CQC quality statements explained: the single assessment framework for care homes

The CQC single assessment framework assesses care homes against 34 quality statements grouped under the five key questions: safe, effective, caring, responsive and well-led. Each statement is a plain sentence describing what a good provider does, each is judged using up to six categories of evidence, and each is scored from 1 to 4. The scores produce the key question ratings and the overall rating. For a registered manager, the practical task is to know what evidence sits under each statement in your home and to be able to produce it.

The short answer

The quality statements replaced the key lines of enquiry, the KLOEs, when the single assessment framework was introduced. The five key questions did not change. What changed is that the long lists of KLOE prompts became 34 we statements, and CQC now gathers evidence continuously and can assess some statements without visiting. The evidence CQC wants is much the same as before: people's experience, what staff and partners say, what inspectors observe, your processes, and your outcomes. The scoring is more visible than it was, with each statement scored 1 to 4. The best way to prepare is to map your existing records to each statement, score yourself honestly each quarter, and fix the gaps. Nothing in the framework requires new paperwork if the records you already keep are good.

How assessment works now

Under the old model, a rating came from an inspection visit and stayed until the next one. Under the single assessment framework, CQC gathers evidence on an ongoing basis from notifications, the provider information return, feedback from people and staff, information from the local authority and the ICB, and on-site inspection where it chooses to visit. An assessment can look at all 34 statements or a subset, and the rating for a key question can change after an assessment of only some of its statements.

This means the home is always, in effect, being assessed. Your notifications, your complaints handling, your safeguarding referrals and what relatives say to CQC all feed the evidence base whether or not an inspector is in the building. It also means that an inspection visit is shorter and more focused than it used to be, and inspectors arrive with a view already formed from the evidence they hold.

CQC has been revising how it operates since the 2024 Dash review found problems with its delivery of the framework, so check the current guidance for the detail of scheduling and scoring. The quality statements themselves have not changed.

At a glance: the five key questions and 34 statements

From KLOEs to quality statements

The KLOEs were the key lines of enquiry, a set of questions under each key question, each with prompts, that inspectors used to structure a visit. Managers built evidence files around them, and many still have folders labelled S1 to S6. The quality statements consolidate that structure. Where the safe key question had six KLOEs with dozens of prompts, it now has eight statements, each a single sentence starting with we.

The underlying expectations did not move much. Safe staffing is still safe staffing; medicines are still medicines; governance is still governance. What a manager who built a KLOE evidence file needs to do is re-map it, not rebuild it. Most KLOE folders map onto one or two statements each, and the gaps that appear are usually around the new emphases: equity, workforce wellbeing, environmental sustainability, and learning culture as a thing in itself.

Inspectors still ask KLOE-shaped questions in conversation because the statements are broad, so the old prompts remain useful for anticipating what will be asked.

The six evidence categories

Every quality statement is assessed using some or all of six evidence categories. Knowing which categories apply to which statements tells you what an inspector is looking for.

• People's experience: what residents and relatives say, through conversations, surveys, complaints and compliments.
• Feedback from staff and leaders: what your team says in interviews, surveys and conversations with the inspector.
• Feedback from partners: the local authority, safeguarding team, GP practice, district nurses, commissioners and advocates.
• Observation: what the inspector sees on the day, from the mealtime to the medication round to the way a carer speaks to a resident.
• Processes: policies, care plans, risk assessments, audits, training records, rotas, meeting minutes.
• Outcomes: what actually happened to people: falls, pressure ulcers, weight, hospital admissions, complaints resolved, goals achieved.

Processes are only one category of six. A home with excellent paperwork and poor observed care will score badly, and a home with thin paperwork and strong outcomes and feedback will do better than it expects. The categories are also why a digital record matters: outcomes are only visible if someone can pull the numbers.

How scoring and ratings work

Each quality statement assessed is given a score from 1 to 4. A 4 means the evidence shows an exceptional standard, 3 a good standard, 2 some shortfalls, and 1 significant shortfalls. Where evidence is gathered under several categories, each category is scored and the statement score is derived from them. The statement scores under a key question are added and expressed as a percentage of the maximum, and the percentage gives the key question rating.

The bands CQC published were 25 to 38 percent inadequate, 39 to 62 percent requires improvement, 63 to 87 percent good and 88 to 100 percent outstanding. The overall rating is then derived from the five key question ratings using the same principles as before, with limiters so that an inadequate or requires improvement key question caps the overall rating.

CQC has said it is simplifying its use of scoring following the Dash review, so treat the percentages as indicative and check the current guidance. The principle that matters for a manager is unchanged: a single statement with significant shortfalls, particularly in safe or well-led, can pull a whole key question down. See CQC ratings and requires improvement for what happens next.

Safe: the eight statements

The safe key question has the most statements and the most weight in practice. They are learning culture; safe systems, pathways and transitions; safeguarding; involving people to manage risks; safe environments; safe and effective staffing; infection prevention and control; and medicines optimisation.

In a care home the evidence is concrete. Learning culture is your incident log, the reviews, the actions and the staff meeting minutes showing the learning was shared. Safe transitions is your admission process, hospital passports and discharge reconciliation. Safeguarding is the log of concerns, the referrals, the outcomes and the training. Involving people to manage risks is the risk assessments with the person's own views and positive risk taking recorded. Safe environments is the maintenance log, fire checks, water safety and equipment servicing. Safe staffing is the dependency tool, the rotas, agency use, recruitment checks, induction and supervision. Infection control is the audits, the cleaning schedules and the outbreak plan. Medicines optimisation is the MAR, the audits, the errors and the PRN protocols.

Most of that lives in your CQC compliance file and your care records already. The task is to know where.

Effective: the six statements

The effective statements are assessing needs; delivering evidence-based care and treatment; how staff, teams and services work together; supporting people to live healthier lives; monitoring and improving outcomes; and consent to care and treatment.

Assessing needs is the pre-admission assessment and the care plan built from it, reviewed on time. Evidence-based care is whether your practice follows recognised guidance: MUST, Waterlow, IDDSI, the Mental Capacity Act code, NICE medicines guidance, and whether your policies reference them. Working together is the record of contact with GPs, district nurses, the community learning disability team, the mental health team, and how information flows in and out. Healthier lives is annual health checks, oral health, screening, activity and diet. Monitoring outcomes is the numbers: weights, falls, pressure damage, infections, hospital admissions, and what you did when they moved. Consent is capacity assessments, best interests decisions, DoLS and LPS authorisations, and evidence that people's consent is sought day to day.

Health monitoring that holds MUST, BMI, weights and charts in the care record makes the outcomes statement much easier to evidence than a folder of paper charts.

Caring: the five statements

The caring statements are kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people's immediate needs; and workforce wellbeing and enablement.

Caring is assessed mostly through observation and people's experience rather than documents, which is why it is the key question most homes rate well on and the one hardest to prepare for. Inspectors watch how staff speak to residents, whether doors are knocked on, whether people are rushed, whether choices at mealtimes are real, whether a distressed resident is noticed and comforted. They talk to residents and relatives about whether staff know them and treat them with respect.

The documents that support it are the parts of the care plan that describe the person, their history, preferences and routines, and the daily notes that show those preferences being honoured. Workforce wellbeing is new under this key question and covers supervision, staff support, reasonable adjustments for staff and whether the team feels valued, evidenced through staff feedback, surveys and supervision records.

Responsive: the seven statements

The responsive statements are person-centred care; care provision, integration and continuity; providing information; listening to and involving people; equity in access; equity in experiences and outcomes; and planning for the future.

Person-centred care is care plans written around the person's goals and reviewed with them. Continuity is how care is coordinated across services and consistent across shifts, including handover. Providing information is the accessible information standard in practice: easy read, large print, pictures, translation, and evidence people understand what they are told. Listening is the complaints log, the outcomes, resident and relative meetings, surveys and what changed because of them. Equity in access and equity in experiences are newer emphases and ask whether people with particular characteristics, such as a learning disability, a mental health condition or a protected characteristic, get the same access and outcomes as everyone else, and what you do about barriers. Planning for the future is advance care planning, end of life wishes and ReSPECT or equivalent forms.

Learning disability and mental health services should expect the equity statements to be explored closely, with reference to the right support, right care, right culture guidance.

Well-led: the eight statements

The well-led statements are shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability; partnerships and communities; learning, improvement and innovation; and environmental sustainability.

This is the manager's key question. Shared direction is the statement of purpose, the values and whether staff can describe them. Capable leaders is the registered manager's visibility, knowledge and support, and the provider's oversight. Speak up is the whistleblowing policy, the freedom to speak up arrangements, and whether staff say they would raise concerns and be heard. Workforce equality is recruitment, the staff profile, and how discrimination is handled. Governance is the audit programme, the action plans, the quality meetings, the provider's visits and the business continuity plan. Partnerships is the relationships with commissioners, the local authority, health services and the community. Learning and improvement is what changed this year and why. Environmental sustainability is what the home does about energy, waste and its footprint.

Well-led scores drive the overall rating. A home with strong governance evidence usually finds the other four key questions easier, because the same audits and action plans are the evidence there too.

Mapping your records to the statements

Take a sheet with the 34 statements down the side and six columns for the evidence categories. For each statement, write where the evidence lives in your home: which folder, which system report, which meeting minutes, which survey. Where a box is empty, decide whether the evidence exists and is simply not identified, or does not exist. Most homes find that processes are well covered, people's experience and partner feedback are patchy, and outcomes are hard to pull together.

Then fix the gaps in order of risk: safe and well-led first, then the statements where the evidence is missing entirely. A partner feedback gap is fixed by asking the GP practice and the local authority for a short written comment each year. An outcomes gap is fixed by producing a monthly dashboard of falls, weights, pressure damage, infections, complaints and admissions.

Keep the map current. It is the document that lets a deputy answer an inspector when the manager is on leave.

Self-assessment: scoring yourself each quarter

Once the map exists, score each statement from 1 to 4 every quarter using the same scale CQC uses, and be honest. A 3 means you can produce evidence across the relevant categories that shows a consistently good standard. A 2 means there are shortfalls you know about. A 4 is rare and needs evidence of something genuinely beyond good, sustained over time.

1. Book a half day each quarter with the deputy and, if you have one, the quality lead.
2. For each statement, review the evidence in each applicable category and agree a score with a one-line reason.
3. For every 1 or 2, write an action with an owner and a date.
4. Calculate the percentage for each key question so you can see where you would sit.
5. Review last quarter's actions and record what closed.
6. Share the summary with the provider and the staff team.
7. File it with the audits as governance evidence.

Inspectors like to see self-assessment because it evidences the well-led statements directly. A self-assessment that scores everything 4 is not credible; one that scores several statements 2 with clear actions is.

People's experience: gathering it properly

People's experience is the first evidence category for a reason. Inspectors speak to residents and relatives before, during and after a visit, and they read complaints and reviews. Your own evidence in this category needs to be systematic: resident meetings with minutes, relative surveys at least annually with the results and the actions, keyworker conversations recorded in the care plan, and a complaints process that records the outcome and what changed.

In learning disability and mental health services, gathering experience needs adjustment: easy read surveys, pictorial options, advocacy involvement, and observation for people who cannot say. Record how you did it.

The test is whether you can show an inspector something that changed because a resident or relative said it should. One good example, with the dates, is worth more than a folder of survey forms.

Staff and partner feedback

Staff feedback is gathered through supervision, team meetings, an annual staff survey and exit interviews, and inspectors will ask staff directly whether they feel supported, whether they would raise concerns and whether the manager is visible. The documents that back it up are the supervision records, the meeting minutes and the survey results with actions. HR records that hold supervision and training against each staff member make this quick to evidence.

Partner feedback is the category most homes have least of. Ask the GP practice, the district nursing team, the community team, the safeguarding lead and the commissioner for a few lines once a year, and keep the emails. Record joint working: multidisciplinary meetings, professional visits, safeguarding strategy meetings, and what came out of them.

Inspectors contact partners themselves, so the relationships need to be real. A commissioner who has not heard from you since the contract was signed is not a partnership.

Observation: what inspectors see on the day

Observation is the category you cannot prepare on paper. Inspectors watch the front door, the mealtime, the medication round, a personal care interaction if invited, the lounge, the way the phone is answered, and the state of the building. They notice residents who are unengaged for long periods, staff who talk over people, call bells that ring, and doors that are locked without explanation.

The best preparation is a home that runs the same way every day. Managers who walk the floor daily and record what they see, and who act on it, tend to find observation evidence is in their favour. A short daily walkround note, kept in the governance file, is itself evidence of oversight.

See the inspection day hour by hour for what a visit looks like from the inside.

Outcomes: the numbers

Outcomes are the category that has grown most in importance and that most homes struggle to produce. The question is what happened to people. How many falls, how many with injury, and is the trend improving. How many pressure ulcers acquired in the home. How many residents lost weight, and what happened. How many infections, hospital admissions, safeguarding concerns, complaints, and medication errors. How many care plan goals were achieved.

Produce these monthly as a short dashboard and review them at the governance meeting with a note on what you are doing about each. A digital system that records incidents, health monitoring and audits in one place can produce most of this as a report; on paper it takes a day a month, which is why it rarely happens.

Outcomes evidence also protects you. A home with a rise in falls that can show the analysis and the response is a home with a learning culture; a home that does not know its falls number is not.

Learning disability and mental health services

For these services CQC applies the right support, right care, right culture guidance alongside the framework, and inspectors will look for evidence under each statement that the service is built around the person rather than the building. Expect particular attention to involving people in managing risks, consent and the Mental Capacity Act, restrictive practice and its reduction, positive behaviour support, equity of access to health care, workforce culture, and whether people are supported to live ordinary lives in the community.

The evidence is the same categories, but the balance shifts towards people's experience and observation. Advocates, families and the community team are important partners. Care plans need to show the person's goals and choices, not just their needs. Restrictive practices need a register, a reduction plan and evidence of review.

