Care homes in England must report certain events to CQC without delay: every death of a person using the service, serious injuries, abuse and allegations of abuse, the outcome of DoLS applications, incidents involving the police, events that stop or threaten the running of the service, and the absence of the registered manager for 28 days or more. Each has a regulation behind it and a form to send. Missing a notification is a breach in its own right, separate from whatever happened.
The short answer
CQC reporting is a duty on the registered person under the Care Quality Commission (Registration) Regulations 2009. The events are set out in Regulations 14 to 18 and most homes deal with the same handful: deaths under Regulation 16, and serious injuries, abuse, DoLS outcomes, police incidents and service disruption under Regulation 18. The test for each is the definition in the regulation, not how the home feels about the event. Notify the same or next working day, keep the reference, and record the decision not to notify where you decided an event did not meet the test. Then build the decision into your incident process so it happens every time, rather than relying on the manager remembering. A home that notifies promptly and accurately is showing CQC that it is open; a home that does not is showing the opposite.
Where the duty comes from
The duty sits in the registration regulations, not in the fundamental standards. The relevant regulations are Regulation 14, the absence of the registered manager for 28 days or more; Regulation 15, changes to the registered person or the service; Regulation 16, the death of a person using the service; Regulation 17, the death or unauthorised absence of a person detained under the Mental Health Act; and Regulation 18, other incidents. Regulation 18 is the one that covers most of what a care home notifies, and it is why managers talk about CQC Regulation 18 notifications.
The duty is on the registered person, which means the registered manager and the provider. A deputy can send the form, but the registered manager is accountable for it being sent. Failure to notify is an offence and CQC can take enforcement action for it independently of the event itself, and a pattern of missed or late notifications is one of the things that most damages a provider's standing with its inspector.
The notifications also feed CQC's ongoing assessment of the home under the single assessment framework, so every one you send is evidence, and every one you miss is a gap the inspector will find when they compare your incident log with their records.
At a glance: what to notify and when
| Event | Regulation | Form | When |
|---|---|---|---|
| Death of a person using the service, anywhere, from any cause | Reg 16 | Death notification | Without delay |
| Death or unauthorised absence of a person detained under the Mental Health Act | Reg 17 | Death or absence notification | Without delay |
| Serious injury to a person using the service | Reg 18(2) | Other incidents | Without delay |
| Abuse or allegation of abuse involving a person using the service | Reg 18(2) | Other incidents | Without delay |
| Outcome of a DoLS application, granted or refused | Reg 18(4A) | DoLS notification | Without delay after the outcome |
| Incident reported to or investigated by the police | Reg 18(2) | Other incidents | Without delay |
| Event that stops or could stop the service running safely, such as loss of utilities, fire, flood, staffing collapse or outbreak | Reg 18(2) | Other incidents | Without delay |
| Registered manager absent for 28 days or more | Reg 14 | Absence notification | Before or as soon as the absence is known |
| Changes to the registered person, nominated individual, address or service | Reg 15 | Changes notification | As set out in the regulation |
The forms are on the CQC provider portal. Use the current version and keep the confirmation.
Deaths
Every death of a person using the service is notified, whatever the cause, wherever it happened. A resident who dies peacefully in bed at 94 is notified. A resident who dies in hospital after a fall is notified. A resident on a short respite stay who dies during it is notified. The only exception is a person who had left the service before they died, and even then record the reasoning.
The form asks for the circumstances: where the person died, whether the death was expected, the cause if known, whether the coroner is involved, and whether any incident preceded it. Answer factually. Where a fall, choking episode, pressure ulcer or medication error preceded the death, say so and send the other incidents notification for that event as well if it meets the test.
Send the death notification the same or next working day. Do not wait for the death certificate or the coroner's decision; you can update CQC later. Deaths of people detained under the Mental Health Act, which may apply in some mental health homes, go under Regulation 17 with a different form.
Serious injury: the definition
The Regulation 18 definition of serious injury is precise, and the judgement calls are easier if you apply it rather than your instinct. An injury is serious if it leads to, or if left untreated would lead to, any of the following: impairment of sensory, motor or intellectual function likely to last at least 28 days; changes to the structure of the body; prolonged pain or psychological harm of 28 days or more; a shortening of life expectancy; or the need for treatment to prevent death or any of those effects.
Changes to the structure of the body covers fractures, so every fracture is notified. Treatment to prevent those effects covers most hospital admissions for injury, so a resident admitted after a fall with a head injury is notified even if the scan is clear. A category 3 or 4 pressure ulcer, an unstageable ulcer or deep tissue injury acquired in the home is notified as a serious injury. A scald or burn needing hospital treatment is notified. A choking episode needing abdominal thrusts and an ambulance is normally notified.
