CQC ratings explained: what Requires Improvement means and how care homes get back to Good

CQC ratings for care homes run on a four-point scale: Inadequate, Requires Improvement, Good and Outstanding. A Requires Improvement rating means the service is not performing as well as it should and CQC has told the provider what must change; it is not a failing grade, but it is public, it affects placements and recruitment, and it does not go away until CQC assesses again. This guide explains how the rating is built, what each level means in practice, and the route that homes actually take from Requires Improvement back to Good.

The short answer

Under the single assessment framework every quality statement CQC assesses is scored from one to four. Those scores are combined into a percentage for each of the five key questions, and the percentage sets the rating for that key question. The five key question ratings then combine into the overall rating. Requires Improvement usually means several statements scored two, often in safe and well-led, and the report will name breaches of regulation alongside. Getting back to Good means fixing the named breaches with evidence, fixing the governance that let them happen, and showing CQC sustained improvement rather than a burst of activity.

At a glance: the CQC rating scale

The table below sets out the four ratings, what each means in CQC's own terms, the approximate score band that produces it, and what typically follows for a care home.

How a CQC rating is built from quality statement scores

The mechanics matter because they tell you where to focus. Each key question has a set of quality statements: eight under safe, six under effective, five under caring, seven under responsive and eight under well-led. When CQC assesses a statement it gives a score: one for significant shortfalls, two for shortfalls, three for good, four for exceptional. The scores under a key question are added together and expressed as a percentage of the maximum possible. That percentage falls into one of the four rating bands.

Because the arithmetic is per key question, a home can be Good overall with Requires Improvement in safe, or Requires Improvement overall because two key questions dipped. CQC does not have to assess every statement at every visit. It can assess a handful, update those scores, and leave the others at their previous score. That is why a home that thought it was doing well can find its rating changed after a visit focused on medicines and governance alone. It is also why self-assessment against every statement, not just the ones raised last time, is the only reliable way to know where you stand.

What Requires Improvement actually means for a care home

In plain terms, Requires Improvement means the inspector found enough shortfalls that the service cannot be called Good, but not so many or so serious that it is unsafe. The report will usually name one or more breaches of the fundamental standards, most often Regulation 12 (safe care and treatment), Regulation 17 (good governance) and Regulation 18 (staffing), and will issue requirement notices asking for an action plan.

What it does not mean is that care is bad. Many homes rated Requires Improvement provide kind, competent care and were let down by records, audits or a period of staffing pressure. Inspectors know this and reports often say so. But the public sees the rating, not the nuance, and the consequences flow from the rating. A home can be rated Requires Improvement on its first inspection after registration simply because it has not yet had time to show sustained good practice, and that is worth explaining to families.

What Inadequate means and how special measures work

Inadequate is the failing rating. It means CQC found significant shortfalls, usually with a risk of harm, and it triggers enforcement. A service rated Inadequate overall, or Inadequate in well-led, is placed in special measures. CQC will re-assess within a set period, typically around six months, and if the service is still Inadequate CQC will move to cancel registration unless there is a clear reason not to. Warning notices with deadlines and conditions on registration, such as a bar on new admissions, are common alongside.

The route from Inadequate to Good usually passes through Requires Improvement, and CQC will want to see that the immediate risks were removed first and the governance rebuilt second. If you are reading this with an Inadequate rating, the rest of the article applies, but the timescales are shorter and the need for external support, from the local authority quality team or a consultant, is greater.

What Good and Outstanding mean and why the gap between them is wide

Good means the service meets expectations across the key questions: people are safe, care is effective and kind, the service responds to needs, and it is well led. Most care homes in England are rated Good, and Good is the rating a well-run home should expect. CQC Outstanding is different in kind rather than degree. It requires evidence of exceptional practice: innovation, outcomes clearly better than expected, a culture that others learn from, and consistency across every key question. It is rare, and it is hard to sustain because the next assessment tests whether the exceptional practice is still there.

For a home currently at Requires Improvement, the target is Good. Aiming for Outstanding before Good is secured leads to initiatives that look impressive and leave the basics unattended. Get medicines, records, governance and staffing right, hold them for a year, and then think about what exceptional would look like for your residents.

The consequences of a Requires Improvement rating

The consequences are practical and immediate. Local authority and integrated care board commissioners may pause new placements or require an improvement plan before placing again, particularly if safe is Requires Improvement. Families looking for a home read the rating first and many will not visit a home rated below Good. Existing families may ask questions and some will consider moving. Staff read the report too, and good staff worry about their own registration or reputation and may leave; recruitment becomes harder because candidates check ratings.

