Understanding CQC Quality Statements: A New Approach to Care Assessments

The Care Quality Commission (CQC) is the independent regulator for health and social care services in England. Its fundamental role is to ensure that healthcare providers deliver safe, effective, compassionate, and high-quality care to individuals. To uphold this regulation, the CQC evaluates care services against a set of standards, historically known as key lines of enquiry (KLOEs). In a move to streamline and enhance the assessment process, the CQC has introduced Quality Statements to replace the previous KLOEs and prompts. This blog will explore how CQC quality statements are designed to provide a clearer, more concise framework for evaluating care services.

Understanding the New CQC Quality Statements

The CQC introduced Quality Statements to streamline and enhance the assessment process replacing the previous KLOEs and prompts. CQC’s assessment framework is now made up of 5 key questions, with a set of quality statements under each question. 

CQC quality statements are specific declarations that outline the expectations for high-quality care. They are benchmarks for both providers and inspectors to assess the quality of care delivered.

The previous framework, which consisted of KLOEs and around 300 associated prompts, has been streamlined into 34 Quality Statements. With the introduction of quality statements, CQC aimed to simplify the evaluation process, making it more transparent and focused. 

The ‘Making It Real’ framework was created in collaboration with various partners and individuals who have direct experience using health and care services. The ‘Making It Real’ framework serves three primary purposes:

• It promotes personalised care for service users.
• It supports professionals working in the health, care, and housing sectors.
• In addition, it offers a clear set of principles focused on what truly matters to individuals receiving care

This ensures that quality statements reflect the needs and preferences of those who rely on these services.

CQC ‘I’ and ‘We’ Statements

The CQC uses ‘I statements’ and ‘We statements’ within its Single Assessment Framework (SAF) to evaluate health and social care services in England. These statements play distinct yet complementary roles in the assessment process.

CQC ‘I Statements’

‘I statements‘ articulate the expectations and experiences of individuals receiving care. They are derived from what people have expressed as important to them in health and social care settings. 

CQC I statements play a crucial role in the ‘people’s experience’ evidence category. It helps them gather relevant information, and listen and act on people’s experiences. Their experience facilitates informed decision-making and enables the CQC to take appropriate action.

CQC ‘We Statements’

‘We statements’ are declarations from the provider’s perspective, outlining the commitments and responsibilities necessary to deliver high-quality, person-centred care. CQC quality statements expressed as ‘We’ statements aim to:

• Clearly define what is expected of providers in terms of care delivery. 
• Relate directly with relevant regulations, providing a framework for compliance and guiding providers in aligning their practices with regulatory standards.
• Enable providers to self-assess their performance against these statements, promoting continuous improvement and accountability within their can services. 

Differences Between CQC ‘I’ and ‘We’ Statements

Here are some ways in which CQC I and We statements can differ from each other. 

	‘I Statements’	‘We Statements’
Perspective	They reflect the service user’s viewpoint, emphasising personal experiences and expectations regarding care.	They express the provider’s commitments and responsibilities, focusing on the delivery of care that meets regulatory standards.
Function in Assessment	They assist the CQC in gathering evidence about people’s experiences, ensuring that care aligns with what individuals value most.	They provide a framework for what providers should be doing to deliver good care and support, serving as a basis for self-assessment and continuous improvement.
Example	I have care and support that is coordinated, and everyone works well together and with me.	We detect and control potential risks in the care environment. We make sure that equipment, facilities and technology support the delivery of safe care.

CQC 34 Quality Statements

The CQC asks 5 key questions as part of their assessment framework. It asks whether health and social care services are

• Safe
• Effective
• Caring
• Responsive, and 
• Well-led

Each of these key questions includes a number of quality statements, making up a total of 34. You can find the complete set of 34 quality statements on the CQC website. 

Safe – Quality Statements

Ensuring safety in care involves a comprehensive system where policies, actions, and culture align to protect individuals from harm. A safety culture begins with openness and learning. Staff must feel confident raising concerns, knowing they’ll be investigated thoroughly and lead to improvements. Risks must be managed collaboratively, not overlooked or ignored.

Safety also hinges on whether safeguarding protocols, safe transitions between services, infection prevention, and other processes minimise risk. Clear communication not just among staff but also with individuals and families who should know where to turn when health conditions worsen or safety feels compromised is also essential. Finally, staff must be adequately trained, supported, and present in sufficient numbers to ensure that care is delivered effectively.

1. Learning culture
2. Safe systems, pathways, and transitions
3. Safeguarding
4. Involving people to manage risks
5. Safe environments
6. Safe and effective staffing
7. Infection prevention and control
8. Medicines optimisation

We have worked closely with care industry experts who shared valuable insights into common evidence sources and categories, essential for assessing care quality across the five key areas. This has helped us align our approach with industry best practices and the CQC inspection framework.

