Everyone has the right to receive high-quality care, whether this is the service they receive from their GP, emergency healthcare, social care or residential care.

The Care Quality Commission exists to monitor, assess and rate care providers to ensure acceptable standards of care are met and upheld across a range of healthcare settings.

As a specialist in care home insurance, we have put together this guide to explain the role of the CQC and what care providers must do to meet the necessary standards.

In this guide, we cover:

What is the CQC?

The Care Quality Commission is the independent regulator of health and adult social care in England. It was established in 2009 as an executive nondepartmental public body of the Department of Health and Social Care. Its purpose is to help ensure care facilities meet the necessary standards of health and social care.

What does the CQC do?

The CQC works to ensure health and social care services in England provide people with safe, effective, compassionate and high-quality care. The main roles and responsibilities of the CQC are to inspect, monitor and regulate these services to ensure they meet fundamental standards of quality and safety. Just as importantly, the CQC publishes its findings, including performance ratings to help people make informed decisions about their care or the care of others.

Who does the CQC regulate?

Activities regulated by the CQC include the treatment, care and support provided by hospitals, GP practices, ambulance services, care homes and care home agencies, mental health services, domiciliary services, hospices, community adult social care services, clinics and dental practices.

Before a care provider can carry out any of the activities regulated by the Care Quality Commission, they must register with the CQC and demonstrate that they meet a number of legal requirements. If they are not registered, they are committing a criminal offence.

What does the CQC look for?

Inspectors will gather evidence using five key questions to structure their inspection and record their findings.

  1. Are they safe? Are care seekers, staff and visitors protected from harm? Does the facility have adequate staff on duty with the required skills to care for patients/residents? Is medication being administered safely and effectively? Is the home being kept clean and hygienic?
  2. Are they effective? Is the care, treatment and support offered achieving a good outcome? Are the staff aware of the residents’ individual care requirements? Is the quality of life for care seekers being improved?
  3. Are they caring? Do staff involve their residents and treat them with compassion and dignity? Does the care facility as a whole have a caring culture? For care homes, what is the visiting policy for family and friends?
  4. Are they responsive to people’s needs? Are services able to effectively meet the care seekers’ needs and be adaptable if needs or preferences change? Are family and friends involved in the creation of care plans? For care home residents, does the care plan include information about their interests and hobbies?
  5. Are they well-led? Are the senior leadership team and management of the care facility doing a good job of delivering excellent person-centred care? Do all staff members understand what is expected of them, and do they feel comfortable reporting any concerns?

How often does the CQC inspect healthcare facilities?

All new healthcare facilities will be inspected by the Care Quality Commission within 6–12 months of opening. After this initial inspection, the CQC will inspect the facility at least once every three years.

What happens during a CQC inspection?

During an inspection, the CQC inspectors will:

  • Meet with the senior team
  • Speak with staff members and residents
  • Observe the care provided
  • Inspect the care facility
  • Review records, policies and documentation

How does the CQC rate healthcare facilities?

Following a CQC inspection, the care facility will be given one of four ratings:

  • Outstanding: The service is performing exceptionally well.
  • Good: The service is performing well and meeting the CQC’s expectations.
  • Requires improvement: The service is not performing as well as it should and the CQC has outlined how it must improve.
  • Inadequate: The service is performing badly and the CQC has taken action against the organisation or person who runs the service.

What else should a healthcare facility consider?

Having adequate insurance in place is a requirement of the CQC and other relevant regulatory bodies but it can also be vital to protect you from the many risks you face as a healthcare provider.

Gallagher has over 25 years’ experience in providing insurance for care home businesses and we understand the challenges that care home managers face as they seek to provide quality care—often operating within restricted budgets.

We can work with you to design an insurance programme that reflects the services you provide. This could include, for example, cover for specific liabilities such as medical malpractice, treatment risk and potential abuse claims. You can find out more about the range of covers provided by Gallagher on our care home insurance page or speak to our specialist team.

  • Gallagher Care Team


The sole purpose of this guide is to provide guidance on the issues covered. This article is not intended to give legal advice, and, accordingly, it should not be relied upon. It should not be regarded as a comprehensive statement of the law and/or market practice in this area. We make no claims as to the completeness or accuracy of the information contained herein or in the links which were live at the date of publication. You should not act upon (or should refrain from acting upon) information in this publication without first seeking specific legal and/or specialist advice. Arthur J. Gallagher Insurance Brokers Limited accepts no liability for any inaccuracy, omission or mistake in this publication, nor will we be responsible for any loss which may be suffered as a result of any person relying on the information contained herein.