Care workers' guide to CQC

Types of inspections

Inspectors carry out 2 types of inspection that involve a site visit:

• unannounced – where we do not tell the service before we arrive
• announced – where we tell the service a few days before that we are coming.

The majority of inspections are unannounced.

Unannounced inspections

Most inspections of care homes and nursing homes are unannounced. This helps us get a true picture of the care people receive on a day-to-day basis.

Unannounced inspections can take place at any time, on any day of the week. For example, if inspectors have concerns about care provided outside of usual hours, they may visit during the evening, at night, or at the weekend rather than during a traditional 9 to 5 working day.

Inspectors should show their warrant card before entering the premises. Our information about how to check the identity of a CQC inspector explains what these ID badges include and how to make sure an inspector is genuine.

Announced inspections

Announced inspections are more common in services that support people in their own homes, such as homecare (domiciliary care) and supported living services.

If we want to visit a private home, we will ask the care provider to help us get permission. We don’t have the right to enter private homes without this permission.

What happens during an inspection

Our inspection team will want to see that the care in your service is good. To do this they will:

• talk to staff to understand what is like to work there and the care you provide
• talk to people and relatives to understand how they feel about care
• observe everyday interactions between you and people you care for
• contact people over the phone or ask for their consent to visit them in their home (if the service is a homecare service).

What we expect from you

People’s voices and experiences are vital to understanding if a service is providing good quality care. If people can’t tell us about their care, we use observations of everyday interactions between care workers and the people they care for and feedback from relatives and staff to identify the quality of that care.

You don’t need to stop your work to speak with an inspector. We know that putting people’s care and support first is the right thing to do. We want to see a true picture of what it is like for people who receive care and for care workers supporting them. Inspectors know that their presence can cause anxiety and will try to do their best to ease this. Ultimately, we just want you to be yourselves.

Where we have rated services as good or outstanding, it is often due to the good work and the engagement we see between care workers and people they care for. Evidence of good care includes speaking to people with kindness, engaging people in activity, knowing people’s personality and responding to people’s needs in a timely way (including sitting and engaging with them).

Physical contact with people in your care

Some care workers shared in the focus group that they don’t know if they can offer physical contact when inspectors are present, such as a hug, holding someone’s hand, or returning a warm welcome. They shared with us that some leaders instruct staff not to provide physical contact during inspection.

Appropriate physical contact can be an important and compassionate part of supporting people, particularly when someone is distressed or looking for reassurance. It can be a meaningful way of communicating care, comfort, and connection.

Physical contact and personal space are deeply personal for each individual and should always be led by the person receiving care. People’s preferences, cultural backgrounds, and past experiences should be understood and respected.

Care providers should make sure that their safeguarding training, policies, and care planning supports staff to understand appropriate personal and physical boundaries. Where physical contact is an agreed part of someone’s care or support, inspectors may expect to see this reflected in care plans or support records.

When inspectors observe physical contact, they will consider it in context. Acts such as holding someone’s hand or offering a hug, when the person welcomes this and it’s provided with kindness and respect, can demonstrate caring, compassionate, and dignified support under the ‘caring’ key question.

For example, an inspector may observe a person living with dementia who is looking for reassurance through holding hands or asking for a hug. A care worker responding with warmth and sensitivity can have a positive and meaningful impact on that person’s wellbeing. We would use that interaction as evidence of a service that’s compassionate and caring.

Ultimately, we want to see staff supporting people in the same way they do every day. Inspections are not about stopping compassionate care. They are about making sure that the systems, training, and leadership in the service support good, person‑centred practice.

How we ensure providers support care workers

Organisations and care providers have a responsibility to ensure care workers are supported, protected, and valued.

Our inspectors review and report on workforce equity and culture as part of the well-led key question and the safe key question.

How inspectors identify the right levels of staff a service should have

CQC can’t tell care providers how many members of staff they need, but if the evidence suggests that staff can’t meet people’s needs, then we will take action. We only see a snapshot during an inspection, so we rely on feedback from staff, people using the service and visitors if they have concerns around the level of staff available.

We will check that:

• The provider has assessed how many staff it should have to meet the needs of the people in its care and how this affects the care environment. For example, a care home that has multiple floors and corridors on different levels will affect how many staff are seen and their availability.
• Staff have had sufficient training to support people’s needs. For example, people who may present in distress and need lots of support.

We speak with:

• people using the service and their relatives
• staff
• professionals that might visit the service.

We observe:

• how staff respond to people’s needs
• how staff interact with people – this is particularly important for people living with dementia or have a condition that affects their mental capacity.

We also check whether a staffing rota matches with the number of staff on duty at the time.

What happens if inspectors find something wrong

We want services to improve, and we have a variety of powers to try to support providers to do so. Our enforcement policy sets out how we address breaches of regulations and protect people from harm.

