CQC Compliance for Care Providers in England

Who this guide is for

This guide is for anyone who runs, manages or plans to set up a health or adult social care service in England. That could be a care home, a home care agency, a GP practice or a private clinic. It includes service providers, registered managers, nominated individuals and directors. It covers:

• Whether you need to register with the Care Quality Commission (CQC).
• The fundamental standards and the other regulations a registered provider must meet.
• Registered managers and the fit and proper person rules for directors and staff.
• Statutory notifications, the duty of candour and displaying your rating.
• Draft reports, factual accuracy comments, ratings and rating reviews.
• CQC enforcement: Action Plan requests, Warning Notices, conditions, suspension, cancellation and prosecution, and how to respond.

What this guide does not cover

• Care services in Wales, Scotland or Northern Ireland: the CQC only regulates services in England, and each of those nations has its own regulator.
• Homes for children, fostering and adoption agencies and other children's social care settings: Ofsted regulates those, not the CQC.
• A complaint or concern from someone getting care, or their family: see our care concerns guide.
• Council care assessments and care charges: see our social care guide.
• Your duties as an employer to care staff, such as contracts and pay: see our employer guide.
• A worker's rights after raising a concern about a service: see our whistleblowing guide.
• The full list of regulated activities and every exception and exemption: this guide does not cover them in detail. Read the CQC scope of registration guidance or ask the CQC.
• CQC fees and fixed penalty amounts: this guide gives no money amounts.
• Advice on a particular prosecution, tribunal appeal or claim: get legal advice from a solicitor.

At a glance

• Any person or organisation carrying on a regulated activity in England needs CQC registration, unless an exception or exemption applies.
• Registered providers must meet the regulations, including the fundamental standards, the level below which care must never fall.
• CQC ratings run from outstanding to good, requires improvement and inadequate, and must be displayed.
• Check the draft report fast: factual accuracy comments are due within 10 working days.
• Disagreeing with a rating is not enough to change it: a rating review only looks at whether CQC followed its process, and there is no tribunal appeal.
• A Warning Notice allows representations only. Proposed conditions, suspension or cancellation can be challenged in writing and then appealed to the First-tier Tribunal.

What the rules depend on

• Is the service in England?
• Does what you do count as a regulated activity, and does an exception or exemption apply?
• Are you the registered provider, the registered manager, a nominated individual or a director?
• First, work out exactly what the CQC has sent you. It could be: a draft report, a published report, an Action Plan request, a Warning Notice, a Notice of Proposal, a Notice of Decision, or a notice or court order under the urgent procedures. The time limit and the way to challenge it depend on which one it is.
• When was it served, and was it sent by email, by post or by hand?
• Has something happened that must be notified to the CQC, or that triggers the duty of candour?
• Was anyone harmed or put at risk of harm?

"Do we need to register?"

• The CQC registers the regulated activity that is carried on, not the type of service or the profession.
• The service provider must register. A provider can be an individual, a partnership or an organisation, such as a company, a charity, an NHS trust or a council.
• It is the legal entity carrying on the regulated activity that must register, not the place where the care is given.
• The regulated activities are listed in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They include personal care and accommodation for persons who require nursing or personal care.
• If you carry on any of those activities in England, you must register unless an exception or exemption applies.
• Apply only when everything is in place to start the service, including the locations and the staff.
• It is a criminal offence to carry on a regulated activity in England without being registered. This is in section 10 of the Health and Social Care Act 2008.
• If the case goes to the Crown Court, the penalty for that offence can be a fine, up to 12 months in prison, or both.
• Suppose you are registered in England and also plan to provide a service to people living in Wales, Scotland or Northern Ireland. The CQC strongly advises you to check with that nation's regulator whether you need to register there too.

"Registered managers, directors and staff"

• A manager is the person in day-to-day charge of carrying on the regulated activity. The Care Quality Commission (Registration) Regulations 2009 set out when a service must have a registered manager as a condition of its registration.
• Under regulation 7, a registered manager must meet four tests:
• They must be of good character.
• They must have the qualifications, competence, skills and experience to manage the regulated activity.
• They must be able to do so because of their health (after reasonable adjustments).
• They must be able to give the CQC the information it requires about them.
• A new manager cannot manage regulated activities until the CQC confirms their registration. The CQC says its assessment can take a few months.
• Regulation 5 covers a provider that is a body other than a partnership, such as a company. That provider must not appoint or keep a director, or anyone doing a director's job, unless they are fit and proper.
• For directors, being fit and proper means:
• good character;
• the right qualifications, competence, skills and experience;
• being able to do the job after reasonable adjustments; and
• not having been responsible for serious misconduct or mismanagement in carrying on a regulated activity.
• The CQC cannot prosecute for a breach of regulation 5 or regulation 7, but it can take other regulatory action.
• For staff (regulation 19, fit and proper persons employed), the provider must:
• only employ people who can give care appropriate to their role;
• have strong recruitment procedures; and
• carry out relevant checks, such as criminal records and work history.

"What are the fundamental standards?"

