CQC part 3: The assessment & inspection process

What is a CQC inspection?

All CQC service providers are subject to regular inspections in order to monitor the service being delivered. The CQC must ensure your service meets the ‘Five Key Lines of Enquiry’, or KLOE (sometimes also referred to as the 'Five Key Questions). These 'lines of enquiry' make sure that the care your service provides is safe, effective, responsive, caring and well-led.

The frequency of inspections, the size of the inspecting team, and whether the CQC informs the service of when they are visiting is related to several factors. This includes the type of service that is being inspected, the provider’s previous rating and the CQC analysis risk. 

Typically, the following types of service providers will be aware of what CQC call an ‘announced comprehensive’ inspection:

• NHS acute and specialist trusts
• NHS mental health trusts
• NHS community health trusts
• NHS ambulance service trusts
• Specialist substance misuse services
• NHS GP practices and GP out-of-hours services
• Adult social care services

There are also ‘focused’ inspections, which are typically smaller in scale, but share some similarities with ‘comprehensive’ assessments. They do not necessarily look at all five key lines of enquiry.

Focused assessments are carried out if:

• There is a need to investigate a concern that might have been raised during a comprehensive inspection or via monitoring work.
• There has been a change in a provider’s circumstances. For instance, a change in ownership or management, by means of a sale, merger or acquisition.
  
  

What can I expect from a CQC inspection? 

Before your physical inspection, you will be asked to provide some key documentation and upload it to the CQC portal - you can learn more about this documentation on our dedicated Registration Process page.

To begin your on-premises inspection, the CQC inspectors will usually meet with the senior staff at your service. This will involve the inspectors introducing themselves, providing the scope and purpose of the inspection and how findings will be communicated. 

It is quite common practice for the service provider to also provide a short presentation. This could include a review of your service, as well as any findings and views on your performance. 

What kind of evidence do the CQC collect?

The inspection team will use the basis of the 'Five Key Lines of Enquiry' and a set of quality statements to structure their visit, focusing on any areas that are of concern, and/or where your service is performing very well. 

There are six different types of evidence the CQC can gather. These include:

• Collecting views from service users - this may be by speaking directly to them, using survey cards and NPS scores. They also gather any information from complaints and concerns, incidents or near-misses.
• Collating information from your staff - this can be pre-planned or random on the day.
• From observing care, reviewing care pathways, records, inspecting the physical areas of service delivery and reviewing documents and policies.

This process typically takes between two and five hours.

How will feedback from the inspection be provided?

Once the inspection has finished, the inspectors hold a short feedback meeting with senior staff. In this, they will provide a summary of what has been found during the visit, any issues that have arisen, and any immediate actions you’ll need  to take. 

The results of your service visit will be posted to the CQC website, which is visible to the public.

They will also provide a plan for any future announced visits, and explain briefly about how judgements and ratings are made and published.

What is the CQC’s New Single Assessment Framework?

The CQC used to have three different assessment frameworks: one for hospitals, one for adult social care and one for primary medical services. 

However, since the end of 2023 this has been streamlined into a ‘Single Assessment Framework’. This aim of this is to simplify the process and provide a single, overall set of expectations, with a clearer understanding of what constitutes a ‘good’ service and ‘quality’ care. 

This new framework now applies to all providers, local authorities and integrated care systems. 

How much notice will I be given?

As mentioned above, the notification timeline for an inspection is highly variable and depends on the type of service, as well as previous ratings and findings on previous inspections. If you’re not one of the listed service providers that would typically receive a notification about an ‘announced comprehensive inspection’, it’s likely you can expect an unannounced inspection.

What kind of documents do the CQC request?

It is generally expected that you will have all documentation relating to your service provision - from paperwork for patients, service users and staff, to policies and procedures, HR paperwork, audits and feedback. The CQC may request to see a sample of these.

How much notice will I be given before an inspection?

The notification timeline for an inspection is highly variable and depends on the type of service, as well as previous ratings and findings on previous inspections.

If you’re not one of the listed service providers that would typically receive a notification about an ‘announced comprehensive inspection’, it’s possible you could expect an unannounced inspection.

As such, once a provider has been granted successful registration, it's wise to ensure that the Registered Manager and/or Nominated Individual of the organisation dedicate some time ensuring that everything is up to scratch.

Like all things, the more prepared you are, the better. Usually with an announced inspection, the CQC will give a minimum of two weeks notice. Use this time to plan and ensure that key people, such as the Registered Manager, are available.

What are the ratings that the CQC use for inspections?

There are 4 ratings provided: