The Care Quality Commission (CQC) is the independent body that checks health and social care services to make sure they meet basic standards of quality and safety.
These CQC regulations help ensure that care providers deliver safe, effective, and high-quality services with compassion. In this blog post, we will cover the full list of CQC regulations and what they mean to care providers.
Here is a plain-English summary of the main requirements in Part 3 (regulations 4 to 20A) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is a summary only; check the legal wording on legislation.gov.uk and the CQC guidance on the regulations for providers and managers.
Regulation 4: Requirements where the service provider is an individual or partnership
Regulation 4 applies where the service provider is an individual or a partnership. The provider must be fit to carry on the regulated activity, which includes being of good character, being able to do the work given their health (after reasonable adjustments), and having the necessary qualifications, competence, skills and experience. Read regulation 4 for the exact wording.
Regulation 5: Fit and proper persons: directors
Regulation 5 ensures that directors of care services are suitable for their roles. It requires that:
- Where the provider is a body other than a partnership, it must not appoint or have in place a director who is not of good character, who lacks the necessary qualifications, competence, skills, experience or health for the role, or who has been responsible for serious misconduct or mismanagement. See regulation 5.
To adhere to this regulation, providers need to:
- Conduct thorough background checks on potential directors.
- Have the information required by Schedule 3 available, which can include a criminal record check from the Disclosure and Barring Service where the law allows for the role; see the DBS guidance for employers.
- Verify qualifications.
- Review past employment history.
- Assess character, conduct, and competence.
These steps are really important to prevent individuals who may endanger safety and well-being from holding essential positions.
Regulation 6: Requirement where the service provider is a body other than a partnership
Regulation 6 applies where the service provider is a body other than a partnership. The body must give CQC the name of a nominated individual (a director, manager or secretary who supervises the management of the regulated activity), and take all reasonable steps to make sure that person is fit for the role. See regulation 6.
Regulation 7: Requirements relating to registered managers
Regulation 7 sets out what makes a person fit to manage a regulated activity as a registered manager. Whether a service needs a registered manager depends on the registration rules in regulation 5 of the Care Quality Commission (Registration) Regulations 2009 and the CQC guidance on the regulations for providers and managers. Among other things, a registered manager must be:
- Appropriately qualified.
- Competent and experienced in managing the specific services provided.
They should also demonstrate leadership qualities that promote a safe, inclusive, and supportive environment within the care setting.
Registered managers play an important role in:
- Supervising daily service operations.
- Managing staff and resources effectively.
- Ensuring compliance with CQC regulations.
- Continuously improving service quality and safety.
Regulation 8: General
Regulation 8 is short: it requires a registered person to comply with regulations 9 to 20A (the fundamental standards) in carrying on a regulated activity. See regulation 8 and the CQC fundamental standards of care.
Regulation 9: Person-centred Care
Regulation 9 requires that care services be customised to meet the individual needs and preferences of each service user. This approach ensures that care is:
- Personalised for each individual.
- Respectful of their dignity.
- Supportive of their independence.
- Attentive to their specific wishes and requirements.
Providers must:
- Develop detailed care plans tailored to the individual.
- Regularly review these plans.
- Reflect the service user’s choices and preferences, and involve the person and, where appropriate, those close to them. See regulation 9.
This regulation emphasises delivering personalised care that respects and responds to the unique needs of each person.
Regulation 9A: Visiting and accompanying in care homes, hospitals and hospices
Regulation 9A was introduced to improve the quality of life for individuals in care settings by making specific provisions for visitors. It ensures that:
- Residents in care homes.
- Patients in hospitals.
- Clients in hospices.
Unless there are exceptional circumstances, people who stay overnight in these settings must be facilitated to receive visits, and people attending a hospital or hospice without an overnight stay must be enabled to be accompanied. See regulation 9A. This regulation emphasises the importance of supporting the social and emotional wellbeing of individuals through maintained relationships with loved ones.
Care providers must:
- Facilitate these visits effectively.
- Balance safety needs, especially during infectious disease outbreaks.
This approach helps ensure that individuals remain connected with their loved ones while receiving care.