• The fundamental standards are set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. When the CQC registers a service, it checks the service is likely to meet them.
• They are: person-centred care (regulation 9); visiting and accompanying (regulation 9A); dignity and respect (regulation 10); need for consent (regulation 11); safe care and treatment (regulation 12); safeguarding from abuse and improper treatment (regulation 13); nutrition and hydration (regulation 14); premises and equipment (regulation 15); receiving and acting on complaints (regulation 16); good governance (regulation 17); staffing (regulation 18); fit and proper persons employed (regulation 19); duty of candour (regulation 20); and display of ratings (regulation 20A).
• The visiting and accompanying rules have applied to care homes, hospitals and hospices since 6 April 2024. Unless there are exceptional circumstances:
• people staying there must be helped to receive visits;
• care home residents must not be discouraged from going out on visits; and
• people attending a hospital or hospice without an overnight stay must be able to have a family member, friend or supporter with them.
• Complaints: the provider must have a system to handle and respond to complaints, investigate them thoroughly and act if problems are found.
• Good governance: the provider must have effective governance and systems to check the quality and safety of care.
• Staffing: there must be enough suitably qualified, competent and experienced staff, with the support, training and supervision they need.

"What must we notify the CQC about?"

• Registered providers must notify the CQC about certain changes, events and incidents that affect their service or the people who use it.
• The events and incidents include: the death of a person using the service; a serious injury to a person using the service; allegations of abuse; police involvement in an incident; and events that stop the service running safely and properly. They also include the outcome of an application to deprive a person of their liberty (DoLS); the absence of a registered person for 28 days or more, and their return; children and young people in adult psychiatric units; and the death or unauthorised absence of a detained mental health patient.
• The death of a person using the service must be notified without delay.
• You only need to send a notification about a medicines error if it causes a notifiable event. Examples are a death, a serious injury, an allegation of abuse or an incident reported to the police. If you do send one, say in the notification that a medicines error was a known or possible cause.
• The CQC can prosecute a failure to notify directly: no one needs to have been harmed.

"Something has gone wrong: the duty of candour"

• Under regulation 20, registered persons must act in an open and transparent way about the care and treatment given. This applies to the people they care for and to people acting for them.
• As soon as reasonably practicable after you become aware of a notifiable safety incident, you must do two things. First, tell the relevant person that it has happened. Second, give them reasonable support, including when you tell them.
• That notification must be given in person by one or more representatives of the provider.
• It must include a true account of what you know about the incident, the further enquiries you think are needed, and an apology. It must then be followed up in writing, and a written record kept.
• The CQC guidance on the duty of candour explains what counts as a notifiable safety incident and gives examples. Check it for your type of service.
• Failing to notify the relevant person as regulation 20 requires is an offence. The rest of regulation 20 is enforced through other regulatory action.

"Our rating and report"

• The CQC looks at whether services are safe, effective, caring, responsive to people's needs and well-led. It rates them outstanding, good, requires improvement or inadequate.
• The CQC says it will bring in new assessment frameworks at the end of 2026, after publishing the final versions in summer 2026. Check the CQC website for the approach that applies to your assessment.
• The CQC sends the draft report by email to the registered person.
• You have 10 working days from the date of CQC's email to send factual accuracy comments.
• The CQC will not extend that period unless there are exceptional circumstances. If you cannot meet the deadline, tell the CQC why straight away, in writing.
• If there are no factual inaccuracies, you can confirm you have reviewed the draft, and the CQC can then publish the final report.

"Can we challenge our rating?"

• A rating cannot be appealed to the First-tier Tribunal.
• The CQC offers a rating review. It is a CQC policy, not a legal right of appeal.
• The only ground for a rating review is that CQC did not follow its own process for making ratings decisions.
• You cannot ask for a review just because you disagree with the CQC's judgements.
• You can only ask after the report is published. Use the CQC's online form and ask within 15 working days of publication. Your request should normally be no more than 500 words.
• The form must be completed by the registered manager, the nominated individual, or the chief executive of an NHS trust.
• You get one chance per report. A review can move ratings down as well as up.

"Displaying our rating"

• Under regulation 20A, once you have a rating you must show it in two places. First, at each place where you provide regulated activities. Second, on your website, together with the CQC's website address and where the report can be found.
• The rating must be on display at the premises and on the website no later than 21 calendar days after the CQC publishes it.
• Asking for a rating review does not stop the duty to display the rating. You may add a note that you have asked for a review.
• The CQC can prosecute a failure to display the rating directly, without first serving a Warning Notice.

"The CQC has asked us for an action plan"

• Action Plan requests used to be called Requirement Notices.
• The CQC considers one where, among other things:
• a provider is in breach of the regulations;
• the impact on people is not immediately significant; and
• the provider should be able to improve within a reasonable time.
• Your report must show how you will meet the legal requirements and what action you are taking, or will take. This must be within a timeframe the CQC judges reasonable.
• Not sending the report within the set timescale is an offence and could lead to enforcement action. The CQC may refuse an action plan that does not deal with the problems.

