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How we inspect and regulate: a guide for providers

  • Organisations we regulate

Our inspection teams are formed from a national team of clinical and other experts, including people with experience of receiving care.

Intelligent monitoring helps us to decide when, where and what to inspect, including listening better to people's experiences of care and using the best information across the system.

Our inspections are in-depth and we inspect in the evenings and at weekends when we know people can experience poorer care.

Five key questions

Our inspectors use professional judgement, supported by objective measures and evidence, to assess services against our five key questions:

  • Are they safe?
  • Are they effective?
  • Are they caring?
  • Are they responsive to people’s needs
  • Are they well-led?

What do we mean by safe, effective, caring, responsive and well-led?


By safe, we mean that people are protected from abuse and avoidable harm.


By effective, we mean that people's care, treatment and support achieves good outcomes, promotes a good quality of life and is based on the best available evidence.


By caring, we mean that staff involve and treat people with compassion, kindness, dignity and respect.


By responsive, we mean that services are organised so that they meet people's needs.


By well-led, we mean that the leadership, management and governance of the organisation assures the delivery of high-quality person-centred care, supports learning and innovation, and promotes an open and fair culture.


We also rate services. These ratings will help people to compare services and will highlight where care is outstanding, good, requires improvement or inadequate.

We don't rate dental care services. This is because we are only inspecting 10% of dentists, as compared to other sectors that we regulate, dental services present a lower risk to patients' safety and the quality of care is good.

Where a key question is rated as requires improvement or inadequate we will make a judgement about whether a regulation has been breached. Our guidance for providers and managers explains how to meet regulations under Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Care Quality Commission (Registration) Regulations 2009.

Our approach has been developed over time and through consultation with providers, stakeholders, care professionals, the public, and people who use services.

We will continue to learn and adapt how the approach is put into practice, for example how we include a focus on particular care pathways or conditions in our inspections.

Key lines of enquiry

To direct the focus of their inspection, our inspection teams use a standard set of key lines of enquiry (KLOEs) that directly relate to the five key questions we ask of all services – are they safe, effective, caring, responsive and well-led?

Having a standard set of KLOEs ensures consistency of what we look at under each of the five key questions and that we focus on those areas that matter most.

This is vital for reaching a credible, comparable rating.

To enable inspection teams to reach a rating, they gather and record evidence in order to answer each KLOE.

How KLOEs and evidence build towards ratings

Diagram showing how KLOEs and evidence build towards ratings

* The sources of evidence we use for adult social care services are different from the ones we use in other sectors. This is because there is less data available in adult social care. For these services we use evidence from: Intelligent Monitoring (including local information); on-site inspection; pre-inspection information gathering; and speaking with people who use services, their families and carers, and staff.

Concerns, complaints and whistleblowing

Concerns raised by people using services, those close to them, and staff working in services provide vital information that helps us to understand the quality of care.

We will gather this information in three main ways:

  • Encouraging people and staff to contact us directly through our website and phone line, and providing opportunities to share concerns with inspectors when they visit a service.
  • Asking national and local partners (for example, the Ombudsmen, the local authority and Healthwatch) to share with us concerns, complaints and whistleblowing information that they hold.
  • Requesting information about concerns, complaints and whistleblowing from providers themselves.

We will also look at how providers handle concerns, complaints and whistleblowing in every inspection.

Last updated:
21 April 2016