Regulation 10: Dignity and Respect
Regulation 10 is dedicated to ensuring that service users are treated with dignity and respect. This standard is really important for making sure all interactions with healthcare professionals adhere to principles that prioritise individual human rights. It includes:
- Respecting privacy.
- Ensuring confidentiality.
- Engaging in a manner that recognises the value of each individual.
Providers must create an environment where service users:
- Feel listened to, valued, and respected.
- Receive accommodations necessary for disabilities, age, or cultural needs.
This applies not only to direct interactions but also how personal care tasks are handled, considering privacy and personal preferences.
Regulation 11: Need for Consent
Regulation 11 emphasises the essential importance of obtaining consent from individuals before administering any care or treatment. This regulation ensures that:
- Service users are fully informed about their care options.
- They can make decisions regarding their treatments based on this information.
Providers must:
- Obtain consent in a way that the individual understands.
- Consider factors like language barriers, mental capacity, and physical condition.
If a service user lacks the capacity to give consent, providers must follow legal frameworks, such as the Mental Capacity Act to ensure decisions made are in the best interests of the individual. This process respects each person’s rights and supports ethical medical practices.
Regulation 12: Safe Care and Treatment
Regulation 12 requires that all care and treatment provided must be safe, actively reducing any risks to the health, safety, and welfare of service users. Providers must:
- Assess risks to the health and safety of service users.
- Implement measures to mitigate these risks.
This includes:
- Ensuring equipment is suitable and well-maintained.
- Managing medicines safely.
- Protecting users from unsafe care.
Also, providers are required to have emergency plans in place. These plans should include clear procedures that all staff understand, ensuring safety across various situations.
Regulation 13: Safeguarding service users from abuse and improper treatment
Regulation 13 is essential for protecting service users from abuse, harm, and improper treatment. This protection covers:
- Physical, sexual, mental or psychological, financial abuse.
- Neglect and degrading treatment.
Providers must establish and operate effective systems and processes to prevent abuse of service users (see regulation 13), for example by:
- Providing proper training for staff to recognise and respond to all forms of abuse.
Also, they must implement robust procedures to:
- Report and respond to any allegations of abuse.
- Ensure all allegations are taken seriously and investigated thoroughly.
These measures are essential for safeguarding service users effectively and preventing future incidents.
Regulation 14: Meeting Nutritional and Hydration Needs
Regulation 14 focuses on ensuring that service users receive adequate nutrition and hydration to maintain good health and well-being. This is important in care settings where individuals might not be able to effectively communicate their needs or have complex health conditions affecting their dietary requirements.
Providers must:
- Assess the nutritional and hydration needs of each individual.
- Provide meals and fluids that meet these needs, taking into account personal preferences, religious or cultural backgrounds, and dietary restrictions.
Also, they need to:
- Offer support to those who require assistance with eating and drinking.
- Monitor the effectiveness of nutritional care plans.
This regulation ensures that all service users have access to the necessary nutrition and hydration for their health.
Regulation 15: Premises and Equipment
Regulation 15 ensures that the premises and equipment used in care delivery are safe, suitable, and well-maintained. This standard is important for preventing avoidable harm and reducing health risks to service users. Providers must:
- Ensure that the design and layout of the premises cater to the needs of service users, promoting effective care delivery while maintaining their dignity.
- Guarantee that all equipment is fit for its intended purpose, with regular inspections and maintenance checks to ensure safety and effectiveness.
This regulation covers:
- The suitability of physical environments such as treatment rooms and public areas.
- Premises and equipment being kept clean and to a standard of hygiene suitable for how they are used (see regulation 15).
By adhering to these standards, care providers help safeguard the health and well-being of service users through a secure and conducive environment.
Regulation 16: Receiving and Acting on Complaints
Regulation 16 features the importance of an effective and transparent approach to managing complaints within health and social care settings. Providers must:
- Have a system in place to receive, handle, and respond to complaints from service users or their representatives.
- Make sure the complaints system is accessible. See regulation 16.
Providers are required to:
- Investigate each complaint thoroughly and impartially.
Furthermore, insights gained from these complaints should be used to improve services. This demonstrates the provider’s commitment to continually enhancing care based on user feedback.
