Understanding CQC Ratings: What Care Agencies Need to Know in 2026

What is the CQC and Why Does It Matter?

The Care Quality Commission (CQC) is the independent regulator of health and adult social care in England. For domiciliary care agencies, CQC registration is a legal requirement—you cannot provide regulated activities (including personal care) without it.

Beyond registration, CQC inspections and ratings have a significant impact on your business:

• Reputation: Ratings are publicly available and influence client decisions
• Contracts: Many local authorities require a minimum of "Good" rating for contracts
• Enforcement: Poor ratings can lead to conditions, suspension, or cancellation of registration
• Recruitment: Quality staff prefer to work for well-rated agencies

As of 2025, approximately 84% of adult social care services in England are rated Good or Outstanding, according to CQC's State of Care report.

The CQC Rating System Explained

CQC rates services on a four-point scale:

Outstanding ⭐⭐⭐⭐

What it means: The service is performing exceptionally well.

Services rated Outstanding demonstrate:

• Innovative approaches that benefit people using the service
• Best practice that others could learn from
• Consistently exceptional outcomes for people
• Strong leadership that drives continuous improvement

Statistics: Only about 5% of domiciliary care services achieve Outstanding ratings.

Good ⭐⭐⭐

What it means: The service is performing well and meeting expectations.

A Good rating indicates:

• Safe, effective, caring, responsive, and well-led care
• All fundamental standards are met
• People receive quality care that meets their needs
• The service operates as expected

Statistics: Approximately 79% of services are rated Good.

Requires Improvement ⭐⭐

What it means: The service is not performing as well as it should and needs to improve.

This rating indicates:

• Some aspects of care fall below expected standards
• Issues need to be addressed within a reasonable timeframe
• People may not always receive the quality of care they should expect
• The provider must submit an action plan

Statistics: Around 14% of services are rated Requires Improvement.

Inadequate ⭐

What it means: The service is performing badly and significant improvements are required.

An Inadequate rating indicates:

• Serious concerns about the quality and safety of care
• People are at risk of harm
• Immediate action is required
• The service may be placed in special measures

Statistics: Approximately 2% of services receive Inadequate ratings.

The Five Key Questions

CQC assesses all services against five key questions, each with its own rating:

1. Safe

What CQC looks for:

• Protection from abuse, neglect, and avoidable harm
• Safe staffing levels and skill mix
• Safe medication management
• Learning from incidents and near-misses
• Infection prevention and control
• Risk assessments and management

Common issues:

• Incomplete or outdated risk assessments
• Poor medication records
• Insufficient staff supervision
• Failure to report safeguarding concerns

2. Effective

What CQC looks for:

• Evidence-based care and treatment
• Good nutrition and hydration support
• Pain management
• Staff training and competence
• Consent and Mental Capacity Act compliance
• Multi-agency working

Common issues:

• Care plans not reflecting current needs
• Staff not trained in Mental Capacity Act
• Poor communication between services
• Lack of outcome monitoring

3. Caring

What CQC looks for:

• Kindness, respect, and compassion
• Dignity and privacy
• Involvement in care decisions
• Emotional support
• Independence promotion

Common issues:

• Rushed visits that don't allow time for interaction
• Lack of continuity of care (different carers each visit)
• Not respecting preferences and choices
• Poor communication with families

4. Responsive

What CQC looks for:

• Person-centred care planning
• Meeting individual needs and preferences
• Accessible information
• Complaints handling
• End-of-life care (where applicable)

Common issues:

• Generic care plans not tailored to individuals
• Poor handling of complaints
• Inflexible service delivery
• Not adapting to changing needs

5. Well-Led

What CQC looks for:

• Clear vision and values
• Effective governance and oversight
• Strong leadership at all levels
• Quality monitoring and improvement
• Positive workplace culture
• Partnership working
• Regulatory compliance

Common issues:

• Registered manager not in post or not engaged
• Poor audit and quality assurance processes
• Staff feeling unsupported
• Not learning from feedback or incidents

How CQC Inspections Work

Types of Inspection

Comprehensive inspections: Review all five key questions in depth. Usually for new services or following previous poor ratings.

Focused inspections: Look at specific areas, often in response to concerns or information received.

Unannounced visits: Most inspections are unannounced to see normal operations.

