What CQC Inspectors Look For in 2026 — A Care Home Guide

The Current Framework — What Has Changed

The CQC's Single Assessment Framework (SAF), introduced in 2024, replaced the previous Key Lines of Enquiry (KLOEs) with 34 Quality Statements. These statements are assessed across the same five key questions that care providers have long been familiar with: Safe, Effective, Caring, Responsive, and Well-Led.

However, 2026 is bringing further significant changes. Independent reviews — including those conducted by Dr Penny Dash and Professor Sir Mike Richards — identified serious problems with the SAF's complex 132-data-point scoring model. The CQC has acknowledged these concerns and is moving to reform the framework. Key changes underway include:

• The complex numerical scoring model is being removed in favour of professional judgement and clearer rating characteristics
• Sector-specific frameworks are being reintroduced — adult social care, hospitals and primary care will each have their own framework
• Clear descriptors will define what Outstanding, Good, Requires Improvement and Inadequate actually look like in practice
• A more intelligence-led, risk-based approach to prioritising assessments

Critically — unless your service is notified as an early adopter, any inspection before the end of 2026 will be conducted under the current SAF and Quality Statements. You cannot afford to wait for the new framework. Inspection volumes have increased significantly, with CQC completing over 50% more inspections in November 2025 compared with November 2024.

The Five Key Questions — What Inspectors Focus On

1. Safe

Safety remains the area that attracts the most scrutiny. Inspectors look beyond whether policies exist — they want to see evidence that safe practices are embedded in day-to-day care. The most common pathways to an Inadequate rating under Safe include:

• Medication management failures — incorrect dosages, gaps in medication administration records (MAR charts), poor storage and inadequate hygiene during administration
• Inadequate or outdated risk assessments — generic risk assessments that do not reflect individual residents' current needs
• Insufficient staffing — inspectors assess whether staffing levels are adequate to meet residents' needs safely, including during nights and weekends
• Safeguarding processes — evidence that staff understand their safeguarding duties and that concerns are reported and investigated appropriately

2. Effective

Inspectors assess whether care achieves good outcomes for residents. They look at care plans, training records and how well staff can demonstrate competence — not just that they have attended training. Regulation 9A, which came into force on 6 April 2024 and addresses residents' right to have visitors, is now embedded in the Quality Statements for both Caring and Effective key questions.

3. Caring

This key question focuses on the relationships between staff and residents. Inspectors observe interactions directly — how staff speak with residents, whether consent is sought for care decisions, and whether residents are treated with dignity and respect. Recent downgraded services have frequently shown inspectors finding that residents are not treated with adequate respect or that meaningful activities are limited.

4. Responsive

Inspectors look at how well the service responds to individual needs. Generic care plans that read like templates rather than personalised documents are consistently highlighted as a weakness. Each care plan must reflect the individual's specific needs, preferences and risks.

5. Well-Led

Well-Led is arguably the most consequential key question, because weaknesses here underpin failures across all other areas. A single Inadequate in Safe or Well-Led can significantly reduce an overall rating. Inspectors assess:

• Whether governance frameworks actually drive improvement, not just produce paperwork
• Leadership visibility and the quality of oversight during periods of pressure or change
• Whether audits and action plans identify the most significant risks and follow through to resolution
• How learning from incidents, complaints and feedback is embedded in practice

What Good Documentation Looks Like

Analysis of January 2026 inspection reports reveals a consistent pattern: services that receive poor ratings are rarely failing because of a single lapse. More often, inspectors identify weaknesses in governance and documentation that have developed gradually and remained unaddressed.

Inspectors are not looking for gaps in documentation — they are looking for gaps in challenge and follow-through. Policies, audits and action plans are usually present in services that receive poor ratings, but they fail to identify the most significant risks or do not result in sustained change.

Services that achieve and sustain strong ratings consistently demonstrate:

• Policies that are current, specific to their service and clearly owned by named individuals
• Evidence that policies are understood and applied by staff at all levels — not just filed away
• A clear line of sight between policy, practice and outcomes
• Governance systems that surface risks early and address them decisively
• Documentation that is immediately accessible — not assembled in the fortnight before an inspector arrives

The Key Documents Inspectors Expect to See

While documentation alone does not guarantee a good rating, the absence of current, well-maintained policies is a reliable route to a poor one. Care homes should have current, reviewed policies covering at minimum:

• Safeguarding Adults Policy — aligned to the Care Act 2014 and the Cumbria (or relevant local) Safeguarding Adults Board arrangements
• Medication Management Policy and Administration SOP
• Infection Prevention and Control Policy
• Moving and Handling SOP
• Deprivation of Liberty Safeguards (DoLS) Policy — noting the planned transition to Liberty Protection Safeguards
• Complaints Procedure
• Whistleblowing Policy
• Falls Prevention Policy
• Mental Capacity Assessment SOP
• Visiting Policy — reflecting Regulation 9A requirements effective April 2024
• Health and Safety Policy
• Recruitment and DBS Policy

All policies should reference current UK legislation, carry a review date within the last twelve months, and be signed off by a named responsible individual.

Preparing for an Unannounced Inspection

Care home assessments typically begin on the same day that notification is received — in practice, this means your compliance must be continuous, not reactive. The CQC can also update ratings at any point based on new evidence or concerns, not only at formal inspection.

The most practical preparation steps are straightforward: audit your documentation regularly, ensure policies reflect current legislation and guidance, make sure staff can articulate key policies in plain language, and maintain a governance trail that demonstrates how concerns are identified, escalated and resolved.