A CQC inspection of a care home usually starts unannounced before 8am and runs until late afternoon. Inspectors spend most of the day talking to people who live in the home, watching care being given, speaking to staff, and checking records against what they have seen and heard. Your job as registered manager is to keep the home running normally, make evidence easy to find, and make sure staff answer honestly rather than guessing.
The short answer
Under the CQC single assessment framework, the site visit is one part of a rolling assessment rather than a single exam, but it is still the day that decides how much of your evidence lands. Expect the inspector to arrive early, ask for the rota, the incident log and a list of people, and then spend the morning with residents and staff and the afternoon in records. Have a small inspection pack ready at all times, brief staff to answer from their own knowledge, and use the management interview at the end of the day to explain what you know about your own home. Below is how the day usually runs, hour by hour, with what to have ready at each stage.
How the single assessment framework changes inspection day
The old key lines of enquiry have gone. Since the single assessment framework came in, CQC assesses services against 34 quality statements grouped under the same five key questions: safe, effective, caring, responsive and well-led. Each quality statement is scored using six evidence categories: people's experience, feedback from staff and leaders, feedback from partners, observation, processes, and outcomes. The scores roll up into the rating you already recognise, from Outstanding down to Inadequate.
What this means on the day is that the inspector is not working through a fixed script. They arrive with a set of quality statements they intend to look at, chosen from what they already know about you: notifications, your last rating, complaints, whistleblowing, local authority feedback and anything you have sent through the provider portal. A home with a recent safeguarding cluster will see a heavy focus on the safe key question. A home with a management change will see a heavy focus on well-led. If you have read your own notifications for the last twelve months, you can predict most of what they will ask.
The site visit can also be shorter than it used to be, because some evidence is gathered before and after. Do not read a short visit as a good sign or a bad one. It usually means they came with specific questions.
How often do CQC inspect a care home?
There is no fixed interval any more. Under the single assessment framework, CQC says it will assess services based on risk and on the information it holds, rather than on a calendar. In practice, homes rated Good or Outstanding can go several years without a site visit, while homes rated Requires improvement or Inadequate, or homes with a rise in notifications, will see inspectors sooner and more often. A change of registered manager, a serious incident, a whistleblowing contact or a poor local authority quality visit can all trigger an assessment.
The practical consequence is that you cannot plan for an inspection window. The homes that do well are the ones that could be inspected on any Tuesday. That means the evidence pack described below lives in one place and is updated monthly, not assembled the week before.
Before 7am: what should already be true
Everything that makes inspection day calm happens before it. On any given morning, the person in charge of the home should be able to put their hands on the following inside ten minutes:
- Today's rota with names, roles, and who is agency or bank.
- A list of everyone living in the home with room numbers, funding type and any DoLS or LPS status.
- The incident and accident log for the last three months, with reviews signed off.
- The safeguarding log with referral references and outcomes.
- The training matrix showing who is in date for what.
- Recruitment files with DBS, references and right to work in a consistent order.
- The last three months of audits: medication, care plans, infection control, environment.
- Your statement of purpose and the current registration certificate on the wall.
If any of those would take an afternoon to assemble, that is the job for this month, not for inspection week. A home that keeps its records in one system can print or show most of this from a single screen. A home on paper needs a labelled folder in the office that the deputy and the senior on shift both know about. The CQC compliance view in a good care system does most of this automatically, but a well-kept paper folder does the same job if it is kept.
7am to 8am: the call and the first ten minutes
Most residential and nursing home inspections are unannounced. Some learning disability and mental health services get short notice, usually 48 hours, so people can be supported to take part in a way that suits them. Either way, the first ten minutes set the tone.
The inspector will show identification, explain who they are and what they intend to look at, and ask who is in charge. If you are not on site, the senior should ring you and then carry on. Do not make the inspector wait in the hallway while someone finds the manager. Show them to a room they can use, offer a drink, and hand over the four things they always ask for first: today's rota, the list of people, the incident log and the safeguarding log.
Tell staff on the floor that CQC are in and that care carries on as normal. Do not send anyone home, do not call in extra staff, and do not start tidying. Inspectors have seen every version of a home putting on a show and it always reads as exactly that.
If the registered manager is off
The inspector will assess the home as it runs without you. That is not a problem if the deputy knows the systems. It is a problem if the deputy has never opened the audit folder. Cross-train before you need to.
