To open a learning disability care home in England you need a suitable building, a registered manager, CQC registration for the regulated activity of accommodation for persons who require nursing or personal care, and the policies, staff and systems that show you can deliver safe care from the first day. Expect the process to take months, not weeks, and expect the order of the steps to matter: commissioners before property, manager before application, systems before the first resident.
Start with the right model, not the building
CQC assesses new learning disability and autism services against its guidance on right support, right care, right culture. The expectation is a small service, typically for six people or fewer, in an ordinary house in an ordinary street, close to the community the people come from, and not on the same site as other care services. A large converted building on the edge of town for twelve people will struggle to be registered, however good the intentions.
Write down the model before you look at property: who the service is for, how many people, what needs you will and will not support, what a normal week will look like for someone living there. This becomes your statement of purpose, and it will be tested at the fit person interview.
Talk to commissioners first
Learning disability placements are almost all funded by local authorities and integrated care boards. Before you commit to a property, speak to the commissioning team for the area. Ask what they need, what they will pay, whether they have people waiting for a service like yours, and whether they are seeking new providers at all. A home built without that conversation can be registered and empty. Ask who is on section 117 aftercare, because that changes how the placement is funded.
Property and planning
- Check the planning use class. A residential care home is usually class C2, and a change of use from a dwelling may need permission.
- Get a fire risk assessment before you buy or sign a lease. Detection, compartmentation, doors and escape routes drive the budget.
- Think about single rooms, en-suites, a kitchen people can use themselves, outdoor space, and how someone who does not want company can avoid it.
The provider and the registered manager
The provider is the legal entity, usually a company, with a nominated individual responsible for supervising the management of the service. Every care home must also have a registered manager, and for a new provider the manager application usually goes in alongside the provider application. CQC looks for a manager with relevant experience of learning disability services, a suitable qualification or a plan to get one, a DBS check countersigned by CQC, and references. The fit person interview tests both the nominated individual and the manager on the model, the regulations and how they will know the service is safe.
Recruit the manager early. They should write the policies, design the systems and recruit the team, because they will be held to account for all of it.
CQC registration for a new provider
- Register the company, open a bank account, arrange insurance.
- Apply for DBS checks countersigned by CQC for the nominated individual and the manager.
- Write the statement of purpose: the regulated activity, the service type, the people you will support, the address, how the service is run.
- Prepare the financial viability evidence CQC asks for and the business plan behind it.
- Submit the provider and manager applications through the CQC portal.
- Prepare for the fit person interview and any site visit with policies, the training plan, the staffing model and sample records ready.
- Do not accept anyone until the certificate of registration is issued. Carrying on a regulated activity without registration is an offence.
Policies, procedures and systems
You need a full set of policies before registration, and they must describe what you will actually do, not what a template says. The core set covers safeguarding, Mental Capacity Act and DoLS, medication, infection control, fire, health and safety, recruitment, training, supervision, complaints, whistleblowing, duty of candour, positive behaviour support and restrictive practice, data protection, and business continuity.
Decide your recording system before the first resident, not after. Paper is cheaper on day one and expensive every day after. Whatever you choose must give you a person-centred care plan, risk assessments with PEEPs done first, eMAR, daily logs staff can write quickly, incident review with root cause, an HR record with a training matrix, and a way to show all of it to an inspector. Look at the evidence an inspector expects and work back from it. A new provider on a tight budget should check the total cost: some systems charge per module, and Kiwi's £300 per home per month with no contract was set with new homes in mind.
Recruiting and training the first team
- Safe recruitment from the start: references, DBS before unsupervised work, right to work, employment history with gaps explained.
- Learning disability and autism training for everyone, using the Oliver McGowan framework, before opening.
- Safety-critical mandatory topics before the first shift: fire, moving and handling, safeguarding, MCA and DoLS, infection control, medication for anyone administering, positive behaviour support.
- Care Certificate started for new care workers.
- An induction plan with shadowing, using the manager and any experienced staff, and recorded.
- Supervision booked from month one.
Timeline for opening a learning disability care home
| Stage | What has to be true before the next stage |
|---|---|
| Model and commissioners | Written model, commissioner interest confirmed, funding rates understood |
| Property | Planning confirmed, fire risk assessment done, adaptation budget agreed |
| Manager | Manager in post or contracted, DBS applied for |
| Policies and systems | Full policy set written, recording system chosen and set up |
| CQC application | Statement of purpose, financial evidence, applications submitted |
| Registration | Fit person interview passed, certificate received |
| Team | Staff recruited, mandatory training done, rota covers the first resident |
| First resident | Assessment, transition plan, funding agreement signed |
The first resident
The first admission sets the standard for every one after it. Before the person moves in:
- A pre-admission assessment in person, with the person, their family and the current provider, covering needs, risks, communication, what a good day looks like and what causes distress.
- A transition plan with visits, overnight stays if possible, and familiar objects and routines carried across.
- Capacity assessment for the decision to move, with a best-interests decision and DoLS application where needed.
- The PEEP written on day one, then the other risk assessments, then the care plan, all in the person's record before the end of the first week.
- The funding agreement signed by every funder, with the rate, the start date and the section 117 position confirmed in writing.
- Medication reconciled with the GP and pharmacy and on the eMAR before the first dose.
In the first week, read every daily log and every handover yourself. What the team records in week one is what they will record in year three.
Common mistakes new providers make
- Buying the building before talking to commissioners.
- Applying for registration before the manager is in post.
- Policies copied from a template that describe a different service.
- Choosing a recording system after opening, then migrating months of paper.
- Opening with one resident and a full staff team, with no plan for the gap.
- Treating registration as the finish line rather than the start.
Registration gives you permission to begin. The inspection that follows will judge the home on what the records show happened to the first people who lived there. Build it so that showing them is easy.
Frequently asked
How many residents can a new learning disability care home have?
CQC's right support, right care, right culture guidance expects new services to be small, typically for six people or fewer, in ordinary housing within the community and not co-located with other care services. Larger models are unlikely to be registered.
Do I need a registered manager before applying to CQC?
A care home must have a registered manager, and for a new provider the manager application normally goes in with the provider application. Recruit the manager early so they can write the policies, build the systems and recruit the team they will be accountable for.
Can I admit a resident while the CQC application is being processed?
No. Carrying on a regulated activity without registration is an offence. Wait for the certificate of registration before anyone moves in, and use the waiting time to train the team, finish the policies and set up the recording system.
