Standards

CQC standards and quality statements explained

Two things are often confused: the fundamental standards, which are the law, and the five key questions and quality statements, which are how CQC assesses and rates you against them. Getting the distinction straight makes evidence gathering far simpler.

The fundamental standards are the legal floor

Regulations 9 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 set out what no service may fall below. These are enforceable in their own right — some, including safe care and treatment and safeguarding, carry criminal liability.

Regulation 9 — person-centred care.
Regulation 10 — dignity and respect.
Regulation 11 — need for consent, read with the Mental Capacity Act 2005.
Regulation 12 — safe care and treatment, including risk assessment, medicines and infection control.
Regulation 13 — safeguarding service users from abuse and improper treatment, including restraint.
Regulation 14 — meeting nutritional and hydration needs.
Regulation 15 — premises and equipment.
Regulation 16 — receiving and acting on complaints.
Regulation 17 — good governance, including accurate records and quality monitoring.
Regulation 18 — staffing: sufficient numbers, suitably qualified, trained and supervised.
Regulation 19 — fit and proper persons employed.
Regulation 20 — duty of candour. Regulation 20A — display of ratings.

The five key questions

CQC assesses every service by asking whether it is safe, effective, caring, responsive and well-led. Well-led carries disproportionate weight in adult social care: weak governance tends to show up as failures elsewhere, and it is the domain most often rated below good.

The quality statements, grouped by key question

Quality statements are written as commitments from the provider's perspective. Organise your evidence folders by statement and gaps become obvious. The themes under each key question are:

Safe — learning culture; safe systems, pathways and transitions; safeguarding; involving people to manage risks; safe environments; safe and effective staffing; infection prevention and control; medicines optimisation.
Effective — assessing needs; delivering evidence-based care and treatment; how staff, teams and services work together; supporting people to live healthier lives; monitoring and improving outcomes; consent to care and treatment.
Caring — kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people's immediate needs; workforce wellbeing and enablement.
Responsive — person-centred care; care provision, integration and continuity; providing information; listening to and involving people; equity in access; equity in experience and outcomes; planning for the future, including end of life.
Well-led — shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability; partnerships and communities; learning, improvement and innovation; environmental sustainability.

The six evidence categories CQC draws on

For each quality statement CQC looks for evidence from a mix of sources. Knowing the categories tells you what to collect:

People's experience of care — surveys, feedback, complaints, conversations and observations.
Feedback from staff and leaders — including whether people feel able to speak up.
Feedback from partners — commissioners, safeguarding teams, GPs, district nurses, advocates.
Observation — the environment, interactions, mealtimes, medicines rounds.
Processes — policies actually in use, audits, care plans, risk assessments, training records.
Outcomes of care — falls, pressure ulcers, hospital admissions, weight loss, achievement of people's own goals.

Turning the statements into an evidence folder

For each quality statement, name the two or three pieces of evidence you would show, and who holds them.
Keep a rolling twelve months of audits with the action taken and the re-check that closed it — an audit with no action is worse than no audit.
Record feedback and what changed as a result. 'You said, we did' is the simplest way to evidence responsive and well-led.
Track outcomes over time, not just incidents in isolation, so you can show improvement rather than activity.
Do an honest self-assessment against each statement, score it, and write your own improvement plan. Being able to show that you already knew about a weakness and were acting on it changes the conversation entirely.

Common questions

What are the 5 CQC standards?

They are the five key questions CQC asks of every service: is it safe, is it effective, is it caring, is it responsive to people's needs, and is it well-led. Each key question is broken down into quality statements written as 'we' statements from the provider's point of view, and CQC scores the evidence behind them.

What are CQC quality statements?

Quality statements are short commitments grouped under the five key questions — for example 'we make sure people are at the centre of their care and treatment choices'. They replaced the older key lines of enquiry (KLOEs) and describe what good looks like in practice, which is why your evidence should be organised against them rather than against policy titles.

What are the fundamental standards?

The fundamental standards are the legal minimum set out in Regulations 9 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 — person-centred care, dignity and respect, consent, safe care and treatment, safeguarding, nutrition, premises and equipment, complaints, good governance, staffing, fit and proper staff, duty of candour and display of ratings. Breaching them can lead to enforcement action, not just a lower rating.

How does CQC score a service now?

CQC gathers evidence against the quality statements, scores it, and aggregates those scores upward into a rating for each key question and an overall rating of outstanding, good, requires improvement or inadequate. Because scoring is at quality statement level, a single weak area no longer necessarily drags a whole domain down — but nor can strong areas hide a specific gap.

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