There are financial effects: insurers may ask questions at renewal, lenders may notice, and a home that relies on new admissions to stay full can find occupancy falling within months. The rating must be displayed at the entrance and on the website under Regulation 20A, so it cannot be hidden. None of this is a reason for despair; all of it is a reason to move quickly and visibly.

Reading the report properly before doing anything

The report is the map. Read it twice: once for the findings and once for the evidence the inspector relied on. Every key question section will name the quality statements assessed, the score, and what was found. The breaches of regulation are listed with the specific failures. Look for the words must and should, and note which findings are about outcomes (a resident came to harm), which are about processes (audits did not pick it up), and which are about culture (staff did not feel able to raise concerns).

Then map each finding to a root cause. A missed dose is a finding; the cause might be a paper MAR with no prompt for gaps, a senior not competency-assessed, or a stock system that let the medicine run out. The action plan must address the cause, not just the finding, or the same finding will reappear at the next assessment. Our guide to how to read a CQC report goes through the structure line by line.

The first 72 hours after the draft report arrives

The draft report comes to the provider for a factual accuracy check before publication. The first three days set the tone for everything that follows. Here is the order that works.

1. Read the draft in full and list every finding, breach and score in a single document.
2. Check the facts. Note anything that is wrong, unclear or missing evidence you gave on the day, with the evidence attached.
3. Submit the factual accuracy response within the deadline, usually ten working days, arguing only about facts and process, not opinion.
4. Tell staff what the rating will be, what it means, and that the plan starts now, before they read it online.
5. Tell residents and families in plain terms, with a letter and a meeting, and tell them what you are doing.
6. Inform commissioners and your insurer, with the draft action plan.
7. Start the immediate risk actions the same week: anything that put a person at risk gets fixed before the plan is even written up.

Factual accuracy challenges and ratings reviews

The factual accuracy process is your chance to correct errors and to add evidence that was available at the time of the assessment but not considered. It is not a chance to argue that the inspector was too harsh. Challenges that succeed are specific: the report says no PRN protocols were in place, but here are the protocols dated before the visit that the inspector was shown. Challenges that fail are general: we believe the home is Good.

After publication, a provider can request a ratings review, but only on the grounds that CQC did not follow its own process in reaching the rating. Reviews rarely change a rating and the time is usually better spent on improvement. If you genuinely believe process was not followed, seek advice and submit within the time limit, but do not let the review delay the action plan.

Building an improvement plan that CQC will believe

An improvement plan is a table: finding, root cause, action, owner, date, evidence of completion, evidence of sustained change. The last two columns are what separate a plan that gets you back to Good from one that gets you a second Requires Improvement. Every action needs something an inspector can pick up and check, and a second something that shows it stuck three months later.

Keep it live. Review it weekly with the deputy and monthly with the provider, and record the review. Close actions only when the evidence exists, and reopen them if a later audit shows regression. Send updates to CQC and commissioners at the intervals they ask for, and volunteer them if they do not ask. A plan that shows movement every month is the strongest well-led evidence you can produce. Digital compliance tools that hold the plan alongside the audits make the link between finding and evidence visible.

Fixing medicines: the most common cause of Requires Improvement in safe

Medicines optimisation is the quality statement most often scored two in care homes. Typical findings are gaps on MAR charts, stock that does not reconcile, PRN medicines without protocols, controlled drugs with missing witness signatures, creams and thickeners not charted, and audits that did not find any of it. The fix has three layers: competence, system and audit.

Competence means every person who administers medicines has been observed and signed off against your policy, with refreshers when errors occur. System means the recording method makes gaps visible: an eMAR that will not let a dose be skipped without a reason and counts stock as it goes, or a paper system with a daily check by the senior. Audit means a monthly medicines audit against NICE NG67 with findings recorded and actions taken, plus spot checks. The evidence for CQC is the audit trail showing errors falling over time. Our medication audit checklist sets out what to check.

Fixing governance: the finding behind every other finding

Regulation 17 appears in most Requires Improvement reports because when anything else fails, the inspector asks why the manager's systems did not catch it. The fix is an audit schedule that actually runs, with results that record what was found rather than ticks, an action plan that closes with evidence, and manager oversight that can be seen: signed audits, reviewed handovers, incident reviews with root causes, and meeting minutes that show issues discussed.

Start with the audits that relate to the findings in your report, then build outwards. If the report criticised care plan reviews, the care plan audit is monthly until it has been clean for three months, then quarterly. Keep a governance calendar so nothing depends on memory. The evidence CQC wants is a manager who can say what the home's problems are this month, because their own systems found them.