Common evidence sources for the ‘safe’ quality statement include health and safety policies, risk management systems, staff recruitment and training, care planning, consent processes, medication management, handling complaints, learning from incidents, and engaging external professionals when needed.

‘Safe and effective staffing’ quality statement assesses staffing levels. This assessment is based on whether the care provider has the recommended number of staff in guidance from national bodies. However, it does not take into account whether care services could be delivered in a more efficient and effective way. A CEO at an NHS foundation trust said ‘they could just add more staff and get a better rating, but it wouldn’t necessarily imply better quality care.’

Effective – Quality Statements

Effectiveness in care means tailoring their service delivery approach to each individual’s needs, aligning care with evidence-based practices, legislative standards, and the values of the people. It begins with a comprehensive assessment, factoring in not just health and well-being but also communication preferences and cultural considerations. Care plans should support the independence of individuals while reducing the likelihood of future needs.

Services should work seamlessly across teams and systems to avoid fragmented care. Monitoring outcomes and using data to refine practices ensures that care continually evolves to meet both clinical standards and personal expectations. 

9. Assessing needs
10. Delivering evidence-based care and treatment
11. How staff and teams work together
12. Supporting people to live healthy lives
13. Monitoring and improving outcomes
14. Consent to care and treatment 

Some evidence categories CQC assess for the ‘effective’ quality statement include care planning, consent, clinical records, diet, feedback processes, and audit outcomes.

None of the assessments carried out for secondary and specialist care looked at the ‘caring’ key question. 

Caring – Quality Statements

Achieving excellence in the ‘caring’ area requires intentionality. Providing support isn’t enough. What matters the most is how care is delivered. Treating individuals with kindness, compassion, and dignity is foundational. People need to feel respected, valued, and seen as individuals, not just as recipients of care. 

People’s strengths, aspirations, and cultural identities should shape their care plans. Choice and independence are equally important for service users. Care services should actively empower individuals, promoting autonomy over decisions that affect their lives. Their immediate needs or concerns should be addressed effectively. Finally, supporting and valuing the staff is the foundation of compassionate, person-centred care.

15. Kindness, compassion, and dignity
16. Treating people as individuals
17. Independence, choice, and control
18. Responding to people’s immediate needs
19. Workforce well-being and enablement

Key indicators divided into evidence categories for the ‘caring’ quality statement during inspections include care records, consent/MCA, clinical records, diet/nutrition, feedback systems, premises checks, audit analysis, HR/recruitment, staff training/rotas, competency assessments, policies, and audit outcomes.

Responsive – Quality Statements

Responsiveness in care means anticipating and adapting to individuals’ needs in a way that truly respects their autonomy. Person-centred practices ensure that individuals are always at the heart of their care decisions. 

Care providers follow an integrated approach where people should feel that their care is not only tailored to their current needs but that it’s designed with their future in mind. Accessibility is a key factor here, with care teams ensuring that everyone, regardless of their background or situation, has the support they need when they need it. Listening to feedback, especially from those most vulnerable to inequality, is essential in refining care practices and outcomes. Care must evolve in response to the person, not the system. 

20. Person-centred care
21. Care provision, integrity, and continuity
22. Providing information
23. Listening to and involving people
24. Equity in access
25. Equity in experiences and outcomes
26. Planning for the future

Key evidence categories inspected for the ‘responsive’ quality statement include staffing allocation, person-centred care delivery, technology use, handling concerns, audits, care planning, activity planning, consent, and community inclusion. Evidence is gathered through care records, feedback, and reviews.

Well-Led – Quality Statements

At the core of any exceptional care service lies strong leadership that creates a culture aligned with core values such as transparency, equity, and inclusion. Care services must drive change through a shared vision, with leaders empowering teams and promoting diversity. Every voice, from staff to residents, must be heard. When leaders demonstrate integrity and openness, they not only improve the service but also inspire a commitment to high standards across the board.

Effective leadership also depends on accountability and continuous improvement. If care services operate with clear governance structures and management systems, they are better equipped to deliver sustainable care. With data on risk, performance, and outcomes, they can make informed decisions that enhance care quality. Furthermore, leaders should actively engage with their communities to ensure the care system is responsive. 

27. Shared direction and culture
28. Capable, compassionate, and inclusive leaders
29. Freedom to speak up
30. Workforce equality, diversity, and inclusion
31. Governance, management, and sustainability
32. Partnerships and communities
33. Learning, improvement, and innovation
34. Environmental sustainability, sustainable development

The key indicators relating to the ‘well-led’ quality statement, divided into evidence categories, during any inspection: Policies and procedures are in place and up to date, guiding staff practices. Business plans are shared with staff to align with the organisation’s vision. Staff are aware of and contribute to the mission and values, with ongoing reviews for improvement. 

