CQC Compliance Documentation: The Single Assessment Framework

The Care Quality Commission's (CQC) Single Assessment Framework has fundamentally changed how health and social care providers in England are inspected and rated. The framework introduced 34 quality statements across five key questions, a new evidence-based scoring system, and a shift towards continuous assessment rather than periodic inspections.

Following Professor Sir Mike Richards' Phase 1 Review in October 2024, the CQC is now undertaking a Phase 2 Review with sector-specific frameworks expected to roll out in 2026. The direction is clear: sector-specific assessment, reintroduced rating characteristics, and greater emphasis on narrative evidence and professional judgement.

For care providers — whether residential homes, domiciliary care agencies, or NHS trusts — the documentation requirements have changed. This guide covers what the framework requires, what inspectors actually look for, and how to build a documentation review process that keeps your service inspection-ready.

How the Single Assessment Framework Works

The framework is built around the same five key questions CQC has always asked, but with a new structure underneath.

The Five Key Questions

Quality Statements

Each key question contains quality statements — commitments that providers should demonstrate. There are 34 quality statements in total, grouped under the five key questions.

Quality statements replaced the previous Key Lines of Enquiry (KLOEs). Under the Phase 2 Review, CQC is proposing to replace quality statements with "supporting questions" and reintroduce rating characteristics that more clearly define what Good and Outstanding look like. Regardless of terminology changes, the underlying principle remains: you must demonstrate, with evidence, that your service meets each requirement.

Evidence Categories

CQC gathers evidence from six categories, with equal weighting across each:

The key shift: equal weighting. A provider with excellent policies (Processes) but poor outcomes (Outcomes) or negative feedback (People's experience) will not achieve a Good rating. Documentation must demonstrate performance across all six categories.

What Inspectors Actually Look For

Safe: Documentation Requirements

Safeguarding:

• Safeguarding policy current and tailored to your service
• Evidence staff know how to raise concerns (training records, supervision notes)
• Safeguarding referral records with outcomes documented
• Links to local authority safeguarding procedures

Medicines management:

• Medication Administration Records (MARs) — complete, accurate, no gaps
• Medication error reporting and follow-up documentation
• PRN (as-needed) protocols with clear criteria for administration
• Controlled drugs registers

Staffing:

• Staffing rotas showing safe staffing levels maintained
• Dependency assessments linked to staffing calculations
• Agency usage records with competency checks
• Recruitment files with all pre-employment checks (DBS, references, right to work)

Common gap: Incomplete recruitment files. Every staff member's file must contain a full set of pre-employment checks. Missing DBS checks or gaps in employment history are among the most common Safe domain findings.

Effective: Documentation Requirements

Assessment and care planning:

• Initial assessments completed before or on admission
• Care plans individualised, person-centred, and regularly reviewed
• Evidence of resident and family involvement in care planning
• Mental capacity assessments where relevant, with best interests decisions documented

Nutrition and hydration:

• Nutritional screening assessments (e.g., MUST tool)
• Food and fluid intake charts where clinically indicated
• Weight monitoring records with actions for significant changes
• Dietary preferences and requirements documented

Staff training:

• Mandatory training matrix showing completion rates
• Competency assessments for clinical tasks (medication, catheter care, etc.)
• Supervision records — regular, documented, with actions
• Induction records for all new staff

Common gap: Care plans that haven't been reviewed. CQC expects care plans to be living documents, reviewed regularly and after any significant change. A care plan written on admission and never updated is a serious finding.

Caring: Documentation Requirements

Privacy and dignity:

• Evidence that preferences about personal care are documented and followed
• Records showing how dignity is maintained during care delivery
• Communication needs assessed and documented (Accessible Information Standard)

Involvement:

• Records of resident and family meetings
• Evidence people are involved in decisions about their care
• Advocacy referrals where appropriate

Common gap: No documented evidence that people were asked about their preferences. Inspectors look for specificity — not "resident prefers female carer" buried in a generic form, but evidence this preference is known, communicated to all staff, and consistently respected.

