CQC Inspection Checklist: What Inspectors Look For

How CQC assessment works now

CQC's assessment framework is built on five key questions. They ask whether a service is safe, effective, caring, responsive to people's needs, and well-led. Under each key question sits a set of quality statements, commitments written as “we statements” that describe what good care looks like and link directly to the regulations. Alongside them, “I statements” describe what good care feels like from the point of view of the person receiving it.

You will often see these called the five CQC domains. It is the same five areas (safe, effective, caring, responsive and well-led), but CQC's own term is key questions, and quality statements sit underneath them.

Ratings are unchanged: outstanding, good, requires improvement, inadequate.

One change is worth knowing, because a lot of published guidance has not caught up with it. In December 2024 CQC stopped scoring at evidence category level. Scores are formed at quality statement level. If you are following advice that tells you to optimise category-by-category scores, that advice is out of date. Note also that it is now simply the “assessment framework”: CQC dropped the word “single” in January 2024.

The six evidence categories inspectors draw on

Everything an inspector considers falls into six evidence categories: people's experience of health and care services; feedback from staff and leaders; feedback from partners; observation; processes; and outcomes.

Two of those six are the ones providers systematically under-prepare. Feedback from partners means local authority commissioners, safeguarding teams, district nurses, GPs and hospital discharge teams. Their view of you is forming continuously, whether or not you manage it. Outcomes means showing that what you do changes something for the person, which is a different claim from showing that you did it.

Processes is the category most providers over-invest in, because it is the easiest to evidence. A folder of signed policies proves a process exists. It does not prove the process works.

Which categories carry most weight varies by sector. CQC publishes separate evidence priorities for homecare and shared lives services and for care homes and supported living.

Safe: what inspectors ask to see

Safe has the widest evidence surface of the five, and it is where most enforcement activity begins.

Have ready:

• Safeguarding referral log, with outcomes recorded and not just referrals made
• Incident and accident records showing what was investigated, the root cause identified, who was assigned the action, and evidence that the action was completed
• Risk assessments dated within your own stated review cycle, and demonstrably updated after any change in need
• Medicines records: MAR charts, staff competency assessments, and audits of both
• Recruitment files with the full set of pre-employment checks, and a written rationale wherever a DBS return was not clear
• Training records showing completion, not enrolment
• Infection prevention and control records

The question an inspector is answering is not whether something went wrong. Things go wrong in every service. It is whether you noticed, whether you acted, and whether the same thing then stopped happening. A service that reports more incidents and closes them well presents better than one that reports few and cannot explain why.

Effective: what inspectors ask to see

Effective is about whether care achieves what it is meant to achieve.

Have ready:

• Care plans recording the person's own goals in their own words, and review records showing those goals changing over time
• Assessments of need completed before care started
• Nutrition and hydration monitoring, where relevant to your service
• Evidence of joint working with other professionals, including what came back from them
• Consent records
• Mental Capacity Act documentation: capacity assessments that are decision-specific and time-specific, best interests decisions recording who was consulted, and DoLS or Court of Protection authorisations where they apply

Mental Capacity Act evidence is where otherwise well-run services most often lose ground. Blanket capacity assessments, or assessments that record a conclusion without recording the assessment itself, are common and are treated seriously.

Caring: what inspectors ask to see

Caring is the key question least amenable to documentation, which is precisely why it needs preparing.

Inspectors weight direct observation and people's own words heavily here.

Have ready:

• Feedback from people using the service and their families, gathered systematically rather than as a testimonial exercise
• Complaints and compliments, with what changed as a result
• Evidence of how privacy and dignity are protected in practice
• Records showing people exercising choice and control over their care

The strongest evidence under this key question is usually not a document. It is a member of staff, on the day, describing a person's preferences without needing to look them up. That makes staff continuity and handover quality part of your Caring evidence, whether you have thought of it that way or not.

Responsive: what inspectors ask to see

Responsive covers whether care adapts to the person.

Have ready:

• Personalised care planning, including for people whose needs are not typical of your service
• How you meet communication needs under the Accessible Information Standard
• Your complaints process, with timescales met and outcomes recorded
• End-of-life care planning, where relevant
• Evidence that you have identified and responded to inequalities, including for people with protected characteristics and people more likely to experience poorer care

That last point is explicit in CQC's framing and is routinely missed. “We treat everyone the same” is not a response to it.

Well-led: what inspectors ask to see

Well-led caps more ratings than any other key question, because weakness here undermines confidence in everything else.

Have ready:

• Governance and audit calendar, with evidence of completion rather than scheduling
• Audit findings with action plans, named owners, and verified closure
• Quality assurance demonstrating provider-level oversight, not only registered manager oversight
• A risk register that is live
• Supervision and appraisal records at the frequency your own policy states
• Staff survey results, and what you did about them
• Notifications submitted to CQC and other bodies
• Business continuity planning
• A documented learning culture: the thread running from an incident, through analysis, to a change in practice, to confirmation that the change held

If you can produce that final thread for three unrelated incidents from the past year, you are in a stronger position than most services.

What changes depending on your care setting

CQC sets different evidence priorities for homecare and shared lives services than for care homes and supported living, and the practical differences matter.

In domiciliary care compliance your evidence is distributed across people's homes and staff who work alone. Lone working risk assessments, call timing and duration records, missed and late call reporting, community spot checks, travel time between calls, medication administration without supervision, and remote supervision all carry weight they simply do not in a building-based service.

In residential care compliance the evidence is concentrated in one building, which cuts both ways: easier to produce, harder to explain away. Environmental safety, staffing levels against dependency, mealtime observation and restrictive practice come to the fore.

In supported living compliance the tension is between support and autonomy. Capacity, tenancy rights, positive behaviour support, and the line between supporting someone and restricting them are what get tested.

The week before your assessment

By this point you are assembling, not fixing. Pull your evidence together in the order an inspector will ask for it, and check three things.

First, that every action you have recorded as complete actually has evidence of completion attached. Second, that your supervisors and senior staff can each describe your oversight routines without prompting, because inspectors may speak to any member of the team, not only the people you nominate. Third, that anything you have changed in the last three months is reflected in the documents that describe it, because a policy that contradicts current practice is worse than no policy. This is also where evidence of a learning culture either holds together or does not.

What happens after the assessment

An assessment does not end when the inspector leaves. You receive a draft report before anything is published, and you have a route to challenge it on grounds of factual accuracy. CQC updated its guidance on what providers should expect to see in a draft assessment report in May 2025.

Two things follow, and both are worth deciding before you need them. Someone in your organisation has to own the factual accuracy response, with the time to do it properly, because it is a document-by-document exercise rather than a letter of objection. And the strength of that response depends entirely on evidence you already held on the day. You cannot create it afterwards. A finding that says you could not demonstrate something is very hard to answer if the record genuinely did not exist at the time.

This is the practical case for keeping evidence retrievable rather than merely complete. A service that can show with dates that a document existed and was available can correct a factual error. A service that has to reconstruct it cannot.

Check CQC's current guidance for the process and timescales that apply to your assessment, as these are updated from time to time.

Download the CQC inspection checklist

A single-page version of the above, organised by key question, for printing or sharing with your team. No sign-up required.

Frequently asked questions