A bruise, a skin tear dressed in the home, or a fall with no injury is not, unless it forms part of a safeguarding concern. Record the decision either way.
Serious injury: the judgement calls
The hard cases are the ones where the outcome is uncertain on the day. A resident who hits their head and is observed in the home overnight has not yet met the test; if they are admitted the next day, notify then. A resident with a suspected fracture sent for an X-ray is notified once the fracture is confirmed, and if you are not sure, notify anyway and update. A resident who develops a pressure ulcer that the district nurse grades category 2 is not notified, but if it deteriorates to category 3, it is.
Where you are genuinely unsure, notify. CQC would rather receive a notification that turns out to be unnecessary than miss one, and a home that over-notifies slightly is never criticised for it. A home that under-notifies is.
Make the decision on the day and record it on the incident. If the picture changes, revisit it. An incident review that asks the notifiable question explicitly, as part of CQC compliance, prevents the common failure where everyone assumed someone else had decided.
Abuse and allegations: what counts
Regulation 18 requires notification of any abuse or allegation of abuse in relation to a person using the service. Abuse takes its Care Act meaning: physical, sexual, psychological, financial, discriminatory, organisational, neglect, self-neglect, domestic abuse and modern slavery. The key word is allegation. You do not decide whether the abuse happened before notifying; you notify because it has been alleged, and the notification says what you have done about it.
That means an allegation by a resident against a member of staff is notified even if you think it unfounded. An allegation by a relative is notified. A resident-on-resident incident that caused harm or distress is notified. A pressure ulcer or a fall where neglect is possible is notified as abuse alongside the serious injury notification. Financial concerns about a relative are notified. A safeguarding referral you make to the local authority is nearly always matched by a CQC notification.
The notification asks what happened, who is involved, whether the person is safe, whether the local authority and police have been told, and what action you have taken. See safeguarding adults in care homes for the referral process that runs alongside.
DoLS outcomes
Every DoLS application has an outcome, granted or refused, and the outcome is notified to CQC under Regulation 18(4A) using the DoLS form. Where the authorisation is granted, the notification includes whether any conditions were attached. Where the application was refused, or where the person died or left before the assessment, that is notified too. The urgent authorisation the home grants itself is not notified; the outcome of the standard application is.
Homes with many residents under DoLS often fall behind on this because the outcome arrives weeks or months after the application and the letter goes in a file. Keep a DoLS register with the date applied, the date of outcome, the expiry date and the date CQC was notified, and check it monthly. Your care records should hold the authorisation against the resident with the expiry date visible.
Where the Liberty Protection Safeguards eventually replace DoLS, the notification duty will follow; check current guidance. See the Mental Capacity Act and DoLS checklist for the application process.
Police incidents
Any incident that is reported to or investigated by the police is notified. That covers a theft from a resident, an assault, a missing person report, a resident's death referred to the police by the coroner, damage to the building, a member of staff arrested for a matter connected to work, and a call to the police about a resident's behaviour. It covers incidents where the home called the police and incidents where someone else did.
The notification asks what happened, the police reference, and what the home has done. If the same event is also an abuse allegation or a serious injury, send the notification once and tick every box that applies rather than sending three.
Some homes hesitate to notify police involvement because it feels like an admission. It is not. It is evidence that the home takes incidents seriously and involves the right people. The absence of a notification when CQC later learns from the police that they attended is far more damaging.
Events that stop the service running
Regulation 18 also covers events that stop, or could stop, the service being carried on safely and properly. In a care home that means a fire, a flood, loss of heating, water or power for more than a short period, a gas leak, structural damage, an infectious outbreak that closes the home to admissions, a staffing collapse that leaves the home below safe numbers, a cyber attack that takes down the care records, and the sudden absence of the registered manager or the whole senior team.
The notification says what happened, what the effect on residents is, and what the home has done, including any evacuation or move. Send it as soon as the immediate situation is under control, and update CQC when the service is back to normal.
These are the notifications most often missed because the home is busy dealing with the event. Put the notification on the business continuity plan checklist so whoever is running the response knows it is a task.
Manager absence and changes
Regulation 14 requires notification when the registered manager is, or is expected to be, absent for 28 days or more, and again when they return. That includes long-term sickness, maternity leave, secondment and extended holiday. The notification says who is in charge in the meantime and how the provider is supporting them. When a registered manager leaves, the provider must apply to cancel their registration and the new manager must apply to register; the interim arrangements are notified.
Regulation 15 covers changes: a new nominated individual, a change of provider address or contact details, a change to the statement of purpose, a change to the number of beds, and closure of the service. Some of these are applications rather than notifications, so check the guidance.