Managers in these services should read the statements alongside the right support guidance and note where each one is addressed.

Using the framework as a management tool

The framework is useful outside inspection. Structure your governance meeting around the five key questions, with the dashboard for outcomes and the audit results for processes under each. Structure the provider's monthly visit the same way. Use the statements to write the annual quality report and the improvement plan. Use the I statements in resident and relative surveys, because they are already written from the person's point of view.

A home that runs its governance this way finds that inspection preparation stops being a separate activity. The evidence is already organised the way CQC will ask for it, and the actions are already dated and owned. See how to prepare a care home for CQC inspection for the practical run-up.

Kiwi's CQC compliance module maps audits, actions and evidence to the quality statements and holds the incident reviews, health monitoring and training records the outcomes and processes categories need; if you want to see how that would look for your home, book a demo.

Common mistakes

• Rebuilding the evidence file from scratch instead of re-mapping the existing KLOE folders.
• Treating processes as the whole answer and ignoring observation, experience and outcomes.
• No partner feedback at all, so the category is blank.
• Self-assessment that scores every statement 4.
• Outcomes data that exists only in individual records and is never pulled together.
• Equity, workforce wellbeing and environmental sustainability ignored because they are unfamiliar.
• Preparing for inspection as an event rather than running governance around the framework all year.
• Assuming the rating will not change because there has been no visit.

What good looks like on inspection day

The manager can say which quality statements they think are strong and which are weaker, and why, because the quarterly self-assessment says so. For any statement the inspector raises, the manager can produce evidence under at least three categories within a few minutes: a record, a number and something a resident or partner said. The staff give consistent answers about values, speaking up and support. The residents and relatives say they are listened to and can give an example. The building and the mealtime match the paperwork.

The governance file shows a quarterly self-assessment, monthly audits with closed actions, a monthly outcomes dashboard, and meeting minutes that show learning shared. The inspector leaves with the impression that the framework is how the home is run, not how it prepared for the visit.

Final conclusion

The single assessment framework did not change what good care looks like. It changed how CQC describes it and how it gathers the evidence. The 34 quality statements are a manageable list, the six evidence categories tell you what to collect, and the scoring tells you where a weakness will hurt. Map your records to the statements, score yourself honestly every quarter, close the gaps in order of risk, and run your governance around the five key questions. Do that and the framework becomes the structure of a well-run home rather than a test you sit once every few years.

Frequently asked

How many CQC quality statements are there?

There are 34, spread across the five key questions: eight under safe, six under effective, five under caring, seven under responsive and eight under well-led. Each one is written as a we statement describing what a good provider does, and each is assessed using evidence from up to six categories.

What replaced the KLOEs?

The quality statements replaced the key lines of enquiry when the single assessment framework was introduced. The five key questions stayed the same, but the many detailed KLOE prompts were consolidated into 34 statements written from the provider's point of view. The evidence CQC looks for is broadly the same; the structure is simpler.

How does CQC scoring work under the single assessment framework?

Each quality statement is scored from 1 to 4 based on the evidence: 1 means significant shortfalls, 2 some shortfalls, 3 a good standard and 4 an exceptional standard. The scores for the statements under a key question are combined into a percentage that gives the key question rating, and the key question ratings give the overall rating. Check current CQC guidance, because CQC has been simplifying how it uses scoring.

What are the six evidence categories?

People's experience of health and care services, feedback from staff and leaders, feedback from partners, observation, processes, and outcomes. Not every category is used for every statement, and CQC publishes which categories apply to each statement for care homes.

Does CQC still do inspections under the single assessment framework?

Yes. On-site inspection is one way of gathering evidence, alongside remote review of documents, calls with staff and relatives, and information from partners such as the local authority. An assessment can be triggered by risk, by a planned schedule or by a change in the service, and it may look at some or all of the quality statements.

What is the difference between an I statement and a we statement?

We statements describe what the provider does, for example we have a proactive and positive culture of safety. I statements describe what a person using the service should be able to say, for example I feel safe and am supported to understand and manage any risks. The we statements are the quality statements; the I statements help providers and inspectors judge them from the person's point of view.

Is well-led still the most important key question?

In practice it carries the most weight, because a poor well-led rating usually pulls the overall rating down and because governance evidence underpins most of the other statements. Registered managers should treat the eight well-led statements as the backbone of their evidence.

Sources

• CQC: Single assessment framework
• CQC: Quality statements for providers
• CQC: Evidence categories and how we use them
• CQC: How we assess and rate services, including scoring
• Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
• Department of Health and Social Care: Review into the operational effectiveness of the Care Quality Commission (Dash review, 2024)
• CQC: Guidance for providers on the fundamental standards