Responsive: Documentation Requirements

Person-centred care:

• Life history and personal preferences documentation
• Activities programmes tailored to individual interests
• Evidence of reasonable adjustments for people with disabilities or communication needs

Complaints:

• Complaints log with every complaint recorded
• Investigation records and outcomes
• Evidence of learning from complaints (changes made as a result)
• Timescales for response documented and met

Common gap: Complaints records with no follow-up actions. CQC wants to see the complete cycle: complaint received → investigated → resolved → learning shared → changes implemented.

Well-led: Documentation Requirements

This is often the make-or-break domain. Poor governance documentation can pull down an otherwise good service.

Governance:

• Quality assurance audit programme (medicines, infection control, care plans, health and safety)
• Audit results with identified actions, deadlines, and evidence of completion
• Risk register — actively maintained, reviewed regularly, linked to quality improvement
• Board or management meeting minutes showing oversight of quality and safety

Continuous improvement:

• Quality improvement plan with measurable objectives
• Evidence of actions taken in response to audits, complaints, incidents, and feedback
• Benchmarking against sector data where available

Workforce:

• Workforce development plan
• Sickness and turnover data with actions to address
• Staff wellbeing initiatives documented

Culture:

• Duty of candour records (being open when things go wrong)
• Whistleblowing policy with evidence it's accessible and used
• Freedom to speak up processes

Common gap: Audits that identify problems but show no evidence of action. CQC frequently cites "the provider completed regular audits but these did not lead to sustained improvements." An audit without a completed action plan is worse than no audit — it shows you knew about the problem and didn't fix it.

The Phase 2 Review: What's Coming

The CQC's Phase 2 Review is expected to bring several changes that affect documentation:

• Sector-specific frameworks — tailored assessment criteria for adult social care, hospitals, and primary care, replacing the one-size-fits-all approach
• Rating characteristics reintroduced — clearer definitions of what Requires Improvement, Good, and Outstanding look like (similar to the old KLOEs)
• Simplified scoring — less reliance on mathematical aggregation, more emphasis on professional judgement
• Supporting questions replacing quality statements — offering clearer guidance on what evidence is expected

For providers, this means:

• Greater emphasis on narrative evidence — documentation must tell a story about quality, not just tick boxes
• Context matters more — inspectors will use professional judgement, so documentation that shows reasoning and decision-making is valuable
• Sector-specific expectations — a residential care home and a domiciliary care agency will be assessed against different criteria

Routine inspections will generally occur on a 3 to 5-year cycle, with rapid response inspections triggered by specific concerns like safeguarding alerts or whistleblowing. The long gap between routine inspections makes it even more important to maintain documentation continuously rather than scrambling before an expected visit.

How to Review Your Documentation Systematically

Step 1: Map Documents to the Five Key Questions

Create a document register linking every policy, procedure, template, and record type to the relevant key question:

Flag anything that:

• References the old KLOEs or pre-2023 CQC terminology
• Is a generic template not tailored to your specific service
• Hasn't been reviewed in the last 12 months
• Has no evidence of staff training on the policy

Step 2: Review Care Plans Against Quality Criteria

Care plans are the most scrutinised documents in CQC inspections. Define consistent criteria:

1. Person-centred (weight: 3) — Written around the individual, reflecting their preferences, life history, and goals
2. Current and reviewed (weight: 3) — Updated after significant changes and at regular review intervals
3. Outcome-focused (weight: 2) — Documents what good outcomes look like for this person and how progress is measured
4. Involvement (weight: 2) — Evidence the person and their family were involved in developing and reviewing the plan
5. Accessible (weight: 1) — Written in plain language, available in formats the person can understand

Review a sample of 20 care plans. Look for:

• Generic language that could apply to anyone
• Plans not reviewed since admission or last annual review
• Missing signatures or evidence of involvement
• No link between assessed needs and planned interventions

Step 3: Audit Your Audit Programme

This sounds circular, but it's essential. Check:

• Do your audits cover all five key questions?
• Are audit findings acted upon with documented deadlines?
• Is there evidence that actions were completed?
• Do audit results feed into your quality improvement plan?
• Are audits completed on schedule?