Fixing staffing, training and supervision

Staffing findings under Regulation 18 are usually about numbers, competence or support. For numbers, adopt a dependency tool that converts resident needs into hours, set the rota from it, and record what happens when someone is off sick. For competence, get the training matrix current, add competency assessments for medicines and moving and handling, and complete the Care Certificate for new staff. For support, get supervision back on schedule and record what was discussed, including wellbeing.

The evidence is the dependency tool, the rota, the matrix with nothing expired, supervision records and staff who tell the inspector there are enough of them and they feel supported. An HR and training system that flags expiries and supervision due dates removes the most common cause of regression, which is simply losing track once the pressure of the report fades.

Fixing care plans, risk assessments and records

Findings about records are about accuracy, completeness and currency. Care plans that do not reflect current needs, risk assessments not updated after falls, daily notes that say nothing, and MCA records that are generic all appear under effective and well-led. The fix is a full review of every resident's record, prioritised by risk, with the person and family involved, followed by a review schedule that is kept.

The trap is rewriting everything in a fortnight to look tidy. Inspectors notice plans that all carry the same date and no history. Better is a visible programme: ten plans a week, each reviewed properly, with the review recorded and the date of the next one set. Versioned care records that show what changed and when make the programme self-evidencing.

Fixing culture and staff confidence

A Requires Improvement report often contains a line about staff not feeling supported, not feeling able to raise concerns, or not being aware of the findings. Culture is fixed by behaviour, not by policy. Be visible on the floor. Hold a staff meeting about the report and let people speak. Set up a way to raise concerns and act on the first one publicly. Thank staff for what they do well and be honest about what must change.

The evidence is staff who, six months later, tell the inspector that things have changed and give examples. That is worth more than any document. Supervision that records the conversation, meeting minutes that show issues raised and answered, and a staff survey with actions are the supporting paperwork.

Evidence of change versus promises of change

The difference between a home that returns to Good and one that does not is almost always evidence. CQC has seen every action plan in the world. What moves a score is proof that the action happened and that the outcome changed: a medicines audit trail with errors falling from eight a month to one; a falls log with reviews and a reduction in repeat fallers; a training matrix at full compliance for three consecutive months; supervision records for every member of staff; a care plan audit that is clean.

Build the evidence as you go rather than assembling it before the next visit. Date everything. Keep the before as well as the after, because improvement is only visible against a starting point. A one-page summary of key measures, updated monthly, is the document to hand an inspector at the next assessment.

Keeping commissioners, families and staff informed

Silence after a Requires Improvement rating is read as complacency. Send commissioners the action plan and monthly updates; invite the local authority quality team to visit and to see the evidence. Write to families with the plan in plain language, hold a meeting, and follow up with progress. Tell staff at every team meeting where the plan stands.

This is not public relations. Commissioners and families are evidence sources for CQC under the partners and people's experience categories. A commissioner who has watched you improve month by month will say so when CQC asks. A family who was kept informed will say the home was honest. A member of staff who saw the plan working will say leadership changed.

When CQC comes back and how to ask for a re-assessment

CQC decides when to re-assess based on risk, the seriousness of the findings and its own capacity. For Requires Improvement with requirement notices, a return within twelve months is common but not guaranteed; homes have waited longer. You can write to CQC to say the actions are complete and ask for an assessment, attaching the evidence summary. CQC is not obliged to come, but a clear, evidenced request is often acted on, and the letter itself becomes part of the evidence picture.

Use the wait. A home that has held improved practice for a year has a far stronger case than one that fixed things in a month and drifted. If your evidence shows sustained improvement, ask for a re-assessment and say so plainly.

Using data to prove the rating should change

The single assessment framework values outcomes, and outcomes are numbers. Track a short set of measures monthly: medicines errors, missed doses, falls and repeat fallers, pressure damage, safeguarding referrals, complaints and their resolution time, training compliance, supervision compliance, care plan reviews on time, agency hours. Present them as a simple table with the month of the report as the baseline.

When the inspector returns, that table answers the question they came to ask: has it changed? A home that can show its numbers, explain the dips and describe what it did about them is demonstrating governance, learning and outcomes at once. A dashboard that pulls these figures from daily records saves the manager an afternoon a month and makes the numbers trustworthy.

A checklist for the months before re-assessment

• Every finding in the report has a closed action with evidence of completion and evidence it has been sustained for at least three months.
• Medicines audits for the last three months are clean or show a falling error trend with actions.
• Every resident's care plan and risk assessments have been reviewed within the period your policy states.
• Training matrix shows no expired mandatory training; supervision and appraisal are on schedule.
• Incident, safeguarding and notification logs reconcile with one another.
• Audit schedule has been met every month, with findings and actions recorded.
• Staff can describe what changed since the report and say they feel supported.
• Commissioners and families have received regular updates and can confirm it.
• A one-page outcomes summary with baseline and current figures is ready to hand over.
• The rating poster and website are current.