Regulation 17: Good Governance
Regulation 17 is important for ensuring that providers maintain an effective governance framework to support the delivery of high-quality care. This includes:
- Systems to assess, monitor, and improve the quality and safety of services.
- Systems or processes to ensure compliance with the requirements of the regulations. See regulation 17.
Good governance also involves:
- Proper management of records.
- Maintaining secure, accurate, complete and contemporaneous records for each service user. For data protection duties, see the ICO guidance for organisations.
- Evaluating and mitigating risks to service delivery.
This regulation ensures that organisations are not only aware of their responsibilities but are also equipped to perform them effectively.
Regulation 18: Staffing
Regulation 18 focuses on the adequacy and suitability of staffing, which are essential for delivering effective care. Providers must ensure:
- Appropriate staffing levels and skill mixes at all times to meet the needs of service users.
- Staff are suitably qualified, competent, and receive ongoing training to maintain current and relevant skills.
Also, Regulation 18 features the importance of staff welfare by ensuring:
- Support for staff to perform their duties effectively.
- Opportunities for professional development.
This regulation requires sufficient numbers of suitably qualified, competent, skilled and experienced staff, and the support, training, professional development, supervision and appraisal they need to do their jobs. See regulation 18.
Regulation 19: Fit and Proper Persons Employed
Regulation 19 mandates that care providers employ only individuals who are fit and proper for their roles. This includes ensuring that staff:
- Are appropriately qualified and competent.
- Can provide safe and effective care and treatment.
- Possess the necessary character and health status to safeguard the welfare of service users.
To comply with this regulation, providers must:
- Conduct thorough background checks.
- Have the information required by Schedule 3 available, which can include a criminal record check from the Disclosure and Barring Service where the law allows for the role. See regulation 19.
- Verify references and work histories before employing staff.
This process is important in preventing individuals with a history of misconduct or inadequate care from working in the care sector. Ultimately, it’s about protecting service users by ensuring they receive care from capable, ethical individuals.
Regulation 20: Duty of Candour
The Duty of Candour, as described in Regulation 20, is a legal obligation for care providers to act openly and transparently regarding care and treatment. Specifically, this means that when a notifiable safety incident occurs (the definition is in regulation 20 and the CQC guidance on the regulations for providers and managers):
- Providers must inform the service user (or their advocate or family).
- They should provide an honest account of what happened.
- An apology should be offered.
This regulation plays an important role in maintaining trust between service users and providers. It ensures honesty about mistakes and commits providers to learning from these errors, thereby enhancing care quality and fostering a culture of safety and respect within care settings.
Regulation 20A: Requirement as to Display of Performance Assessments
Regulation 20A mandates that care providers prominently display their performance assessments where service users and visitors can easily see them. This includes displaying the most recent CQC rating, which ranges from “Outstanding” to “Inadequate”. Also, if providers have a website, they must also publish this information online. It is important for care providers to regularly update their performance assessments to reflect any changes in the services they provide. This ensures that service users and visitors are well-informed about the quality of care they can expect. Additionally, when a CQC assessment leads to a new rating, the most recent rating, with its date, must be shown on signs at the provider’s premises and on its website. See regulation 20A.
The purpose of this regulation is to enhance transparency by:
- Allowing current and prospective service users and their families to make informed decisions about their care.
- Encouraging providers to either maintain or elevate standards of quality and care.
This visibility ensures that these ratings are accessible publicly, influencing public perception and trust in the provider’s commitment to high-quality care.
Here is a full list of the Care Quality Commission (Registration) Regulations 2009:
Regulation 12: Statement of Purpose
Under regulation 12 of the Care Quality Commission (Registration) Regulations 2009, the registered person must give CQC a statement of purpose and keep it under review. This important document outlines:
- The fundamental aims and objectives of the provider.
- The types of services offered.
- The needs the provider aims to meet.
Also, the statement should include:
- Information about where the services are provided.
- Details about the provider, including their legal status and contact information.
The aim of this regulation is to ensure transparency by providing service users, their families, and regulators with a clear understanding of what the provider intends to achieve and how they plan to do it. It also acts as a foundational reference for assessing service delivery standards during inspections or audits.