"We have had a Warning Notice"

• The CQC can serve a Warning Notice where a registered person has failed to meet the legal requirements for the care they are responsible for. This is under section 29 of the Health and Social Care Act 2008. NHS trusts get a section 29A notice instead.
• A Warning Notice about a continuing breach sets a date by which the improvements must be made. The law sets no fixed period: the CQC sets one it thinks is reasonable, reflecting the risk to people.
• If the improvements are not made in time, the CQC will consider further action. It aims to check every Warning Notice, with an unannounced visit if needed, within 3 months of the date set in the notice.
• Representations against a Warning Notice must be made in writing within 10 working days of it being served.
• There is no right of appeal to the First-tier Tribunal against a Warning Notice.
• A notice counts as served on a different day, depending on how it is sent:
• by email: the next working day;
• by registered post: the third day after posting; and
• by hand: the day it is handed over.

Example: the same notice, three ways

The CQC sends the same notice on a Tuesday.

• If it is emailed, it counts as served on the Wednesday.
• If it is sent by registered post, it counts as served on the Friday, which is the third day after posting.
• If it is delivered by hand, it counts as served on the Tuesday.

These dates assume there is no bank holiday that week.

• The CQC aims to reply to representations within 20 working days. It can publish a Warning Notice, but it must first give you the chance to make representations about publication.

"The CQC wants to add conditions, suspend or cancel our registration"

• Before it imposes, varies or removes conditions, suspends or cancels a registration, or refuses an application, the CQC normally serves a Notice of Proposal.
• You can make written representations within 28 days of the Notice of Proposal being served. The CQC cannot accept spoken representations: send them in writing by email or post, or deliver them to a CQC office.
• Send everything within the 28 days, including all your evidence: you cannot say you will send representations and then send them or more evidence later.
• For a Notice of Proposal sent by email, the day of service is the next working day after it was sent. For one sent by post, it is 3 calendar days after posting.
• If the CQC decides to go ahead, it serves a Notice of Decision. You can appeal against it to the First-tier Tribunal (Health, Education and Social Care Chamber) within 28 calendar days of service. If you do not appeal, the decision becomes final.
• Under the urgent procedures the CQC serves no Notice of Proposal, so there are no representations, but you can still appeal to the tribunal.
• The CQC can ask a magistrate for an order that cancels a registration immediately (section 30). It can do this if there will be a serious risk to a person's life, health or well-being unless the order is made. The CQC can apply without telling the provider first. The cancellation takes effect when the order is made. You can appeal against the order to the First-tier Tribunal.

"Can the CQC prosecute us?"

• For safe care and treatment (regulation 12), safeguarding (regulation 13, paragraphs 1 to 4) and nutrition and hydration (regulation 14), the CQC can only prosecute if the breach caused one of these:
• avoidable harm;
• a significant risk of such harm; or
• a loss of money or property through theft, misuse or misappropriation.
• Some offences need no harm at all. Examples are failing to display the rating, failing to send a statutory notification, and failing to notify under the duty of candour.

Example: harm and prosecution

A provider does not display its rating at a place where it provides regulated activities. Nobody has been harmed. This can still be an offence, because failing to display the rating needs no harm.

Now take a breach of the safe care and treatment rule (regulation 12). Nobody has been harmed, there is no significant risk of harm, and no money or property has been lost. The CQC cannot prosecute for that breach, because it can only prosecute if one of those things happened.

• For the areas below, the CQC cannot prosecute but can take other regulatory action:
• person-centred care (regulation 9);
• dignity and respect (regulation 10);
• premises and equipment (regulation 15);
• the complaints duties in regulation 16(1) and (2);
• the main good governance duties in regulation 17(1) and (2);
• staffing (regulation 18);
• fit and proper persons employed (regulation 19); and
• parts of other regulations.
• For offences under the 2014 Regulations, there is a defence. It applies if the registered person can show that they took all reasonable steps and exercised all due diligence to prevent the breach (regulation 22(4)).
• For some offences the CQC can offer a fixed penalty notice instead of prosecuting.

Deadlines

• Factual accuracy comments on a draft report: 10 working days from the CQC's email.
• Rating review request: within 15 working days after the report is published, not before.
• Showing a new rating: by the 21st calendar day after publication.
• Warning Notice representations: within 10 working days of service, in writing.
• Notice of Proposal representations: within 28 days of service, in writing, with all your evidence.
• Tribunal appeal: within 28 calendar days of service of a Notice of Decision, an urgent notice or a magistrate's order.
• Death of a person using the service: notify the CQC without delay.
• Duty of candour: tell the relevant person as soon as reasonably practicable.
• Action plan: within the timescale the CQC sets.

Money figures

• This guide gives no money amounts.

Where to go for help

Traps

• A rating is not an enforcement decision. The tribunal cannot change it, and a rating review is not a second look at the evidence unless the process went wrong.
• A rating review does not reconsider the evidence unless the process went wrong. So use the factual accuracy check to correct the evidence before the report is published.
• A Warning Notice has a much shorter time limit than a Notice of Proposal: 10 working days, not 28 days.
• Registering a care setting is not how it works: the provider registers the regulated activity it carries on.
• A medicines error on its own is not always notifiable, but a death, a serious injury or an allegation of abuse is.
• Old names still turn up. Requirement Notices are now Action Plan requests, and the CQC is replacing its current assessment framework at the end of 2026.