals
Assess whether the complaint raises a safeguarding concern — if so, follow safeguarding procedures immediately
Store complaint records securely and in accordance with data protection requirements

Official Resources

⚠️ Important Notice

This complaint record form is provided by Care Handbook for informational purposes. It does not constitute legal advice. Your care home must comply with CQC Regulation 16 and have its own complaints procedure. Complaint records must be handled in accordance with UK GDPR and the Data Protection Act 2018. If a complaint raises a safeguarding concern, follow your safeguarding procedures and report to the local authority immediately.