Regulation 13: Financial Position
Regulation 13 requires the service provider to take all reasonable steps to carry on the regulated activity in a way that ensures its financial viability (it does not apply to English local authorities or health service bodies). See regulation 13 of the 2009 Regulations. This regulation features the importance of sound financial management by necessitating that providers have sufficient resources to ensure continuous and effective operation of their services.
The purpose behind this regulation is to minimise disruptions in service due to financial instability, thereby safeguarding the continuity of care for service users.
Regulation 14: Notice of Absence
Regulation 14 requires the registered person to give CQC written notice of a long planned absence of the registered manager (or of the provider, where the provider is in day-to-day charge), and to tell CQC when they return to duty. See regulation 14 of the 2009 Regulations for the notice rules. Also, this regulation requires that:
- A proposed cover for the period of absence is declared.
- The substitute must be fit and competent to handle the responsibilities of the absent registered individual.
This requirement ensures continuity in leadership and oversight, preventing any negative impact on the quality and safety of care provided.
Regulation 15: Notice of Changes
Regulation 15 requires the registered person to give CQC written notice, as soon as reasonably practicable, of the events it lists. These include a different person carrying on or managing the regulated activity, a change of director, secretary or nominated individual, and insolvency appointments such as a liquidator. See regulation 15 of the 2009 Regulations.
The aim of this regulation is to keep the CQC updated on any changes that could affect a provider’s compliance with standards or registration conditions. Regular updates help preserve the effectiveness of the regulatory framework and ensure that care remains safe, effective, and suitable for service users.
Regulation 16: Notification of death of service user
Under Regulation 16, the registered person must notify the CQC without delay of the deaths the regulation covers, and describe the circumstances of the death. See regulation 16 of the 2009 Regulations. This rule helps oversee and review deaths to spot any patterns or unusual circumstances that might indicate broader issues needing investigation for better safety and care.
Which deaths must be notified depends on the type of provider, so check the CQC guidance on the regulations for providers and managers. Quick reporting is essential not just for record-keeping but also to check for any lapses in care or areas that could be improved.
Regulation 17: Notification of death or unauthorised absence of a service user who is detained or liable to be detained under the Mental Health Act 1983
Regulation 17 is essential for managing the care of individuals detained under the Mental Health Act 1983. It requires providers to report any deaths, as stated in Regulation 16, and any unauthorised absences from the facility.
This notification allows for immediate action to protect both the individual and others by considering their health needs and potential risks linked to their absence. The regulation features care providers’ legal duties towards both the individual and public safety.
Regulation 18: Notification of Other Incidents
Regulation 18 mandates that service providers must inform the Care Quality Commission (CQC) about incidents affecting user safety, security, or well-being. The incidents are listed in regulation 18 of the 2009 Regulations and include abuse or allegations of abuse and incidents reported to or investigated by the police. Check the CQC guidance on the regulations for providers and managers for the full list and what applies to your service.
The purpose is to keep the CQC informed so they can investigate if needed, monitor trends, and enhance standards in the sector. Proper reporting allows the CQC to advise providers on how to prevent such incidents in the future and maintain high care quality.
Regulation 19: Fees
Where a person is responsible for paying for all or part of their own care or treatment, the registered person must give them (or someone acting for them) a written statement of the terms and conditions of the service, including fees and how they are paid, as far as reasonably practicable before the service starts. See regulation 19 of the 2009 Regulations.
Regulation 20: Requirements relating to termination of pregnancies
Regulation 20 applies to registered persons who carry on or manage termination of pregnancy services and are not English NHS bodies, and sets additional requirements for those services. See regulation 20 of the 2009 Regulations and the CQC guidance on the regulations for providers and managers.
Regulation 22A: Form of notifications to the Commission
Regulation 22A requires notifications under regulations 14 to 18, 21 and 22 to be made using the forms CQC provides. See regulation 22A of the 2009 Regulations. This standardisation helps the CQC handle information from providers more efficiently.
This regulation is key in keeping communication between care providers and the CQC clear, organised, and effective. It’s essential for quick and suitable reactions to any incidents or changes in care settings.