1.8 Describe when and how enforcement action can be used

This guide will help you answer 1.8 Describe when and how enforcement action can be used.

The Care Quality Commission (CQC) is the regulator of health and social care services in England. Its role includes monitoring, inspecting, and rating services to make sure they provide safe, effective, caring, responsive, and well-led care.

One of the CQC’s core powers is enforcement. Enforcement action refers to steps the CQC can take to make services comply with the law and provide safe care. If services fail to meet standards or put people at risk, the CQC can intervene. Enforcement acts as both a deterrent and a means to address problems.

Understanding the process and implications of enforcement action is key for anyone in a management or leadership role in adult care.

When CQC Uses Enforcement Action

The CQC expects registered providers and managers to follow the Health and Social Care Act 2008, and requirements set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The law sets out what good care looks like. When services fall below standards, enforcement follows.

Enforcement action can be taken if:

• There is a breach of regulations.
• People using a service are at risk of harm, or their experience falls far below what is expected.
• A provider has failed to improve after being asked.
• Serious safeguarding concerns are identified.
• The service delivers unsafe, ineffective, or unresponsive care.

The CQC will look at whether problems are isolated or show a pattern. The level and type of action depends on the seriousness of the failure.

Triggers for Enforcement

Common reasons for enforcement include:

• Failing to meet fundamental standards, such as dignity, safety, consent, nutrition, or cleanliness.
• Serious incidents (for example, abuse, neglect, injuries, or preventable deaths).
• Persistent, repeated breaches that have not been put right.
• Refusal to co-operate with CQC inspections or requirements.
• Providing care without required registration or beyond the registration conditions.
• Submitting false or misleading information.

The CQC takes into account how the provider responds when things go wrong. Taking responsibility, acting swiftly, and being open are viewed favourably.

Types of CQC Enforcement Action

Enforcement action ranges from informal to formal. The CQC decides which action to take based on the scale of risk, impact on people, and the provider’s response.

The main enforcement actions are:

Requirement Notices

A requirement notice tells a provider they must put things right but does not have a legal penalty. It is often given when:

• There is a breach of regulation that is not serious enough to warrant a warning or prosecution.
• No immediate risk to safety, but care fails to meet expected standards.

The provider gets clear instructions and a deadline to fix the issue. Progress is monitored, and failure to improve can lead to further action.

Warning Notices

A warning notice states that the provider must make improvements by a set date. Unlike a requirement notice, it is a formal notice and is publicly available. This is used when:

• There has been a breach with potential or actual risk to people.
• The problem requires urgent attention and a fast response.

Warning notices will appear on the CQC’s website. This promotes transparency and acts as an additional pressure for providers to make changes.

Cancellation of Registration

This is one of the most serious actions. The CQC can cancel a provider’s registration altogether, which means they must stop operating. This action is taken if:

• There is repeated or serious failure to comply with regulations.
• People are at significant or ongoing risk.
• There is little or no prospect of improvement.

Before cancelling registration, the CQC usually issues notices and gives the provider a chance to respond, unless immediate action is needed to protect people.

Suspension of Registration

The CQC can suspend registration if they need to stop a provider running services temporarily. Suspension is used when:

• There is an immediate risk but the service could improve with time.
• Registration needs to be reviewed while improvements take place.

Suspension lasts for a set period and can be lifted if compliance is shown. If the provider cannot improve, cancellation might follow.

Imposing Conditions

The CQC can add conditions to a provider’s registration. These are rules the provider must follow to keep operating. Examples include:

• Limiting the number of people who can use the service.
• Requiring specific improvements before taking new admissions.
• Demanding certain staff levels or qualifications.

If these conditions are not met, further action like suspension or cancellation might occur.

Fines (Fixed Penalty Notices)

Sometimes, the CQC can issue financial penalties without going to court. Fines are used when:

• The offence is clear and the facts are not disputed.
• The breach relates to document or process failures, like not displaying ratings or failing to notify the CQC of incidents.

Providers can accept a fine or choose to challenge it in court.

Prosecution

The CQC has the power to prosecute providers in court for serious breaches or when other actions have failed. Prosecution may result in:

• Fines set by the court.
• Criminal convictions for individuals or organisations.
• Publicised cases, causing reputational harm.

Prosecution is usually reserved for the most serious failures or where other actions have not worked.

Urgent Actions Under Section 31

Section 31 of the Health and Social Care Act 2008 lets the CQC act urgently if there is a serious risk to people. The CQC can:

• Suspend registration immediately.
• Attach new conditions overnight.
• Cancel registration without delay.

This is often used if there is credible evidence that people will come to harm if care continues.