8am to 10am: the rota, staffing and the morning routine
The first two hours are almost always about the safe key question, and the first thing they check is whether the number of staff on the floor matches the rota and whether that number is enough for the people in the building. They will walk the home during personal care and breakfast. They are watching how long call bells ring, whether people are rushed, whether staff know names and preferences, and whether anyone is left in bed without a reason recorded.
Have a clear answer to how you decide staffing levels. 'We have always had three on days' is not an answer. A dependency tool, a monthly review, and a record of when you changed numbers and why is an answer. If you use one-to-one hours for anyone, be able to show the funded hours, who delivered them today, and how they are recorded.
Agency staff will be asked who they are, what induction they had, and how they know what each person needs. If your agency workers have a signed induction and today-only access to the care plans of the people they are supporting, this is a strong section. If they are working from a verbal handover and a shared login, it is a weak one. Our guide to agency staff in care homes covers what good looks like.
10am to 1pm: talking to people, families and staff
The single assessment framework puts more weight on people's experience than the old framework did, and this is the block where that evidence is gathered. The inspector will speak to as many residents as they can, usually in private, and will ring relatives during the day or in the following week. In learning disability homes they may bring an Expert by Experience. In mental health homes they will ask people about restrictions, choice and whether staff listen.
You cannot script this and you should not try. What you can do is make sure people are supported to take part: someone who uses a communication aid has it to hand, someone who is anxious about strangers is told in advance in a way they understand, and someone who does not want to talk is not pushed.
What questions do CQC ask care staff?
Staff are asked practical questions: how do you know what this person needs, what would you do if you saw a colleague being rough, who would you tell if you were worried about someone's safety, when did you last have supervision, what training have you had on this person's condition, what happens at handover. They are also asked whether they feel able to raise concerns and whether the manager listens.
The right briefing for staff is one sentence: answer honestly from what you know, and if you do not know, say you would check the care plan and show them where it is. Rehearsed answers that do not match the records are worse than an honest gap.
1pm to 3pm: records and the evidence trail
After lunch the inspector usually sits down with records. They will pick two to four people, often those with the most complex needs or a recent incident, and track them through everything: the care plan, the risk assessments, the daily notes, the MAR chart, the weight and fluid charts, the incident forms, the review notes. They are checking one thing above all: does the record match the care they watched this morning and the person they spoke to?
The common failures are predictable. A care plan that says a person needs thickened fluids at level 2 while the kitchen list says level 1. A repositioning chart with gaps at night. A PRN protocol that does not say what the medicine is for or when to give it. A risk assessment reviewed monthly by signature with nothing changed for a year. An incident from six weeks ago with no review and no change to the plan.
This is where digital records earn their keep, because a well-set-up system will not let a note be backdated and shows every gap. Whether you use digital care records or paper, the principle is the same: the record must be written at the time, by the person who did the care, and must connect to the plan.
Medicines
Expect a medicines round to be observed and the MAR checked for gaps, codes without explanation, and controlled drug balances. An eMAR with alerts for missed doses makes this a five-minute check rather than a two-hour one, but the inspector will still want to see the CD register and the fridge temperature log.
What inspectors look for in daily notes
Daily notes are read for content, not volume. The inspector wants to see that the note describes what happened for this person today, in enough detail that the next shift could act on it, and that it refers back to the plan. 'Personal care given, ate well, no concerns' repeated for thirty days is a red flag under the responsive and caring questions, because it tells them nothing about the person.
They also look for consistency between the note and the charts. If the note says someone was unsettled and refused lunch, the fluid chart and the incident log should reflect that. If the note says a person was supported to go out, the outing should be on the activity record. Homes that use structured daily logs tied to each person's goals find this easier, because the note is prompted by the plan rather than written from memory at the end of shift.
Under the single assessment framework the outcome evidence category asks a simple question: is the person better off, and can you show it? Notes that track a goal over time, such as fewer incidents after a PBS plan change or weight regained after a dietitian referral, are exactly what is being looked for.
3pm to 5pm: feedback and the management interview
The last block is the management interview and the verbal feedback. This is where the well-led key question is mostly assessed, and it is where a registered manager can do the most good or the most harm.
The interview covers how you know what is happening in your home. Expect to be asked about your audits and what they found, about the last three incidents and what changed, about staff turnover and why people leave, about complaints and what you learned, about safeguarding referrals and the outcomes, and about your own oversight of the deputy and seniors. They will ask about the provider's oversight of you: how often the owner or operations manager visits and what they check.
