CQC Quality Statements & the 5 Key Questions Explained

Key Takeaways

CQC quality statements are 34 outcome-focused standards, written as “we statements”, that sit under the five key questions and define what good care looks like.
The five key questions, Safe, Effective, Caring, Responsive and Well-Led, have survived every framework change since 2014.
Quality statements apply today, but CQC’s draft frameworks for late 2026 replace them with 24 Key Lines of Enquiry and remove numerical scoring.
CQC scores each quality statement across six evidence categories: people’s experience, staff and leader feedback, partner feedback, observation, processes, and outcomes.
Well-Led is consistently among the hardest key questions to evidence, usually because the governance trail does not exist in reviewable form.
A digital audit trail is the simplest way to evidence that issues were found, actioned, and closed, which is what Regulation 17 asks for.

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. These have changed twice since 2023 and are changing again, so this guide covers what applies now and what is coming.

This blog will explore how CQC quality statements are designed to provide a clearer, more concise framework for evaluating care services.

Table of Contents

KLOEs, Quality Statements, and What Comes Next
Understanding CQC Quality Statements
What Do the Five CQC Key Questions Cover?
The 34 Quality Statements Under Each Key Question
Improve Quality of Care & Ensure Compliance with GoAudits
CQC Quality Statements and Evidence Categories
How the CQC Assesses and Scores Quality Statements

KLOEs, Quality Statements, and What Comes Next

CQC’s assessment structure has changed twice in three years, and a third change is due. Here is the arc.

Until 2023: Key Lines of Enquiry. Five key questions, each supported by KLOEs and more than 300 prompts.

From 2023: the Single Assessment Framework replaced KLOEs and prompts with 34 quality statements, written as “we statements”, each scored 1 to 4 across six evidence categories.

From late 2026: CQC’s proposed sector-specific frameworks would replace the 34 quality statements with 24 Key Lines of Enquiry, framed as structured questions, and remove numerical scoring in favour of rating characteristics.

The Single Assessment Framework was published in July 2022, with assessments beginning in late 2023 and reaching every region by early 2024. Following criticism, CQC ran its Better Regulation, Better Care consultation, which closed in December 2025. The four draft sector-specific frameworks followed on 24 March 2026, with that consultation closing on 12 June and pilots running through the summer.

What this means for providers. The 34 quality statements still apply, and this guide reflects what you will be assessed against today. But the direction of travel is back toward KLOEs, and the five key questions have survived every version. Any audit programme built around Safe, Effective, Caring, Responsive and Well-Led remains valid regardless of which framework is live.

Understanding 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. Subsequent reviews found the result more complex than intended, which is why the framework is changing again.

👉 The CQC developed its quality statements by incorporating key aspects of the Making It Real framework. It is a set of co-produced statements by Think Local Act Personal (TLAP), which describe what good care and support look like. They are not only built into the CQC single assessment framework but also aligned with the Care Act 2014.

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 two kinds of statements within its assessment framework, and they serve different purposes.

‘We statements’ are the quality statements themselves, written from the provider’s perspective. Each one defines what is expected of you, links directly to a relevant regulation, and gives you something to self-assess against. “We detect and control potential risks in the care environment” is a we statement.

‘I statements’ articulate the same expectation from the point of view of the person receiving care, drawn from the Making It Real framework. CQC has linked them to each quality statement, and uses them to gather evidence under the ‘people’s experience’ evidence category. “I have care and support that is coordinated, and everyone works well together and with me” is an I statement.

The practical difference: we statements tell you what to do; I statements tell you what it should feel like to the person on the receiving end. Inspectors use both, which is why evidence of good process alone rarely satisfies them.

	‘I Statements’	‘We Statements’
Perspective	The service user’s viewpoint, emphasising personal experiences and expectations regarding care	The provider’s commitments and responsibilities, focusing on care that meets regulatory standards
Function in assessment	Help CQC gather evidence about people’s experiences, ensuring care aligns with what individuals value	Provide a framework for what providers should be doing, serving as a basis for self-assessment
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

What Do the Five CQC Key Questions Cover?

The CQC’s five key questions are the backbone of every assessment. These five key questions are sometimes called the CQC five standards or the five domains. They are the same thing. They have survived every framework change since 2014 and will survive the next one. The quality statements sit underneath them.

Safe. Whether people are protected from abuse and avoidable harm. Inspectors look at safeguarding systems and whether staff know how to use them, medicines management, risk assessments that are current and followed, staffing levels and skill mix, infection prevention, and how incidents are learned from.
Effective. Whether care achieves good outcomes and is based on evidence. Inspectors look at assessment and care planning, consent and mental capacity, nutrition and hydration, staff training and competence, and how the service works with other professionals.
Caring. Whether people are treated with kindness, dignity and respect. Much of this is assessed by observation rather than documentation: how staff speak to people, whether privacy is respected in practice, whether people are involved in decisions about their own care.
Responsive. Whether care is organised around people’s needs. Inspectors look at personalised care planning, how complaints are handled and what changed as a result, accessibility of information, and end-of-life care where relevant.
Well-Led. Whether leadership, governance and culture support good care. This is where the evidence gap usually sits.

One thing worth knowing: CQC has signalled that roughly 80% of inspection activity will focus on observation and conversations rather than reviewing written policies. Documentation evidences what you do; it does not substitute for it.

What do inspectors look for in a care home?

Inspectors assess against the five key questions, but most of what forms their judgement comes from observation and conversation rather than paperwork. Expect them to watch mealtimes and medication rounds, speak to residents, families and staff at every level, look at the environment including communal areas and bathrooms, and review a sample of care plans against what they have actually seen. Documentation is checked for whether it matches reality, not for whether it exists.

