CQC compliance for complex care

Get the registration and scope right

• Register for the activities you actually deliver, and name the clinical interventions in your statement of purpose.
• Do not accept a package outside your evidenced competence because the commissioner is under pressure. Declining is a governance strength.
• Have a written pre-acceptance assessment: clinical need, equipment, training required, clinical oversight, staffing model and escalation route — signed off before the package starts.

Delegated clinical tasks and competency

• A named registered nurse or clinical lead responsible for training, assessment and ongoing oversight.
• Person-specific competency sign-off for each worker and each task, with dated re-assessment intervals.
• Written care plans and clinical protocols for each intervention, agreed with the community clinical team and reviewed when the person's condition changes.
• Clear boundaries: what a worker may do, what they must escalate, and who they call at 3am.
• Shadowing and supervised practice before a worker is counted in the staffing for a clinical package.

Airway, feeding and seizure management

• Tracheostomy and ventilation: emergency equipment checked every shift and recorded, spare tube and obturator present, suction working, emergency algorithm on the wall, and staff who can demonstrate an unplanned decannulation response.
• Enteral feeding: regimen from the dietitian, tube position checks, flushing, stoma site care, and a plan for blocked or displaced tubes.
• Epilepsy: seizure description and thresholds, rescue medication protocol with time limits, competency to administer, post-seizure monitoring, and when to call an ambulance.
• Deterioration: use a recognised tool such as RESTORE2 or NEWS2, record baseline observations, and evidence escalation to primary care or 999 with outcomes.

Medicines in complex packages

• Reconciliation on discharge from hospital, with changes reflected in the MAR the same day.
• Controlled drugs, syringe drivers and anticipatory medicines handled under clinical direction with recorded competency.
• Time-critical medicines — particularly Parkinson's — administered within window, with exceptions reported.
• Regular medicines audit against the current prescription, not against last month's chart.

Staffing continuity and wellbeing

• Small, dedicated teams per package, with named consistent staff and a trained cover list — not open agency.
• Waking night and continuous care rotas that comply with working time limits and allow for genuine rest.
• Debriefs after clinical emergencies, and access to support for staff working in isolation with high acuity.
• Retention data by package, because turnover is the clearest early warning of an unsafe arrangement.

Clinical governance CQC expects to see

• A clinical governance meeting with minutes: incidents, near misses, deterioration events, medicines errors and competency status.
• Clinical audit of each package, distinct from care plan audit, signed by the clinical lead.
• Joint working records with community nursing, respiratory teams, dietetics, SALT, GP and continuing healthcare commissioners.
• Risk register per package, with mitigations and review dates, escalated to provider level.
• Duty of candour applied and evidenced whenever a notifiable safety incident occurs, alongside CQC notifications.

End of life care

• Advance care plans, ReSPECT or DNACPR documentation valid, current and accessible to staff and paramedics.
• Anticipatory medicines in place, with staff clear on what they may and may not administer.
• Preferred place of care and death recorded and respected, with families supported and staff debriefed.

Common questions

Official sources

• CQC — How we assess services
• NICE NG94 — Emergency and acute medical care (recognising deterioration)
• NICE NG217 — Epilepsies in children, young people and adults
• Regulation 12 — Safe care and treatment

More guides

• Home care and domiciliary compliance
• Supported living compliance
• CQC inspection and assessment questions
• Becoming a CQC registered manager