Sustaining Good once you have it

Homes that fall back to Requires Improvement usually do so because the improvement depended on one person or on an unusual level of effort. The manager who led the recovery moves on; the audits stop; the rota slips. Sustaining Good means building the routines into the home so they run without heroics: a governance calendar, systems that prompt rather than rely on memory, a deputy who can run the audits, and a provider that checks.

It also means keeping the honesty that got you back. The homes that stay Good are the ones whose managers can still say what is not right this month. Our guide to the fundamental standards is a useful annual read to check nothing has drifted.

Common mistakes

• Arguing with the rating instead of fixing the findings, and losing months in the process.
• Action plans that address findings but not root causes, so the same findings reappear.
• Rewriting every care plan in a fortnight so they all carry the same date and no history.
• Audits that restart with enthusiasm and stop after two months.
• Failing to tell families and commissioners, so the first they hear is the published report.
• Improvement that depends on the manager personally and collapses when they are on leave.
• Assuming CQC will return quickly and losing momentum when they do not.
• Aiming at Outstanding before Good is secure.

What good looks like on inspection day

Fourteen months after a Requires Improvement report citing Regulations 12 and 17, the inspector returns to look at safe and well-led. The manager hands over the improvement plan with every action closed and evidenced, and a one-page outcomes table showing medicines errors down from nine in the baseline month to one, repeat fallers halved, training compliance at full for six consecutive months and supervision on schedule for everyone. The inspector follows three residents' medicines and finds every dose accounted for, PRN protocols in place and the last three audits clean. The rota matches the dependency tool. Staff describe the changes in their own words and say the manager is on the floor every day. The safeguarding log matches the notifications. The manager says the current weakness is night-time activity provision and shows the plan for it. The commissioner, contacted the following week, confirms monthly updates and two visits where the evidence matched. The scores for the assessed statements move from two to three, and the rating follows.

Final conclusion

A Requires Improvement rating is a statement about a moment, built from scores on specific quality statements, and it can be changed by fixing what those scores measured. The homes that get back to Good read the report for causes rather than findings, fix medicines, governance, staffing and records in that order, gather evidence as they go, keep everyone informed, and build routines that hold when the pressure is off. The rating then follows the evidence, which is how it should be.

Frequently asked

Is a CQC Requires Improvement rating a fail?

No. It means the service is not performing as well as it should and CQC has set out what must improve. Inadequate is the failing rating. Requires Improvement is public and affects placements and recruitment, so it needs a prompt and evidenced response.

What is the CQC rating scale?

CQC rates services as Inadequate, Requires Improvement, Good or Outstanding. Each of the five key questions gets a rating and they combine into an overall rating. Under the single assessment framework the ratings are built from numerical scores on quality statements.

How long does it take to go from Requires Improvement to Good?

It depends on when CQC re-assesses, which is based on risk and capacity rather than a fixed timetable. Many homes wait around a year, and some longer. Sustained improvement over that period is stronger evidence than a quick fix, so use the time to build routines that hold.

Can a care home challenge a CQC rating?

Providers can challenge factual accuracy in the draft report, usually within ten working days, and can request a ratings review after publication on the grounds that CQC did not follow its process. Factual challenges that are specific and evidenced can succeed. Ratings reviews rarely change the outcome, so the action plan should not wait for one.

Can I ask CQC to re-inspect my care home?

Yes. Write to CQC setting out that the actions are complete, attach the evidence summary, and ask for an assessment. CQC is not obliged to come but a clear, evidenced request is often acted on. The request itself becomes part of the evidence picture.

What is the most common reason care homes get Requires Improvement?

Medicines management under Regulation 12 and governance under Regulation 17 are the most common findings, often together. Staffing under Regulation 18 and records that do not reflect current needs are close behind. Fixing medicines and audit systems first addresses most of the risk.

Do I have to tell families about a Requires Improvement rating?

The rating must be displayed at the home and on your website, so families will see it. It is far better that they hear it from you with an explanation and a plan. Keeping families informed also produces positive people's experience evidence at the next assessment.

Sources

• CQC: single assessment framework guidance
• CQC: how we rate and score services
• CQC: enforcement policy
• CQC: factual accuracy and ratings review process
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• NICE guideline NG67 Managing medicines in care homes
• GOV.UK: Care Act 2014 statutory guidance