What are Key Lines of Enquiry (KLOEs) in Health and Social Care?

KLOEs stand for Key Lines of Enquiry. This term is central to the inspection and regulation of health and social care organisations across England. The Care Quality Commission (CQC) uses KLOEs as a framework for assessing the quality and safety of care provided by services ranging from care homes and hospitals to GP practices and community health services.

KLOEs shine a light on what matters most to people who use these services. They do not cover management theories or policies for their own sake. Instead, they ask straightforward, practical questions about care quality. Inspectors use them to focus on what happens in day-to-day life for patients and service users.

What is The Purpose Behind KLOEs?

The CQC wants to make sure people who need care, support, or medical treatment have a reliable voice. KLOEs reflect the priorities of care users, their families, and carers. Rather than tick-box exercises, they prompt organisations to think about real experiences of safety, effectiveness, compassion, responsiveness, and leadership.

Inspectors apply KLOEs during routine inspection visits, complaints investigations, and special reviews. By doing so, they ensure consistency across different organisations, service types, and local authorities. This means that whether someone lives in Cornwall or Cumbria, the standards expected should be the same.

The Five Domains: What Do They Mean?

The CQC frames its inspection and rating process around five simple yet powerful questions. Each question forms a domain—sometimes called a ‘key question.’ KLOEs break down each domain so nothing gets overlooked.

The five domains are:

• Safe
• Effective
• Caring
• Responsive
• Well-led

Let’s take a look at each.

Safe

Are people safe from abuse and avoidable harm? Safety matters in every setting. Inspectors consider both staffing levels and the way risks to individuals are managed.

Examples of safe practice include:

• Proper medication administration and storage
• Infection prevention and control measures
• Prompt reporting and investigation of incidents

Effective

Does care, treatment, and support achieve good outcomes and help people live healthier lives? Is it based on best practice and evidence?

Inspectors check how staff skills match people’s needs. They consider whether organisations measure progress and support people to make choices based on clear information.

Caring

Are people treated with kindness, respect, and dignity? This domain covers how frontline staff behave in daily interactions.

Care shines through in:

• Listening to people’s concerns and acting on them
• Involving families and carers in decisions
• Respecting privacy

Responsive

Do services meet people’s individual needs? Are they flexible enough to cope with changes or emergencies?

Responsive care means:

• Adaptations for disability, dementia, or language needs
• Timely access to care or support
• Clear complaints arrangements

Well-led

Is the organisation managed well? Does leadership set the right culture and practices for staff and service users?

Inspectors look for:

• Clear roles and responsibilities
• Open, honest communication
• A culture that puts people first

How KLOEs Work in Practice

KLOEs take the five domains and turn them into focused questions. They dig deeper, so no serious issue gets missed. Each domain has several KLOEs, which are then linked to prompts. Prompts are examples of what inspectors might look for, such as whistleblowing policies or staff training records.

For instance:

• Within ‘Safe,’ one KLOE asks: “Are lessons learned when things go wrong?”
• For ‘Caring,’ a KLOE may ask: “Do staff involve and treat people with compassion, kindness, dignity, and respect?”

Care services should already know their strengths and areas for growth. KLOEs help organisations reflect honestly about their day-to-day routines, records, reports, and relationships.

Why Use KLOEs? The Aims for Everyone Involved

KLOEs benefit managers and care teams by providing a shared reference point. They show what inspectors will look for, so nothing comes as a surprise during a visit. At the same time, KLOEs support people using services to understand what they can reasonably expect from caregivers and managers.

Outcomes include:

• Fairness and consistency—everyone is measured by the same markers
• Focused improvements—specific areas for action are easier to identify
• Clear communication—everyone can see what matters most

Language and Structure of KLOEs

KLOEs use plain, open-ended questions instead of technical jargon or lengthy policies. This simplifies the inspection process. They can be used in team meetings, audits, supervision, and handovers—not just by inspectors.

Sample language from the ‘Caring’ domain may include:

• “Do staff treat people with respect and sensitivity?”
• “How do staff encourage people to express their views and be involved in decisions?”

Prompts and Evidence: Putting KLOEs into Action

Every KLOE connects to a set of prompts. A prompt is a specific question or idea for evidence that links back to the KLOE. Prompts keep inspections structured, but they also help organisations prepare and self-assess.

Examples of prompts:

• How does the service support people to understand risks and choices?
• In what ways does the organisation check staffing ratios against people’s needs?
• What do people and relatives say about the reliability and kindness of staff?
• Are lessons learned and shared when something goes wrong?

Sources of evidence include:

• Staff and user interviews
• Service records (such as care plans and risk assessments)
• Observation of practice
• Policies and incident logs

How Inspectors Use KLOEs

CQC inspectors plan their visits around KLOEs. They start by reviewing evidence already held about a service, such as complaints, notifications, and previous inspection reports. On the day, they use KLOEs and prompts to guide interviews, spot checks, and paperwork reviews. They talk to service users, staff, family members, and professionals.

After a visit, inspectors link their findings directly to KLOEs in their written reports. This makes the inspection evidence clearer and more transparent for everyone. Organisations can trace comments and recommendations directly to the questions that matter.

How Services Prepare for KLOEs

Preparing for inspection or self-assessment using KLOEs involves reflection, discussion, and evidence gathering.

Services focus on:

• Involving staff at all levels in regular reviews of practice using KLOEs
• Using real-life examples to show strengths and improvements
• Keeping clear, up-to-date records to back up statements

Many organisations use checklists, action plans, and regular audits, all mapped to the relevant KLOEs. This keeps improvement work focused on what inspectors will look for, but also makes changes more meaningful for staff and those using the service.

Impact on People Who Use Services

KLOEs put the focus squarely on the experiences of people receiving care. They help highlight what works and point out gaps that need urgent action. For people using services, knowing about the KLOEs can help with questions to ask and what to expect from providers.

Benefits include:

• Greater confidence that care will be person-centred and consistent
• More say in how services are run and improved
• Easier access to information about quality and safety

Updating and Reviewing KLOEs

The CQC keeps the KLOEs framework under review. Sometimes, new questions or prompts are added, reflecting changes in law, guidance, or the needs of care users. For example, since Covid-19, prompts relating to infection control have gained extra attention.

Providers should stay up-to-date by:

• Checking the CQC website for the latest versions
• Engaging with CQC newsletters and bulletins
• Attending local or regional events focused on regulation and quality

KLOEs in Action: Everyday Examples

Here are some practical, everyday uses of KLOEs in health and social care:

• A care home uses KLOEs to train new staff, ensuring everyone understands what good care looks like.
• A GP practice updates its complaints process, guided by the relevant ‘Responsive’ KLOEs and prompts.
• A domiciliary care agency holds a regular meeting where staff discuss recent incidents using a ‘Safe’ KLOE framework.
• Inspectors visiting a small supported living service interview people about whether staff show kindness, checking the ‘Caring’ KLOEs.

Common Misunderstandings Around KLOEs

Sometimes, people believe KLOEs are additional paperwork exercises. In reality, they sit at the heart of good care. KLOEs focus on what matters: the actual experiences of care, the attitudes and skills of staff, and the leadership behind services.

Another misunderstanding is that only managers or inspectors should worry about KLOEs. In fact, everyone— from receptionists to support workers— can use KLOEs as conversation starters about what they do well and what needs to change.

Final Thoughts

Anyone working in health and social care in England will come across KLOEs at some point. Understanding what they mean, how they work, and how to apply them in everyday practice supports higher standards and better outcomes for people who rely on these services. With a focus on experience, evidence, and improvement, KLOEs are a practical tool that shapes the quality and reliability of care services across the country.