Safe recruitment and staffing systems are in place, with career development and reasonable adjustments for employees. Staff and service users are encouraged to provide feedback through various channels. Sustainable practices are promoted, and there is an active partnership working with local services. Leadership has oversight, with timely CQC notifications, risk management plans, and accurate quality monitoring systems in place.

The CQC review report revealed that quality statements are causing confusion due to some of them overlapping each other for both care providers and inspectors. Care providers even fail to understand how the CQC prioritises particular quality statements in different sectors, the use of evidence categories related to each quality statement, and the calculation of ratings.

However, a few key facts are here to stay. One of these key observations is that many care services often struggle in the ‘Well-Led’ category, primarily because audits can be time-consuming and challenging to maintain. To address this, we have created a complete bundle of 30+ checklists, including targeted ones for the five key areas of CQC, as well as others that focus on patient safety, compliance, and overall care quality. These checklists will help care homes streamline the preparation process and ensure they meet the rigorous CQC standards, enabling them to deliver better, more consistent care.

Improve Care Quality of Care & Ensure Compliance with GoAudits

GoAudits care audit app and software is an all-in-one solution to improve the quality of care, ensure patient safety, and maintain compliance with CQC.

Available on the web, Android, and iOS devices, GoAudits enable care facilities to conduct efficient mock CQC inspections, facilitate communication and collaboration, gain valuable insights, and improve patient outcomes. With GoAudits, care providers can eliminate paperwork, save time, and focus on patient care.

Here’s how:

• Access pre-built checklists aligned with CQC standards for comprehensive assessments and efficient compliance audits. Customise existing checklists or create new ones to address specific needs and regulations.
• Conduct internal audits and mock CQC inspections faster on the GoAudits mobile app, accessible online and offline. 
• Meet CQC requirements by documenting evidence (of good governance in line with Regulation 17), tracking actions, and demonstrating continuous improvement. 
• Establish a continuous feedback loop where insights from audits and reports inform ongoing enhancements in care delivery and compliance practices
• Use regular internal audits as a training tool to upskill your team on CQC fundamental standards.
• Generate professional, branded reports instantly after each inspection. These reports highlight key findings, scores, and trends.
• Assign tasks, send reminders, and involve the right people at the right time to ensure accountability.
• Gain valuable insights from interactive dashboards that track performance metrics, identify recurring problems, and monitor improvement trends. 
• Assign corrective actions to responsible individuals, track progress, and ensure timely completion.

“Regulation 17 of the Health and Social Care Act draws attention to good governance. With GoAudits, we meet and surpass the requirements of this regulation – making sure our systems and processes meet the requirements of all other regulations – meaning that we operate a safe service.”

– Danielle Ruane, Training, Compliance & IT Manager at Northern Healthcare

Free & Customisable Checklists for Care Providers

GoAudits offers an extensive library of healthcare checklists. Care homes and other care providers can use these free checklists to improve the quality of care and ensure compliance with CQC standards. 

• CQC Inspection Audit
• CQC Dental Inspection Checklist
• CQC Registered Manager Checklist
• MAR/EMAR Audit Checklist
• Care Home Audit Checklist
• Care Home General Observation
• Daily Care Home Audit
• Care Home Cleaning Checklist – Daily
• Care Home Audit Template
• Dignity in Care Audit
• Patient Care Checklist

CQC Quality Statements and Evidence Categories

The CQC evaluates health and social care services using a framework that consists of key questions and quality statements, with evidence gathered across six categories to assess service quality comprehensively. 

1. People’s Experience 

It focuses on understanding individuals’ needs, expectations, lived experiences, and satisfaction with their care, support, and treatment. It includes evidence from surveys, interviews, and feedback forms, providing insight into the accessibility and quality of care from the patient’s perspective. 

2. Feedback from Staff and Leaders

Gathering input from healthcare professionals and organisational leaders includes results from staff surveys, individual interviews, focus groups, and feedback from leadership. It sheds light on the internal culture, staff satisfaction, and leadership effectiveness within a care service. 

3. Feedback from Partners

This involves collecting perspectives from external organisations and stakeholders, such as commissioners, other local providers, professional regulators, accreditation bodies, royal colleges, and multi-agency bodies. 

4. Observation

Direct observation of care delivery allows assessors to evaluate the quality of interactions between staff and patients, the implementation of care procedures, and the overall environment. It provides real-time evidence of service quality and staff adherence to best practices. 

5. Processes

This evidence category examines the policies, procedures, and protocols that guide care delivery. Assessing these processes ensures they are effective, efficient, and aligned with current standards. 