The best answer to almost every question starts with a number and ends with a change. 'We had four falls in March, three at night in the same corridor, we changed the lighting and moved one person's room, and we have had one since.' That is a well-led answer. 'We take falls very seriously' is not.
Verbal feedback
The inspector will summarise what they have found, including concerns. Listen, write it down, ask for clarification on anything unclear, and do not argue. You will have a chance to challenge facts through the factual accuracy process when the draft report arrives. Arguing on the day rarely changes a finding and often colours the well-led judgement.
What the well-led interview really tests
Well-led is often the key question that decides the overall rating, because a home that is well-led fixes its own problems. Inspectors are trying to answer a handful of questions. Does the manager know the home's weaknesses without being told? Is there a plan for each one with a date? Does the provider hold the manager to account? Do staff say the same things the manager says? Is learning shared, or does the same incident keep happening?
The evidence that answers those questions is a service improvement plan that is actually used, audit results that led to action, staff meeting minutes that show issues raised and resolved, supervision records with real content, and a manager who can talk about the last quarter from memory. If you run a monthly quality meeting with the provider and keep the minutes, bring them. If you have a training matrix that shows who is overdue and what you are doing about it, show it. A system that keeps supervision, training and induction in one place makes this a five-minute demonstration.
The evidence categories and how to show each one
Every quality statement is scored across the six evidence categories, so it helps to think about what you hold for each. The table below is the one I use with deputies.
| Evidence category | What the inspector uses | What you should have ready |
|---|---|---|
| People's experience | Conversations with residents, relatives, advocates; surveys | Resident and relative meeting minutes, survey results with actions, complaint outcomes |
| Feedback from staff and leaders | Interviews with care staff, seniors, manager, provider | Supervision records, team meeting minutes, staff survey, exit interview themes |
| Feedback from partners | Local authority, GP, community nurses, safeguarding team, advocates | Professional visit log, MDT notes, local authority quality visit reports |
| Observation | Watching care, mealtimes, medicines, interactions | Nothing to prepare; this is your culture on show |
| Processes | Policies, audits, care plans, risk assessments, recruitment files | Audit schedule and results, policy review dates, care plan review log |
| Outcomes | Incident trends, weight, pressure damage, hospital admissions, goals met | Monthly quality dashboard, incident trend analysis, examples of goals achieved |
Notice that four of the six categories are about what other people say and what actually happened, not about documents. Paperwork matters, but it is one sixth of the picture.
A CQC inspection checklist for the day itself
This is the checklist we keep on the inside of the office door. It is short on purpose.
- Check the inspector's ID and note their name and the key questions they say they will look at.
- Ring the provider or nominated individual and the registered manager if off site.
- Hand over the rota, the list of people, the incident log and the safeguarding log.
- Give the inspector a room, wifi if they need it, and a named person to fetch things.
- Tell staff CQC are here, care continues as normal, answer honestly.
- Make sure people who need support to take part have it.
- Keep a running list of every document requested and when it was provided.
- Note every concern raised during the day so nothing in feedback is a surprise.
- Attend the verbal feedback with the deputy, take notes, do not argue.
- Before the inspector leaves, ask what will be requested after the visit and by when.
How to prepare staff without rehearsing them
Staff preparation is culture, not coaching. The homes that do well are the ones where staff talk about residents the same way whether or not an inspector is listening. You build that with short, regular conversations rather than a briefing sheet the week before.
Three things help. First, make sure every worker knows where the care plan is and how to find the parts that matter for the people they support today. Second, make sure they know the safeguarding route and the whistleblowing route by heart, including that they can contact CQC directly. Third, tell them what an inspection actually is: a visitor asking questions about people they know well. Most staff fear it because nobody has explained it.
What you should never do is give staff model answers. Inspectors ask follow-up questions, and a rehearsed answer falls apart on the second question. An honest 'I would check the plan' followed by actually finding it is worth more than a fluent speech.
Running a mock inspection that is worth the time
A mock inspection is only useful if it is done by someone who does not run the home day to day and if it follows the real shape of the day. Here is the procedure we use twice a year.
- Pick a date the manager does not know about, or at least a week the manager does not know about.
- The reviewer arrives at 7.30am and asks the senior for the four documents. Time how long it takes.
- Walk the home during breakfast and personal care. Note call bell waits, interactions, anyone unattended.
- Speak to three residents and two relatives by phone using open questions about choice, safety and staff.
- Interview three staff, including one agency or bank worker and one night worker, using the questions in this article.