Step 4: Prepare Evidence Folders

Build a "live evidence folder" for each key question:

• Safe — Recent safeguarding referrals and outcomes, medication audit results, staffing level analysis, recruitment file compliance check
• Effective — Care plan review completion rates, training matrix, nutrition screening compliance, outcome data
• Caring — Resident satisfaction survey results, compliments, examples of person-centred care
• Responsive — Complaints analysis with trends, reasonable adjustments made, activities programme and participation data
• Well-led — Governance meeting minutes, quality improvement plan with progress, risk register, audit programme with completed actions

Having evidence ready to present during an inspection is essential. Inspectors may not ask for all relevant evidence — volunteering it can make the difference between Good and Outstanding.

Step 5: Conduct a Mock Inspection

Before your next expected assessment:

• Use the CQC's assessment framework as your audit tool
• Have someone independent review documentation (not the person who wrote it)
• Interview staff — can they articulate how they deliver safe, person-centred care?
• Check that documentation matches observed practice
• Identify and remediate gaps before the inspection

Using AI to Review Care Documentation at Scale

Care providers generate significant volumes of documentation — care plans, progress notes, incident reports, audit records, and policies. Manual review of every document is impractical, particularly for multi-site operators.

What AI-Assisted Review Can Do

• Consistency checking — Are all care plans person-centred and current? Do all sites use the same standard?
• Completeness screening — Are required elements present in every document?
• Language analysis — Flagging generic, task-focused, or copy-paste documentation that should be individualised
• Gap detection — Identifying care plans not reviewed on schedule, missing assessments, incomplete incident follow-ups
• Quality statement alignment — Checking documentation against CQC quality statement requirements

What AI Cannot Do

• Verify that documented care was actually delivered
• Assess clinical appropriateness of care decisions
• Replace the professional judgement of registered managers
• Guarantee a Good or Outstanding CQC rating

Practical Example: Building a CQC Documentation Reviewer

In TeamBench, you could configure a reviewer specifically for CQC care plans:

Reviewer name: CQC Care Plan Quality Reviewer

System prompt:

You are a CQC documentation quality reviewer for adult social care. Review care plans against the CQC's Single Assessment Framework requirements. Focus on person-centred language, evidence of resident involvement, outcome-focused planning, currency of reviews, and alignment with the five key questions (Safe, Effective, Caring, Responsive, Well-led). Flag generic language, missing review dates, lack of resident involvement evidence, and plans that read as task lists rather than person-centred documents. Suggest specific improvements.

Evaluation criteria:

• Person-centred Language (weight: 3) — Written around the individual's preferences, goals, and life history
• Currency (weight: 3) — Evidence of regular review and updates after significant changes
• Involvement (weight: 2) — Documented evidence the person and family contributed to the plan
• Outcome Focus (weight: 2) — Clear outcomes defined and progress measured
• Completeness (weight: 1) — All required sections present and completed

Quality gate: Set a minimum score of 70. Plans scoring below are flagged for revision.

Upload your service's policies, CQC quality statements, and any local authority requirements into a Knowledge Base so the reviewer has full context.

You could also use the readability checker to verify that resident-facing documents — complaints procedures, service user guides, accessible information — meet plain language requirements.

90-Day Preparation Plan

Month 1: Assessment

• Complete a document register mapping every document to the five key questions
• Identify policies referencing old KLOEs or pre-framework terminology
• Review a sample of 20 care plans against quality criteria
• Check all recruitment files for completeness (DBS, references, right to work, employment history)
• Audit your audit programme — are findings leading to actions?
• Review complaints records for completeness (investigation, outcome, learning)

Month 2: Remediation

• Rewrite policies that reference outdated terminology
• Update care plan templates to prompt person-centred, outcome-focused language
• Create or update quality improvement plan with measurable objectives
• Deliver staff briefings on the assessment framework and what inspectors look for
• Build evidence folders for each of the five key questions
• Address all incomplete recruitment files