We only use our regulatory powers to close a service as a last resort. We would take this action:

• to protect people who use regulated services from harm and the risk of harm, and to ensure they receive health and social care services of an appropriate standard
• when the service may not be able to demonstrate improvement.

If you're unhappy about an inspection or inspector

You can complain about an inspection or inspector. Make your complaint to the person you have been dealing with at CQC. They will usually be the best person to resolve the matter.

If you don’t feel able to do this, or you have tried and were unsuccessful, you can contact us and your concerns will then be passed to our complaints team. Our complaints team can deal with complaints from anyone who is directly affected by the way we carry out our work, including complaints about members of our staff or people working on our behalf.

You can also make a complaint on behalf of someone else if they give their consent. This could be a relative or someone you care for.

Sharing information with us

Employers have a duty to provide a process that enables staff to speak up, and to protect staff who do speak up. Inspectors look for this when considering what makes a service well-led, and how a provider demonstrates that their staff are valued and supported.

Speaking with inspectors

Inspectors and their teams should always treat you with respect and dignity. They should be polite and friendly when they approach.

Inspectors may ask to speak with you to find out about people in your care, their quality of life, the support you receive in your role as a care worker and how the service works. Inspectors know you are busy, so don’t be afraid to say if you cannot speak to them when they ask. Instead, arrange to speak with them at a more convenient time when you are able.

Inspectors will always try to speak with you in a private space and will ask if you want to contact them after the visit if that feels more comfortable. You have the right to speak with inspectors independently. If your managers ask to join conversations between inspectors and care workers, inspectors will advise against this to maintain impartiality. However, if a care worker prefers their manager to be present, inspectors will respect that choice and ensure staff still have a way to contact them separately after the site visit if they wish.

On rare occasions, an inspector may stop a member of staff from doing something if they feel a person is at risk of being injured. For example, they may do this if they see a person being moved in an unsafe way.

Inspectors also expect you to tell them if they themselves are doing something that might unsettle people, and they value this.

One inspector gave us an example of this:

“I was observing care staff supporting people in the dining room. One person on the table in front of where I was sitting was becoming a little agitated. A member of staff supported them with compassion but leaned in to me to say, ‘I am sorry but it’s your presence that is upsetting them, would you mind moving somewhere else for now?’

I was impressed at how they handled the situation and thanked them for the observance and ability to approach me to support the person better. I moved away and visibly observed that the person was able to be reassured”.

Giving feedback

Inspectors want to know the following from care workers:

• What you enjoy about your role. Inspectors want to hear what you love about working at the service and how your work has made a positive difference to people’s lives. If there is something you are particularly proud of, share the story – inspectors value real examples of meaningful impact.
• Your experience of raising concerns. If you have ever raised a concern about the quality of care, inspectors want to understand what happened next. Were you listened to? What actions were taken? The need for improvement does not automatically mean a service is poor, and inspectors are looking at how issues are raised and how the provider responds.
• How you support people day-to-day. Inspectors want to know about the people you care for, how you understand and meet their needs, and how the service shares information within the team to achieve the best outcomes for those you support.
• The support you get in your role. Inspectors want to know that you’re supported by your line managers, that you know where to go when you need help and that you’ve had the training and support you need in your role.

Giving feedback off shift

Giving feedback off shift is just as important as feedback shared during an inspection.

You do not need to be working on shift to share your views with us. Care workers who are off shift, on leave, or who work nights or weekends can still contribute to feedback for an inspection by using our online Give feedback on care form.

The form is easy to use, and you only need to type in the name of the service. You can remain anonymous while still reporting that you are a member of staff and the feedback will be considered as part of the inspection.

Feedback can be positive, neutral or negative, and you can send it to us throughout the year so we can build an ongoing picture of the quality of care.

Raising a concern

It’s best to raise your concern openly with us, because that makes it easier for us to follow it up. Our information about how to report a concern if you are a member of staff explains the process and how we handle your privacy.

Our inspectors look at a provider’s culture around the freedom to speak up as part of assessing whether a service is well-led. The Skills for Care CQC inspection toolkit – freedom to speak up gives further information.

We welcome information where staff feel they have not been able to speak up, or where concerns have not been handled appropriately. This information helps us to understand the culture in a service and informs how we plan an inspection. However, we cannot investigate individual employment disputes or cases where staff feel they have been penalised for speaking up.

Where appropriate, we give information to care workers about organisations that can offer support and advice, such as ACAS.

How CQC investigates safeguarding concerns

We don’t investigate individual safeguarding concerns. This is the role of the local safeguarding authority under the Care Act 2014 for adults, and Children's Services in line with the Children Acts 1989 and 2004. However, we do use information from individual safeguarding concerns raised with us to identify whether we should be concerned about the safety of the care for all people at a service. Our information on safeguarding people gives more details.