The 34 Quality Statements Under Each Key Question

The 34 CQC quality statements are divided across the five key questions: Safe has 8, Effective has 6, Caring has 5, Responsive has 7, and Well-Led has 8. You can find the complete set of 34 quality statements on the CQC website.

👉 According to the CQC review report by Dr Penny Dash, the average number of quality statements currently used in CQC assessments under the single assessment framework (SAF) is 9.2, as of 30 July 2024. This means only a third of the total CQC 34 quality statements are used.

It’s important to note that not all aspects are considered for all 34 quality statements. Priority quality statements are identified and tailored for different sectors for planned assessments. Later, other quality statements can be considered based on the risks.

Safe – Quality Statements

Safe has eight quality statements:

Learning culture
Safe systems, pathways, and transitions
Safeguarding
Involving people to manage risks
Safe environments
Safe and effective staffing
Infection prevention and control
Medicines optimisation

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.

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.

👉 The CQC review report revealed that ‘safe and effective staffing’ was the most commonly assessed quality statement under ‘safe’. A staggering 98% of ‘safe’ assessments across different sectors were assessed against this quality statement. This compares with only 30% of ‘safe’ assessments looking at ‘safe systems, pathways and transitions’.

‘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

Effective has six quality statements:

Assessing needs
Delivering evidence-based care and treatment
How staff and teams work together
Supporting people to live healthy lives
Monitoring and improving outcomes
Consent to care and treatment

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.

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

👉 Despite its fundamental importance, the ‘Effective’ key area has received far less attention in recent assessments compared to ‘Safe’. According to the same CQC review report, the CQC conducted 980 assessments under the new single assessment framework between December 2023 and July 2024.

Of those, 75% focused on safety, while only 38% examined the effectiveness of care. In sectors like adult social care, the discrepancy is even more pronounced, with 90% of assessments looking at safety and a mere 13% assessing effectiveness.

Of all the quality statements considered during the same time period, only 13% were within the ‘effective’ key question as compared to the 40% within the ‘safe’ key question.

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

Caring – Quality Statements

Caring has five quality statements:

Kindness, compassion, and dignity
Treating people as individuals
Independence, choice, and control
Responding to people’s immediate needs
Workforce well-being and enablement

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.

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

Responsive has seven quality statements:

Person-centred care
Care provision, integration and continuity
Providing information
Listening to and involving people
Equity in access
Equity in experiences and outcomes
Planning for the future

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.

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

Well-Led has eight quality statements:

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
Environmental sustainability, sustainable development

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.

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.

👉 At GoAudits, we have developed a comprehensive and practical set of checklists, in collaboration with care industry experts, to simplify the CQC inspection process for care homes. They believe the CQC assessment framework is likely to evolve over the coming months (e.g., number of quality statements, scoring, etc.).

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 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 enables 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 CQC inspection 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.

👉 Northern Healthcare, a leading independent provider of supported living services, achieved significant improvements with GoAudits. They streamlined compliance checks across their 15 facilities, conducting 150-200 daily audits. This enabled them to identify and resolve more than 1100 issues quickly, reducing response times and enhancing overall care quality.

They replaced manual processes with GoAudits and saved valuable time and resources. Eventually, their staff could focus more on delivering high-quality care and maintaining compliance standards effectively.

“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 Quality Statements and Evidence Categories

CQC uses six evidence categories: people’s experience, feedback from staff and leaders, feedback from partners, observation, processes, and outcomes.

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.

👉 GoAudits can help care providers streamline evidence collection and quality monitoring. They can efficiently record feedback, document observations by centralizing data from staff, patients, and partners, and track outcomes, ensuring compliance and identifying areas for improvement with clear, actionable insights.

Conduct patient satisfaction surveys and interviews with customisable checklists and templates.
Collect feedback directly from patients and their families, assess and monitor internal processes, identify improvement areas, 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, geolocation, 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.

What Evidence Works for Well-Led?

Well-Led is consistently among the hardest key questions to evidence, and the reason is rarely poor leadership. The evidence of governance doesn’t exist in a form an inspector can review.

What works:

An audit schedule showing what was checked, when, and by whom, running continuously rather than before a visit
Corrective actions assigned to named individuals with deadlines, and records showing they were closed
Trend data over time: audit scores, recurring issues, and what changed as a result
Governance meeting minutes showing quality and risk were discussed and decisions taken
Evidence that staff and service user feedback led to specific changes
A clear picture of who is accountable for what, and what happens when something goes wrong

What does not work: a folder of policies, a single annual audit, or an improvement plan with no evidence of progress against it. Each of these demonstrates intent rather than governance.

The distinction CQC draws is between recording that something happened and demonstrating that issues were identified, acted on, and resolved. Regulation 17 uses the word “drive” deliberately.

How the CQC Assesses and Scores Quality Statements

Where Quality Statements Fit in the CQC’s Assessment Process

CQC’s 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. The 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 Scoring Works

Under the Single Assessment Framework, CQC scores each quality statement from 1 to 4 based on evidence gathered across the relevant categories. Those scores aggregate into a score for each key question, which converts into a rating of Outstanding, Good, Requires Improvement or Inadequate. All five key questions carry equal weight in the overall rating.

Dr Penny Dash’s review found the scoring system lengthy and difficult to understand, and CQC no longer scores each evidence category individually. The draft sector-specific frameworks expected in late 2026 remove numerical scoring altogether, replacing it with rating characteristics.

» For the full scoring methodology, including percentage thresholds and how ratings aggregate, see our guide to the CQC Single Assessment Framework.