Month 3: Testing

• Conduct a mock inspection using the CQC assessment framework
• Re-sample 20 care plans — compare quality to Month 1 baseline
• Test complaints handling process end-to-end
• Interview a sample of staff — can they describe how they deliver person-centred care?
• Verify audit actions are completed and evidenced

Ongoing

• Monthly spot-checks of care plans, progress notes, and incident reports
• Quarterly policy reviews
• Regular staff briefings on quality and safety
• Continuous evidence folder updates
• Annual comprehensive documentation audit

Frequently Asked Questions

What is the CQC Single Assessment Framework?

The Single Assessment Framework is CQC's approach to assessing and rating health and social care providers in England. It uses 34 quality statements across five key questions (Safe, Effective, Caring, Responsive, Well-led) and gathers evidence from six categories with equal weighting: people's experience, staff feedback, partner feedback, observation, processes, and outcomes.

How often does CQC inspect care homes?

Under the current framework, routine inspections generally occur on a 3 to 5-year cycle, depending on service type and quality indicators. Rapid response inspections can be triggered at any time by specific concerns such as safeguarding alerts, complaints, or whistleblowing.

What are quality statements?

Quality statements are commitments that providers should demonstrate through evidence. They replaced the previous Key Lines of Enquiry (KLOEs). Under the Phase 2 Review, CQC is proposing to replace quality statements with "supporting questions" alongside reintroduced rating characteristics.

What documentation do I need for a CQC inspection?

Key documentation includes: care plans, risk assessments, medication records, safeguarding records, complaints logs, staff recruitment files, training records, supervision notes, quality audit reports, governance meeting minutes, quality improvement plans, and evidence of outcomes for people using your service.

What changed in the Phase 2 Review?

The Phase 2 Review proposes sector-specific frameworks, reintroduced rating characteristics (similar to old KLOEs), simplified scoring with less mathematical aggregation, and greater emphasis on professional judgement and narrative evidence. Full rollout is expected in 2026.

Can AI help with CQC documentation review?

AI can assist with first-pass quality screening — checking care plans for person-centred language, identifying overdue reviews, flagging incomplete records, and ensuring consistency across documents. It cannot verify care delivery, assess clinical decisions, or guarantee a CQC rating. It's a quality screening tool, not an inspection substitute.

What are the most common CQC documentation failures?

Common failures include: incomplete recruitment files (missing DBS checks or employment history gaps), care plans not reviewed since admission, complaints records with no follow-up actions, audit programmes that identify issues but show no evidence of remediation, and generic policies not tailored to the specific service.

How do I prepare staff for a CQC inspection?

Regular briefings on what inspectors look for, supervision sessions where staff practise articulating how they deliver person-centred care, ensuring all staff know the safeguarding reporting process and medication protocols, and making sure recent improvements are communicated so staff can reference them during interviews.

Key Takeaways

• CQC's Single Assessment Framework uses 34 quality statements across five key questions, with evidence gathered from six equally weighted categories.
• The Phase 2 Review is bringing sector-specific frameworks, reintroduced rating characteristics, and greater emphasis on professional judgement — expected rollout in 2026.
• Documentation must demonstrate outcomes, not just processes. Policies on a shelf are insufficient — CQC wants evidence they lead to better care.
• Care plans are the most scrutinised documents — they must be person-centred, current, outcome-focused, and show evidence of resident involvement.
• Audits must lead to action — completing audits that identify problems but show no evidence of remediation is a common Well-led finding.
• Evidence folders for each key question should be maintained continuously, not assembled before an expected inspection.
• Staff preparation matters — inspectors interview staff, and "I don't know" responses in areas like safeguarding and medication can trigger negative findings.
• AI-assisted review can screen documentation quality at scale, catching generic language, overdue reviews, and incomplete records before inspectors do.

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This article provides general information about CQC documentation requirements and the Single Assessment Framework and is not legal or regulatory advice. Always consult the Care Quality Commission directly for the most current requirements and seek professional guidance for your specific service.