- Pick three people and track them through plan, notes, MAR, charts and incidents. List every mismatch.
- Interview the manager on well-led: audits, incidents, complaints, turnover, provider oversight.
- Write a one-page feedback note with three strengths and three actions, each with an owner and a date.
- Review the actions at the next quality meeting and again in three months.
Keep the mock inspection reports. They are themselves evidence of well-led, because they show the home looks at itself honestly.
Learning disability and autism homes: Right support, right care, right culture
If you support autistic people or people with a learning disability, the inspector will apply the Right support, right care, right culture guidance alongside the quality statements. In plain terms they are asking whether people have choice and control, whether the home is the right size and model for them, and whether the culture is one of enabling rather than managing.
On the day this shows up as questions about restrictions and how they are reviewed, about whether people are supported to go out and do ordinary things, about how communication needs are met, about PBS plans and whether staff can explain them, and about how incidents are used to change support rather than to justify more restriction. Easy-read care plans and communication passports that people actually use are strong evidence. A PBS plan that staff can describe without reading it is stronger still.
Inspectors will also look hard at whether people's homes look like homes. Locked kitchens, office-style signage and blanket rules that apply to everyone regardless of assessed need all draw questions.
Mental health homes: restrictions, capacity and positive risk
In mental health care homes the safe and caring key questions often turn on how restrictions are recorded. Expect questions about who has a DoLS or LPS authorisation, what conditions attach, and whether the least restrictive option has been considered and recorded for each person. Blanket restrictions, such as a locked front door for everyone or a fixed bedtime, need a clear rationale or they will be raised.
Risk records are read for whether they describe the person or label them. A risk assessment that records what the person has said in their own words, what helps, and what the agreed plan is will stand up. One that reads 'high risk, aggressive, non-compliant' will not. Our article on recording risk in mental health homes covers this in detail.
Inspectors will also ask people directly whether they feel listened to and whether staff explain decisions. Capacity assessments should be decision-specific and dated, and best interests decisions should show who was consulted.
Nursing homes: clinical governance on the day
In nursing homes the inspector, often accompanied by a specialist advisor who is a nurse, will look at clinical oversight. That means wound care records with photographs and measurements, pressure damage tracked against Waterlow scores and repositioning, weight loss against MUST scores and dietitian referrals, catheter and PEG care plans, and end of life planning. They will check NMC registration for every nurse and ask how clinical competencies are assessed and refreshed.
Medicines get particular attention: covert administration with a documented best interests decision and pharmacist input, controlled drugs balances, and PRN protocols with maximum doses and review dates. The nurse in charge should be able to walk through the clinical risk register for the home. If there is a monthly clinical governance meeting with minutes, that is strong well-led evidence.
What to do when something goes wrong during the visit
Something will go wrong. A fall, a medication error, a resident distressed by the visitor, a staff member who freezes. What matters is how the home responds, because the response is exactly what the inspector is there to see.
Respond as you would on any other day. Deal with the person first, complete the incident form before the end of the shift, notify who needs notifying, and tell the inspector what happened and what you did. Hiding an incident that happened while they were in the building is the single worst thing you can do, because they will find it in the records later and it goes straight to the well-led judgement and to your own fitness as registered manager.
If the inspector identifies something serious, such as an unsafe hoist sling or a gap in controlled drugs, act on it while they are there. Take the sling out of use, start the CD count, ring the pharmacist. Immediate action, recorded, is evidence of a safe culture.
After they leave: the following two weeks
The inspector will usually ask for further documents after the visit, with a deadline. Send them on time, in the format asked for, and keep a copy of everything sent. Common requests are policy documents, further training records, a sample of supervision notes, the last provider oversight report and evidence of action on anything flagged on the day.
Write your own summary of the day within 24 hours while it is fresh: who they spoke to, what they looked at, what concerns they raised, what you said. Share it with the provider. Start fixing anything raised immediately, and keep a dated record of the fix, because if the draft report includes the concern you can show it was addressed before publication.
Brief staff the next day. Thank them, tell them what was said, and be honest about what needs to improve. Staff who are kept in the dark assume the worst.
The draft report and factual accuracy
The draft report arrives some weeks later and you have a fixed window, usually ten working days, to challenge factual accuracy. This is a comment on facts, not a debate about judgement. If the report says training compliance was 70 per cent and the matrix says 88, send the matrix. If it says a care plan had not been reviewed and it had, send the review. If it says something you simply disagree with, you may say so, but it is unlikely to change the rating.
