The Care Quality Commission (CQC) regulates health and social care services in England. Since 2014, inspections have been based around five key questions: Safe, Effective, Caring, Responsive, and Well-led. These questions have shaped how providers are rated and how inspectors judge quality. The CQC single assessment framework was rolled out In late 2023. This change matters because while the five key questions remain the foundation, the way inspections are carried out, and the type of evidence used, has shifted. Providers now need to understand how the CQC single assessment framework works in practice and what steps to take to stay compliant.

What is the CQC Single Assessment Framework?

The CQC single assessment framework is the system inspectors use to decide whether health and social care services meet required standards. It replaced multiple overlapping frameworks with one unified model. The idea is to bring consistency to the way different types of providers are inspected — whether that’s care homes, hospitals, GP practices, or local authorities.

The framework still focuses on the same five key questions:

  1. Safe – Are people protected from abuse and avoidable harm?

  2. Effective – Does care achieve good outcomes and follow best practice?

  3. Caring – Are staff compassionate, respectful, and supportive?

  4. Responsive – Is care organised around individual needs and preferences?

  5. Well-led – Is leadership effective in driving high-quality, person-centred care?

While these domains are not new, the 2023 update has changed how the CQC gathers evidence and applies judgments.

Why Did the Framework Change?

The CQC introduced the new single assessment framework to make inspections more consistent and transparent. In the past, providers sometimes felt that inspections were too dependent on individual inspectors’ judgments, or that there were differences in how similar services were rated.

The updated framework is designed to:

  • Create a single set of expectations across all service types.

  • Focus more strongly on people’s lived experience of care.

  • Use a broader range of evidence sources.

  • Support ongoing assessment rather than just one-off inspections.

This means providers need to think less about preparing for a single inspection day and more about maintaining evidence of good practice at all times.

What’s Different in the 2023 CQC Framework?

Several key changes stand out:

1. Quality Statements

Each of the five key questions now links to quality statements. These describe what good care looks like in plain language. For example, under “Safe,” a quality statement might highlight how a provider manages safeguarding or ensures medicines are administered correctly.

Quality statements replace the old Key Lines of Enquiry (KLOEs), although the intention is similar — to guide inspectors in gathering evidence.

2. Six Evidence Categories

Inspectors now use six types of evidence to make judgments:

  • People’s experience of care

  • Feedback from staff and partners

  • Direct observations

  • Processes (such as policies and audits)

  • Outcomes for people

  • Other data sources (like complaints or safeguarding alerts)

By drawing from multiple sources, the CQC aims to build a more complete picture of a service’s quality.

3. Continuous Assessment

Instead of relying only on periodic inspections, the CQC single assessment framework supports ongoing monitoring. This means inspectors can update ratings more dynamically based on new evidence.

4. Standardisation

Previously, some frameworks were slightly different depending on the service type. The new model uses a single language and approach, whether a provider is a care home, hospital, or local authority.

What Stays the Same?

Even though the framework has changed, the essentials remain:

  • The five key questions still form the backbone.

  • Services are still rated as Outstanding, Good, Requires Improvement, or Inadequate.

  • The focus remains firmly on person-centred, high-quality care.

For many providers, the main adjustment is in how evidence is gathered and how quality is demonstrated, not in the fundamental standards themselves.

When Was the CQC Single Assessment Framework Introduced?

The five key questions were first introduced in 2014, following the Francis Report into failings at Mid Staffordshire NHS Trust. That was the moment the CQC shifted away from a simple compliance checklist to a more holistic inspection model.

The updated single assessment framework began rolling out in late 2023 and is continuing through 2024. The rollout is phased, so some providers may already have been inspected under the new model while others are still waiting.

What Are the Five New CQC Standards?

Sometimes people refer to the five key questions as the “five new CQC standards.” In reality, these standards are not brand new — they have been in place for a decade. What’s new is how they are applied through quality statements and evidence categories.

The five remain: Safe, Effective, Caring, Responsive, and Well-led.

Why This Matters for Providers

The updated framework means providers should prepare differently for inspection. Instead of focusing solely on policies and compliance documents, they need to gather real-world evidence across the six categories.

Practical steps include:

  • Review quality statements for each domain and check how your service measures up.

  • Collect feedback regularly from residents, families, staff, and external partners.

  • Demonstrate outcomes, not just processes. For example, don’t just show a policy on nutrition — provide evidence that residents are eating well and outcomes are improving.

  • Train staff on the new expectations so they understand how their day-to-day actions contribute to ratings.

  • Monitor continuously, not just before an inspection.

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FAQs on the CQC Single Assessment Framework

Safe, Effective, Caring, Responsive, and Well-led. These remain unchanged from the 2014 model.

The original five key questions came in 2014. The updated single assessment framework began rolling out in late 2023.

They are clear descriptions of what good care looks like under each domain. For example, a statement under “Caring” might describe how staff treat people with dignity and respect.

Inspectors use six categories: people’s experience, staff and partner feedback, direct observations, processes, outcomes, and data sources.

The ratings remain the same: Outstanding, Good, Requires Improvement, or Inadequate.

There isn’t a single set time, because the new framework supports ongoing assessment. Inspectors may review evidence continuously rather than only during scheduled inspections.

The CQC updated the system to improve consistency, transparency, and focus on outcomes and lived experience.

Final Thoughts

The CQC single assessment framework may look different, but its core purpose is the same: making sure health and social care services deliver safe, effective, person-centred care. By understanding the updated model and preparing evidence across the six categories, providers can stay inspection-ready and demonstrate the quality of the care they deliver. If you’d like support in how to remain compliant throughout your home across you hygiene, laundry, equipment and beyond, book a free consultation below.