What Happens During an Inspection

1. Before the inspection:

   • CQC may request documents in advance
   • They review previous inspection findings
   • They check any concerns or whistleblowing reports

2. During the inspection:

   • Inspectors speak with people receiving care (by phone or visit)
   • They interview staff at all levels
   • They observe care being delivered (sometimes accompany carers)
   • They review records, policies, and documentation
   • They speak with the registered manager and provider

3. After the inspection:

   • Draft report sent for factual accuracy check
   • Final report published on CQC website
   • Rating displayed and provider must display it

Inspection Frequency

• Outstanding or Good services: Typically reinspected every 2–3 years (though CQC can inspect at any time if concerns arise)
• Requires Improvement: Usually reinspected within 12 months
• Inadequate: Frequent monitoring, possible special measures

Preparing for a CQC Inspection

Essential Documentation

Ensure these are up-to-date and readily accessible:

Document	Requirements
Care plans	Personalised, current, reviewed regularly
Risk assessments	Comprehensive and regularly updated
Medication records	Accurate, complete, reconciled
Staff files	DBS, training records, supervision notes
Policies and procedures	Current, accessible to staff
Complaints log	Recorded, investigated, resolved
Incident reports	Logged, investigated, lessons learned
Quality audits	Regular, with action plans
Staff rota	Showing adequate coverage

Staff Preparation

• Ensure all staff know the registered manager and provider
• Staff should understand CQC's role and the five key questions
• Conduct mock inspections or spot checks
• Encourage honest, open communication
• Remind staff that inspectors may accompany them on visits

Service User Preparation

• Inform people that inspectors may contact them
• Reassure them that feedback helps improve the service
• Ensure contact details are accurate

Improving Your CQC Rating

From Requires Improvement to Good

Priority actions:

1. Address specific findings: Create an action plan for each issue
2. Strengthen governance: Implement robust audit systems
3. Invest in training: Ensure all staff are competent and confident
4. Improve care planning: Make every plan truly person-centred
5. Engage with feedback: Act on complaints and compliments

From Good to Outstanding

What distinguishes Outstanding services:

• Innovative practice that benefits people
• Exceptional person-centred care
• Strong evidence of continuous improvement
• Engaged, empowered staff
• Excellent partnership working
• Going above and beyond requirements

Strategies for achieving Outstanding:

1. Document innovation: Record what makes your service special
2. Capture outcomes: Measure and evidence positive impacts
3. Staff development: Invest in leadership at all levels
4. Learn externally: Adopt best practice from other sectors
5. Seek feedback actively: And act on it visibly

Enforcement Action

If CQC has serious concerns, they can take enforcement action:

Action	What It Means
Requirement notice	Must address specific issues within a timeframe
Warning notice	Serious concerns requiring urgent action
Conditions on registration	Restrictions on what the service can do
Suspension	Temporarily prevents new admissions
Cancellation	Registration withdrawn—service must close
Prosecution	Criminal charges for serious breaches

Appealing Against Decisions

Providers can appeal against certain CQC decisions through the First-tier Tribunal (Care Standards). Legal advice is recommended for appeals.

The Business Impact of CQC Ratings

Client Acquisition

• Many families check CQC ratings before choosing a provider
• Poor ratings damage reputation and reduce referrals
• Outstanding ratings can justify premium pricing

Local Authority Contracts

• Most councils require Good or Outstanding ratings
• Some frameworks exclude services rated below Good
• Ratings influence contract renewals

Staff Recruitment and Retention

• Quality staff prefer well-rated employers
• Poor ratings increase turnover
• Outstanding services attract top talent

Insurance and Finance

• Some insurers consider CQC ratings
• Investors may require minimum ratings
• Banks may review ratings for lending decisions

Common Myths About CQC

Myth: "CQC is only interested in paperwork." Reality: While documentation is important, CQC focuses primarily on outcomes for people receiving care. They want to see that policies translate into practice.

Myth: "You can't get Outstanding on your first inspection." Reality: New services can achieve Outstanding if they demonstrate exceptional care from the start.

Myth: "CQC inspectors are trying to catch you out." Reality: Inspectors want services to succeed. They're looking for evidence of good care and will highlight positive findings.

Myth: "Once you have a Good rating, you're safe." Reality: Ratings can change at any inspection. Continuous improvement is essential.

Useful Resources

• CQC Website – Official guidance, reports, and provider resources
• CQC Provider Portal – Submit notifications and access guidance
• Find a CQC Registered Service – Check your own and competitors' ratings
• How to Start a Care Agency – Complete startup guide
• Care Rate Calculator – Calculate sustainable rates for your agency

Summary

CQC ratings are a critical part of running a domiciliary care agency in England. Understanding how inspections work, what inspectors look for, and how to prepare can help you achieve and maintain a strong rating.

Key takeaways:

1. Focus on outcomes for people, not just processes
2. Embed quality into daily operations, don't treat it as an add-on
3. Invest in staff training and wellbeing
4. Maintain accurate, up-to-date documentation
5. Actively seek and respond to feedback
6. Address issues promptly and transparently
7. Aim for continuous improvement, not just compliance

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Last updated: January 2026. CQC processes and requirements change—always verify current guidance on the official CQC website.