CQC Inspection Process & Ratings
Understanding how CQC inspections work, what inspectors will look at, and what the ratings mean for your service.
Types of Inspection
Comprehensive Inspection
A full inspection covering all five key questions. Usually carried out at least once every 2–3 years for services rated Good or Outstanding. For services rated Requires Improvement, the CQC may inspect more frequently. Inspections may be announced or unannounced.
Focused Inspection
A shorter inspection that focuses on specific concerns or areas of improvement. Focused inspections do not usually change the overall rating unless the CQC finds significant improvements or deterioration. They may follow up on previous enforcement action or respond to specific concerns.
What to Expect During an Inspection
During a CQC inspection, inspectors will:
- Speak with people who use the service, their relatives, and carers to understand their experiences
- Observe care delivery and the interactions between staff and residents
- Review care plans, risk assessments, medication records, and other documentation
- Speak with staff, managers, and the registered manager about how the service is run
- Check the physical environment — premises, equipment, cleanliness, safety
- Review staffing levels, recruitment records, training records, and supervision logs
- Check safeguarding records, complaint records, and incident reports
- Review governance systems — audits, quality monitoring, and improvement plans
- Observe meal times and assess nutrition and hydration provision
- Look at how the service monitors and improves the quality of care
CQC Ratings
After an inspection, the CQC awards a rating for each of the five key questions and an overall rating. The overall rating cannot be higher than the lowest-rated key question, unless the inspection team provides a clear rationale.
The service is performing exceptionally well. Practice is innovative, effective, and significantly exceeds the standards required.
The service is performing well and meeting expectations. Care is safe, effective, caring, responsive, and well-led.
The service is not performing well enough and needs to improve. One or more of the five key questions is rated as requires improvement.
The service is performing badly. There are serious concerns and the CQC will take enforcement action to protect people.
Enforcement Action
When the CQC identifies breaches of regulations, it has a range of enforcement powers:
- Requirement notices:Formal notice that a provider must meet a specific regulation by a set date
- Warning notices:Notice that a provider is breaching a regulation and must improve or face further action
- Conditions on registration:Restrictions placed on what a provider can do (e.g. limiting the number of service users)
- Suspension of registration:Temporarily stopping a provider from operating — used in serious cases
- Cancellation of registration:Permanently removing a provider's registration — the most serious action
- Fixed penalty notices:Financial penalties for specific offences
- Simple caution:A formal caution accepted by a provider as an alternative to prosecution
- Prosecution:Criminal prosecution for the most serious breaches, including ill-treatment or wilful neglect