Keep these on the manager's own calendar and the provider's. A home that has been without a registered manager for six months with no notification is a governance finding before anything else is looked at. HR records that flag the registered manager's absence help.
What not to notify
Not everything goes to CQC, and over-notifying trivial events wastes time on both sides. Do not notify a fall with no injury, a medication error with no harm and no safeguarding element, a complaint that has not raised a safeguarding concern, a minor injury treated in the home, a resident going to hospital for a planned procedure or a non-injury illness, a category 1 or 2 pressure ulcer, a routine staffing shortfall covered by agency, or a resident's expected move to another service.
Each of these is still recorded, reviewed and, where appropriate, reported elsewhere: to the local authority as a safeguarding concern, to the commissioner under the contract, to the HSE under RIDDOR for certain accidents involving staff or members of the public, or to the coroner. The CQC notification is one of several reporting duties and it is not the widest.
Record the decision not to notify on the incident with a one-line reason. When an inspector compares your incident log with their notification record, that line is what shows the decision was made.
Other reporting duties that run alongside
A single event can trigger several reports, and the incident process should prompt each one. A safeguarding referral goes to the local authority under the Care Act whenever there is reasonable cause to suspect abuse or neglect. RIDDOR reports go to the HSE for specified injuries to staff, injuries to residents arising from a work activity such as a hoist failure, and dangerous occurrences. The coroner is told of deaths that are unexpected, unnatural or where the cause is unknown, usually via the GP or the police. The commissioner is told of incidents as the contract requires. The duty of candour under Regulation 20 requires the person and their representative to be told of a notifiable safety incident, given an apology and a written account.
Keep a single record of who was told what and when for each incident, with the references. An incident reporting system that prompts each duty as a checkbox with a date and reference is the simplest way to make sure none is missed.
How to send a notification
- Deal with the immediate situation first: the resident's safety, medical help, the police if needed.
- Decide the same day which notifications apply, using the definitions, and record the decision on the incident.
- Log in to the CQC provider portal and choose the right form: death, DoLS, other incidents, absence or changes.
- Complete it factually: what happened, when, who was involved, what the effect on the person is, what you have done, who else has been told.
- Do not include more personal data than the form asks for, and do not name staff unless the form requires it.
- Submit, save the confirmation and record the reference number on the incident.
- Tell the provider or nominated individual that a notification has been sent.
- Update CQC if the picture changes, for example a suspected fracture confirmed or a safeguarding enquiry concluded.
Making notifications routine
The homes that miss notifications are not usually careless; they are busy, and the decision falls between the person who handled the incident and the manager who reads it a week later. The fix is to build the decision into the incident record itself. Every incident form asks the notifiable question with the categories listed, the person completing it answers provisionally, the senior on shift confirms, and the manager signs it off within 24 hours. The reference number goes on the incident.
Then check it monthly. List every incident in the month, the notification decision and the reference, and look for gaps: a fracture with no notification, a safeguarding referral with no abuse notification, a DoLS outcome letter with no DoLS notification. Kiwi's incident review carries a CQC-notifiable flag and the reference against each incident, so the monthly check is a report rather than a trawl; book a demo if you want to see it.
Train seniors and night staff on the categories, because the events happen on their shifts. Put the table from this article by the incident forms.
Late notifications
A notification sent late is still sent, and it is better than one never sent. If you discover an event from last month that should have been notified, notify it now, say in the form that it is late and why, and record what you have changed so it does not recur. CQC may raise it, but a late notification with an honest explanation is treated very differently from one that comes to light because the inspector found it.
A pattern of late notifications is a well-led finding: it says the manager does not have oversight of incidents. If you find several, do a full reconciliation of the incident log against notifications for the last twelve months, notify everything that was missed, and tell your inspector what you found and what you did. That conversation, uncomfortable as it is, protects the home.
Do not backdate anything. The form records when it was sent, and honesty about the delay is the only defensible position.
Learning disability and mental health services
In these services notifications cluster around restraint, absconding, self-harm, resident-on-resident incidents, police involvement and DoLS. Restraint that causes injury meeting the serious injury test is notified; restraint that is alleged to be abusive is notified as abuse. A resident who leaves without support and is reported missing to the police is a police notification. Self-harm requiring hospital treatment is a serious injury notification. Any death of a person detained under the Mental Health Act is a Regulation 17 notification.
DoLS volumes are high and the outcomes arrive slowly, so the DoLS register is essential. Resident-on-resident incidents need particular care: an assault by one resident on another is an abuse notification, and the notification should say what has been done to protect both people.
Restrictive practices that are not abusive and cause no injury are not notified but are recorded in the restraint register and reported to the commissioner as required, and they will be looked at under the safe and caring key questions.