How Enforcement Action is Used

Enforcement action always starts with thorough inspection and gathering of evidence. The CQC inspects services, reviews documents, interviews staff and people using services, and looks at records. Decisions rest on facts rather than opinions.

Step-by-Step CQC Process

The steps usually include:

• Inspecting the service and assessing compliance.
• Gathering evidence about breaches, risks, and harm.
• Speaking to providers about findings.
• Deciding the level of enforcement action needed.
• Notifying the provider of the decision and their rights.
• Allowing the provider to respond (sometimes called “representation”).
• Publishing information about enforcement action where appropriate.

The aim is always to protect people receiving care. CQC prefers providers to fix problems quickly without formal action when this is safe to do.

Proportionality and Fairness

Enforcement decisions must be fair and proportionate. The CQC uses a judgement framework and considers:

• How serious the breach is.
• Whether there is actual or likely harm.
• What the provider has done to put things right.
• Whether there is a repeated pattern.

The CQC’s Enforcement Policy (published on their website) explains these principles. This ensures providers are treated fairly, and responses match the degree of risk.

Informal vs. Formal Action

Not every problem leads straight to enforcement. Sometimes CQC will give informal feedback and ask for voluntary action. If this fails, formal enforcement follows.

Informal Steps Include:

• Giving feedback at the end of inspection.
• Following up with written advice.
• Agreeing action plans with providers.

Formal enforcement steps are taken if breaches are serious, urgent, or ignored.

What Enforcement Action Means for Providers

Facing enforcement action can have a big impact on a service. It can result in:

• Loss of registration (the service must close).
• Restrictions on how or what care can be provided.
• Fines and legal fees.
• Damage to reputation (public reports and media coverage).
• Lower staff morale and loss of public trust.
• Extra scrutiny from other agencies.

Providers have a right to respond to notices, challenge decisions, and appeal to tribunals.

Handling Enforcement Action

As a manager or leader, your priority is responding promptly and constructively.

Actions to take include:

• Read the enforcement notice carefully. Understand what exactly is required.
• Work openly and quickly with the CQC and any other agencies involved.
• Develop a clear action plan and put designated leaders in charge of each point.
• Communicate honestly with staff, people using the service, and their families.
• Document every step you take, keeping clear records for the CQC and any appeals.
• Review training, policies, and day-to-day practice.
• Use root cause analysis to identify what went wrong and how to prevent repeat issues.

Being transparent, taking early responsibility, and showing real improvements can help to mitigate enforcement action and show that you are putting people first.

Examples of Enforcement Scenarios

Scenario 1: Unsafe Medication Practice

An inspection finds medication errors are happening often. People have been given the wrong medicine or missed doses.

• The CQC issues a requirement notice and sets a deadline for improvement.
• If problems continue at the next inspection, a warning notice follows, and a restriction on new admissions is added.
• Persistent failure could result in suspension or cancellation.

Scenario 2: Abuse or Neglect

Evidence is found of physical abuse by a member of staff.

• The CQC invokes urgent action powers, suspending the provider on the spot.
• A full investigation is started by police and safeguarding authorities.
• Registration may be cancelled if there is a systemic failure to protect people.

Scenario 3: Failure to Notify

A provider does not inform the CQC about a serious incident as required by law.

• The CQC issues a fixed penalty notice (fine).
• If this repeats, prosecution may follow.

These examples show how actions escalate depending on risk and response.

Appeals and Complaints Process

Providers have rights throughout the enforcement process. You can:

• Respond to warning and requirement notices.
• Make representations against certain actions.
• Challenge cancellation, suspension or conditions by appealing to a tribunal (First-tier Tribunal: Care Standards).
• Dispute facts or context before a sanction is finalised.

Getting legal advice early can support you in dealing with complex or serious enforcement.

Good Practice to Avoid Enforcement Action

Good leadership and management can reduce the risk of enforcement.

Best practice includes:

• Regular audits of your own service against CQC standards.
• Anonymous staff and resident feedback surveys.
• Up-to-date training for all staff.
• Clear recording and prompt reporting of any incidents.
• Quick, open communication with the CQC about problems and improvements.
• Embedding a culture of learning, transparency, and continuous improvement.

Being proactive saves time, distress, and money and maintains your standing with regulators.

Final Thoughts

Enforcement action by the CQC is used when services fail to meet regulatory standards. Action ranges from requirement or warning notices to fines, urgent suspension, or closure. The choice depends on risk, seriousness, and the provider’s response.

Managers must recognise enforcement action as both a corrective and protective measure. Early action, openness, and a commitment to people’s safety can help services address problems before enforcement becomes necessary.

Knowing when and how the CQC uses enforcement is essential knowledge for everyone in leadership and management in adult care. It allows for a timely and thorough response, helping to safeguard the well-being of people receiving care.