6. Outcomes

Evaluating the results of care, this evidence category looks at patient health outcomes, recovery rates, and overall service effectiveness. It provides quantitative data to measure the impact of care and identify areas for improvement. 

• Conduct patient satisfaction surveys and interviews with customisable checklists and templates.
• Collect feedback directly from patients and their families, assess and monitor their internal processes, identify areas for improvement, and ensure compliance.
• Leaders can easily monitor staff satisfaction, identify issues during inspections, and assign corrective actions to specific team members. 
• Share audit reports and findings with external partners and stakeholders for review. These reports come with attached photos, assigned actions, geo-location, and more. With smart scores, recurring issues, etc., get a complete picture of audit performance.
• Capture photos and videos, take notes, and document observations directly within the app.
• Track process performance and improve care delivery processes with real-time insights into recovery rates, service effectiveness, and more.

Where Does Quality Statements Fit in CQC’s Assessment Process

CQC 34 quality statements play a key role in the assessment process. Here’s how they fit into CQC’s assessment process:

• After deciding which providers to assess (either based on concerns or scheduled reviews), assessors select which quality statements to focus on for each provider. These quality statements guide the areas of care and service performance they will evaluate.
• The evidence collected during the assessment is directly linked to the quality statements. Six evidence categories discussed above are considered. This evidence helps assessors understand the quality of care and measure the provider’s performance against the selected quality statements.
• The evidence is reviewed and scored for the respective quality statement. These scores are then combined to form an overall rating.
• Before finalising the judgment, providers are given a chance to review the factual information and ensure all relevant details have been considered.
• After the factual accuracy process, the findings are published on the CQC website for public access. This includes performance against the quality statements. 

How the CQC Assesses Quality Statements

The CQC assesses quality statements using a structured scoring framework. It’s designed to evaluate the quality of care through specific quality statements and assign scores to different evidence categories associated with these statements. These scores are then used to determine an overall rating (Outstanding, Good, Requires Improvement, and Inadequate).

Scoring Framework

The CQC’s scoring framework focuses on building up scores from the evidence related to each quality statement. Evidence is drawn from various sources, either already available or actively collected, such as from statutory notifications or on-site inspections. 

The CQC assesses these evidence categories continually, meaning that they update scores as new evidence becomes available. 

Quality Statement Scores

To assess a specific quality statement, the CQC reviews evidence across relevant categories. These categories are weighted equally unless certain circumstances, such as a warning notice, require otherwise. The scores for these categories are combined to form a percentage, which is then converted back into a score for easier understanding. The thresholds for converting percentages to scores are as follows:

Percentages	Score
25% – 38%	1
39% – 62%	2
63% – 87%	3
Above 88%	4

Key Question Scores

Each care service is evaluated under five key questions: safe, effective, caring, responsive, and well-led. The CQC aggregates quality statement scores to produce a key question score, again calculating a percentage and using the following thresholds to convert it into a rating:

Percentages	Rating
25% – 38%	Inadequate
39% – 62%	Requires improvement
63% – 87%	Good
88% and above	Outstanding

To provide an overall rating for a service, the CQC aggregates scores from the five key questions. The rating principles are as follows:

• All five key questions are weighted equally.
• An outstanding rating requires at least two key questions to be rated as outstanding and three rated as good.
• A good rating is given if there are no inadequate key question ratings and no more than one rating of ‘Requires Improvement’.
• If two or more key questions are rated as ‘Requires Improvement’, the overall rating will be the same.
• If two or more key questions are rated as inadequate, the service will be rated as ‘Inadequate’ overall.

Implications for Care Providers

The reduction from over 300 prompts and KLOEs to 34 quality statements aims to simplify the assessment process. Care providers can focus on delivering quality care rather than navigating complex assessments. 

CQC 34 quality statements reflect what good care should look like, placing individuals at the centre of care delivery. Each quality statement is linked to specific regulations, providing a clear framework for compliance.

Here’s how care providers can align their internal processes with CQC 34 quality statements.

• Review existing policies and procedures to ensure they align with the new quality statements. This may involve revising protocols to focus more on person-centred outcomes and safety measures.
• Conduct comprehensive training sessions to educate staff about the quality statements and their practical application. 
• Adopt best practices that are grounded in the current evidence-based approach to meet the standards set by the CQC 34 quality statements. It ensures that care is both effective and up-to-date. 
• Involve service users, families, and other stakeholders in the evaluation and improvement of services. Their feedback can provide valuable insights into the effectiveness of care and highlight areas for enhancement.
• Establish systems for monitoring care quality and outcomes. This data will be used to identify areas for improvement and to ensure sustained compliance with the CQC 34 quality statements.

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