Records and data protection
Notifications contain personal and often special category data, so they need to be handled under UK GDPR. Send them through the provider portal rather than by email where possible. Include only what the form asks for. Keep the confirmation and the reference with the incident, in the resident's record where it concerns a resident, not in a shared folder everyone can open. Retain them in line with your records retention policy.
Relatives sometimes ask whether an event was reported to CQC. The answer is yes or no with the date; the content of the notification is shared under the duty of candour where the event was a notifiable safety incident and otherwise on request within the limits of the resident's confidentiality.
The daily record should note that the notification was sent, so the trail from the event through the daily log to the incident and the notification is continuous.
Common mistakes
- Not notifying a death because it was expected.
- Not notifying an allegation because the manager did not believe it.
- Waiting for the fracture to be confirmed and then forgetting.
- DoLS outcome letters filed without the notification being sent.
- Category 3 pressure ulcers treated as a district nurse matter rather than a serious injury.
- Police called at night and nobody telling the manager it needs notifying.
- The registered manager on long-term sick leave with no absence notification.
- No record of the decision not to notify, so it looks like nobody considered it.
What good looks like on inspection day
The inspector arrives with a list of every notification the home has sent in the last year and compares it with the incident log, the safeguarding log, the DoLS register and the accident book. In a well-run home the lists match: every fracture, every safeguarding referral, every DoLS outcome and every police call has a notification reference next to it, and every incident that was not notified has a one-line reason. The references are on the incidents, not in a separate folder.
The manager can explain the definitions and give an example of a judgement call and how they made it. The senior on shift can say which events they would notify and where the form is. The monthly reconciliation is in the governance file. Any late notification in the year has an explanation and a change attached to it.
That is the whole picture. It takes a decision built into the incident record, a monthly check, and a manager who would rather notify once too often than once too few.
Final conclusion
CQC notifications are a legal duty with clear definitions, and the events that must be reported are not hard to recognise once the categories are known: deaths, serious injuries, abuse and allegations, DoLS outcomes, police involvement, service disruption and manager absence. What goes wrong is process, not knowledge. Put the notifiable question on every incident, decide the same day, send the same or next working day, record the reference or the reason for not sending, and reconcile monthly. Do that and notifications stop being a source of anxiety and become part of the evidence that the home is open, well-led and safe.
Frequently asked
What must a care home report to CQC?
The death of any person using the service, serious injuries, abuse or allegations of abuse, the outcome of every DoLS application, incidents reported to or investigated by the police, events that stop or could stop the service running safely, and the absence of the registered manager for 28 days or more. Each has its own regulation and its own form.
How quickly do I have to notify CQC?
Without delay, which CQC treats as the same day or the next working day for most notifications. Deaths, serious injuries, abuse and police incidents should be sent as soon as the immediate situation is dealt with. A notification sent a week later, even if the event was handled well, is a late notification and a breach in itself.
Do I need to report a medication error to CQC?
Only where it caused harm meeting the serious injury definition, where it is part of a safeguarding concern, or where the police are involved. Every error is recorded and reviewed internally regardless. Record the decision not to notify and the reason, so the reasoning is visible later.
Does a fall need to be reported to CQC?
A fall is notified where it causes serious injury, such as a fracture, a head injury needing hospital treatment, or an injury with lasting effects, or where it results in death. Falls with no injury or minor injury are recorded and reviewed but not notified, unless neglect or abuse is suspected, in which case an abuse notification is sent.
Do I notify CQC when a resident dies in hospital?
Yes, if the person was still using your service at the time. The death notification asks where the person died and the circumstances. If the person had been discharged from your service before they died, no notification is needed, but record the reasoning.
What is a serious injury for CQC notification purposes?
An injury that leads to impairment of sensory, motor or intellectual function likely to last at least 28 days, a change to the structure of the body such as a fracture, prolonged pain or psychological harm of 28 days or more, a shortening of life expectancy, or an injury that requires treatment to prevent death or any of those effects. Any admission to hospital for treatment of an injury will usually meet the test.
Who is responsible for sending CQC notifications?
The registered person, which in practice means the registered manager, or the provider or nominated individual where there is no registered manager in post. A deputy can complete and send a notification, but the registered manager remains responsible for making sure it is sent and accurate.
Sources
- CQC: Statutory notifications guidance for providers
- Care Quality Commission (Registration) Regulations 2009, Regulations 14 to 18
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 20 Duty of candour
- Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 2013 (RIDDOR), Health and Safety Executive
- Care Act 2014 statutory guidance, Chapter 14 Safeguarding
- Mental Capacity Act 2005 Deprivation of Liberty Safeguards Code of Practice
- CQC: Notification forms for deaths, DoLS and other incidents