Use the window properly. Read every line, check every number, and respond with evidence attached. Keep the tone neutral. Do not treat it as an appeal; there is a separate ratings review process for that, and it is only for cases where the process was not followed. Our article on what a Requires improvement rating means explains the next steps if the rating is not what you hoped.
Common mistakes
- Calling in extra staff when the inspector arrives, which shows on the rota and on people's faces.
- Giving staff scripted answers that collapse on the second question.
- Assembling the evidence pack the week before instead of keeping it live all year.
- Arguing with findings during verbal feedback instead of using the factual accuracy process.
- Hiding an incident that happened during the visit.
- Treating well-led as a document exercise rather than being able to talk about the home from memory.
- Leaving the deputy unable to find audits, supervision records or the training matrix when the manager is off.
- Ignoring the six evidence categories and preparing only paperwork.
What good looks like on inspection day
A home that is inspection-ready looks the same on the day as on any other day. The senior finds the four documents in five minutes. Staff talk about people by name and know where the care plan is. Residents say they feel safe and that staff listen, and their relatives say the same when rung. The records show today's care in today's notes, written by the people who gave it, and the plan matches what the inspector saw at breakfast. Incidents have reviews, reviews have actions, and actions have dates. The manager can describe the last quarter's incidents, complaints, turnover and audits without opening a folder, and the provider's oversight visits are minuted. Nothing said in verbal feedback is a surprise, because the home already knew its own weaknesses and had a plan for each. If you want to see how a single system such as Kiwi can hold all of that evidence in one place, book a demo and bring your own inspection questions.
Final conclusion
Inspection day under the single assessment framework is a long conversation between the inspector and your home, and most of the evidence is either people's experience or things that already happened. You cannot manufacture either in a morning. What you can do is keep the evidence live, brief staff to be honest, support people to take part, respond to anything that goes wrong as you would on any other day, and use the management interview to show that you know your home better than anyone else in the building. Do that and the rating will reflect the care you actually give.
Frequently asked
Are CQC inspections still unannounced under the single assessment framework?
Usually yes for residential and nursing homes. Some learning disability and mental health services get short notice, often 48 hours, so people can be supported to take part in a way that suits them. Either way, the home should be able to produce the rota, the list of people, the incident log and the safeguarding log within minutes.
What questions do CQC ask care staff during an inspection?
Practical ones: how do you know what this person needs, what would you do if you saw poor care, who would you report a safeguarding concern to, when was your last supervision, and what training have you had on this person’s condition. They also ask whether staff feel able to raise concerns and whether the manager listens. Staff should answer from their own knowledge and say when they would check the care plan.
How often do CQC inspect care homes now?
There is no fixed interval. Under the single assessment framework CQC assesses services based on risk and the information it holds, so a home rated Good may go several years without a site visit while one with a rise in notifications or a rating of Requires improvement will be visited sooner. Plan to be ready on any day rather than in a window.
Should staff be told what to say to the inspector?
No. Tell them to answer honestly from their own knowledge and to say they would check the care plan if unsure. Rehearsed answers that do not match the records or fall apart on a follow-up question do more harm than an honest gap.
Can I send evidence after the inspection visit?
Yes. Inspectors usually request further documents after the visit with a deadline, and you can send evidence of actions taken on anything raised on the day. You can also challenge factual errors in the draft report during the factual accuracy window, usually ten working days.
What is a CQC mock inspection and is it worth doing?
A mock inspection is an internal or external review that follows the real shape of an inspection day: documents on arrival, observation, interviews with people and staff, records tracking and a well-led interview. It is worth doing twice a year if it is done by someone who does not run the home and if the actions are followed up. Keep the reports as evidence of self-assessment.
What should be in a CQC inspection checklist for a care home?
The rota, a list of people with funding and DoLS status, the incident and safeguarding logs, the training matrix, recruitment files, the audit schedule and results, the service improvement plan, meeting minutes and the statement of purpose. Keep it live all year rather than assembling it when an inspection is expected.
Sources
- CQC: single assessment framework
- CQC: quality statements and evidence categories
- CQC: guidance on the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- CQC: Right support, right care, right culture
- CQC: Regulation 20 duty of candour guidance
- Skills for Care: Good and outstanding care guide
- GOV.UK: Care Act 2014 statutory guidance
- NICE: NG21 home care and QS50 mental wellbeing of older people in care homes
