Service Inspections

Scope of this chapter

The Care Quality Commission (CQC) registers, monitors, inspects and rates health and social care services across England.

The purpose of inspection is to ensure that people using services are provided with safe, effective, compassionate, high-quality care and that all regulations are being met.

This chapter provides an overview of the CQC service inspection process and links to a host of useful external resources from the CQC and Skills for Care to support the registered person and their team to understand and prepare for inspection, and to get the most from it.

Relevant Regulations

Related Chapters and Guidance

Comprehensive inspections take an in-depth look at the whole service. 

All services will experience comprehensive inspections. This is the process by which CQC determine an overall service rating 

Focused inspections are more targeted. They are usually a response to specific information received from a commissioner or a family member, or to follow up findings from a previous inspection. As such, not all services will experience a focused inspection process. 

Focused inspections can become a comprehensive inspection if other concerns or issues are identified.

Targeted inspections have an even narrower remit than focused inspections. They assess a specific risk or concern. For example, if there are concerns that medication errors are occurring. 

The CQC uses a direct monitoring approach to regularly review the information it has about all services and make decisions about the need to inspect at any given point in time. 
This information includes:

  • Provider Information Returns (PIR);
  • Comments made through phone calls, letters and emails;
  • Information from other organisations e.g., commissioners, safeguarding adult boards;
  • Information from staff who have raised concerns;
  • Information from the service e.g., notifications;
  • Any other information deemed to be relevant.

The CQC is likely to instigate an inspection process if the information suggests:

  1. People using the service may be at risk of harm;
  2. The service may be in breach of any regulation it is required to meet. 

Depending on the nature of the concern, this inspection could be comprehensive, focused or targeted.

For further information about types of inspection see above.

Traditionally, service inspections always took place on site. However, things are changing, and inspections are now also carried out remotely (in full or part) using technology such as Microsoft Teams, Zoom, telephone calls, email and SharePoint. Remote inspections allow for the inspectors to speak to more people using the service, their families and the staff team. It also causes less disruption for people using the service and poses less risk to people from infection.

For further information and guidance about how remote technology can be used see: How we use remote technology to inspect homecare (domiciliary care) services and extra care housing.

Note: Even though this guidance title suggests it is for homecare and extra care services only, it still applies to other services when a remote approach is taken.

The inspection team is responsible for determining the best method of inspection. This decision will be made based on the information available to them at the time. If the information suggests that the service may not be meeting regulations, an on-site inspection will normally take place.

The senior inspector will decide the size and make-up of the inspection team.

This is determined based on the specific circumstances at the time. For example, the type of inspection to be carried out, the method of inspection and any specific expertise needed to assess risks.

The inspection of a care home will usually be unannounced.

In a few instances, where there are valid reasons, the CQC may let the service know.  For example, in a small home, as this ensures that people using the service will be at home.

Inspections of domiciliary care agencies and Shared Lives schemes will usually be announced 48 hours in advance. This ensures that the registered person can be available on the day of the inspection. 

48 hours’ notice may also be given to supported living schemes and extra care housing schemes, but this will vary depending on the way the service is organised. For example, if the registered person is based on site, the visit could be unannounced.

The inspection framework is the process applied by the inspection team to assess whether the service is meeting all the required regulations. This includes the fundamental standards.

The fundamental standards

For further information about the fundamental standards see: The fundamental standards.

The current inspection framework used by the CQC is called the Key Lines of Enquiry (KLOE). These are divided into 5 areas:

  • Safe;
  • Effective;
  • Caring;
  • Responsive;
  • Well led.

There is extensive guidance on the CQC’s website about the KLOE’s and the evidence that the inspection team will be looking for.

See: Key lines of enquiry for adult social care

Evidence will be gathered in several ways:

  • Speaking to people who use the service;
  • Speaking to staff;
  • Observing care;
  • Reviewing records;
  • Inspecting the places where people are cared for;
  • Looking at documents and policies.

At the end of the evidence gathering process, a meeting should be held with the registered person (or a senior member of staff present at the time). 

During this meeting, the inspection team should:

  • Give a summary of what has been found during the inspection;
  • Highlight any issues that have come up;
  • Identify any action the service needs to take immediately;
  • Outline any plans for further visits;
  • Explain what will happen next in terms of making a judgement and providing a draft report.

After gathering the evidence, the inspection team will take some time to evaluate it and decide on a rating. 

The inspection team will give a rating to each of the 5 key lines of enquiry areas. They will then allocate an overall rating to the service.



A draft report setting out the rationale for their ratings and the evidence used will then be prepared and sent to the registered person for review.

If they wish to respond to the draft report, the registered person has 10 days to do this by submitting a Factual Accuracy Check.

For information and guidance see: Factual accuracy check

The senior inspector will review the comments in the Factual Accuracy Check and amend the draft report and ratings if they deem it appropriate to do so.

After reviewing the Factual Accuracy Check (or after 10 days if no Factual Accuracy Check is submitted) ratings will be finalised, and a final report submitted to the registered person. 

The registered person must ensure that the CQC ratings are displayed in a place where they can be seen. This is a legal requirement.

The ratings and a copy of the final report should also be published on the service’s website (if you have one).

The CQC will also display the ratings and final report on their website.

The Skills for Care inspection toolkits are service specific and can support you to understand what good and outstanding care looks like:

Skills for Care: Preparing for CQC inspection

Inspection toolkit

Improve your CQC rating

Outstanding care

Last Updated: September 12, 2022