If you registered or were last inspected under the old system of key lines of enquiry (KLOEs), CQC's current approach can feel like a different language: quality statements, evidence categories, scores. This guide translates the Single Assessment Framework into plain English and, more importantly, into what it means for how you run your service day to day.

What the Single Assessment Framework is

The Single Assessment Framework is the framework CQC uses to assess health and care services in England. It replaced the previous separate frameworks and their KLOEs, and it applies across sectors: the same framework is used whether CQC is looking at a care home, a home care agency or a hospital, and it is used both at registration and in ongoing assessment.

Two other shifts came with it. Assessment is no longer a single point-in-time inspection visit: CQC can gather and review evidence on an ongoing basis, with site visits as one source of evidence among several. And judgements are built up from scores against individual quality statements rather than from a broad narrative.

One honest caveat: CQC has publicly committed to improving how it assesses services following the independent review of its operations in 2024, so details of the framework and its handbook continue to be refined. The structure below is the foundation, but always check CQC's current guidance for the latest position.

The five key questions

The most familiar part survived. CQC still asks whether services are:

  • Safe: are people protected from abuse and avoidable harm?
  • Effective: does care achieve good outcomes and reflect good practice?
  • Caring: do staff treat people with kindness, dignity and respect?
  • Responsive: is care organised around people's needs?
  • Well-led: do leadership, management and governance assure high-quality care?

Ratings also survived: services are still rated outstanding, good, requires improvement or inadequate, both overall and for each key question.

The 34 quality statements

Under the five key questions sit 34 quality statements. These replaced the KLOEs and their prompts, and they are written as "we" statements: commitments phrased from the provider's point of view, describing what a good service does. Safe, for example, includes quality statements on areas such as safeguarding, involving people to manage risk, safe environments, safe and effective staffing, infection prevention and control, and medicines optimisation. Well-led includes statements on governance, capable and compassionate leadership, workforce equality and learning culture.

The practical value of the quality statements is that they are specific enough to audit against. For each one that applies to your service, you can ask: what do we do, where is it written down, and how would we show it?

The six evidence categories

For each quality statement, CQC gathers evidence from up to six categories:

  • People's experience of health and care services: what people using the service, and those close to them, say and experience.
  • Feedback from staff and leaders: from surveys, interviews and conversations during assessment.
  • Feedback from partners: commissioners, local authorities, healthcare professionals and other agencies that work with your service.
  • Observation: what assessors see when they visit, including care practice and the environment.
  • Processes: your policies, records, audits and how they operate in practice.
  • Outcomes: the results of care, where measurable.

Not every category applies to every quality statement or every service type, but the message is clear: CQC triangulates. A policy on its own proves little if observation and feedback tell a different story.

Scores, and how they become ratings

Evidence for each quality statement is scored on a four-point scale, from evidence showing significant shortfalls in the standard of care through to evidence showing an exceptional standard. Quality statement scores combine into a score for each key question, which translates into the key question rating, and those feed the overall rating. The arithmetic matters less than the principle: your rating is built from many small, specific judgements, so weaknesses in one area can no longer hide behind general goodwill.

What this means for providers day to day

  • Evidence is continuous, not annual. Because CQC can assess at any time, using notifications, feedback and data as well as visits, the services that do well are the ones whose evidence is always reasonably current.
  • Your statutory duties feed the picture. Statutory notifications and your Provider Information Return (PIR) are part of what CQC sees, so treat them as part of your evidence, not admin.
  • Partners' views count. Commissioners and professionals you work with are a named evidence category. Relationships and responsiveness matter.
  • Map before you audit. Take the quality statements that apply to you and map your policies, audits and records against each one. Gaps become visible quickly. Our CQC compliance support builds exactly this kind of evidence framework with providers.
  • Rehearse against the framework. A dry run shows you what an assessor would find before an assessor finds it. See our guide on running a mock inspection that changes behaviour, or our mock inspection service if you want external eyes.

Where to start

Do not try to fix all 34 quality statements at once. Start with the statements under Safe and Well-led, map your current evidence honestly against them and pick the three weakest areas as this quarter's work. If you would like help turning the framework into a practical, prioritised plan for your service, book a free readiness call and we'll walk through it with you.