What is the CQC Single Assessment Framework and What Does It Mean for Your Agency

By Kizito Chukwude

In November 2023, the Care Quality Commission (CQC) began rolling out the Single Assessment Framework — the most significant change to how it regulates and inspects health and social care services in nearly a decade. If you trained as a registered manager before 2023, the framework you learned about is no longer the current one. If you are registering your service now, this is the framework your agency will be assessed against from day one.

This guide explains what the Single Assessment Framework is, why CQC introduced it, what changed and what stayed the same, and how the new evidence and scoring model works in practice. It is the explainer you need to read before you start adapting your service to the new system.

Why CQC Replaced the Previous System

Before the Single Assessment Framework, CQC used Key Lines of Enquiry — known industry-wide as KLOEs — together with their associated prompts. Inspectors used KLOEs to assess services under the five key questions: Safe, Effective, Caring, Responsive, and Well-Led.

The KLOE system had clear strengths. It gave services a detailed roadmap of exactly what CQC was looking for. Providers could structure their evidence and self-assessments against specific KLOEs. The methodology was relatively predictable.

It also had significant weaknesses. KLOEs were process-focused — they tended to ask whether something existed, not whether it worked. The system was tied to scheduled inspections, which meant ratings could go years between updates. Different inspector teams sometimes interpreted KLOEs inconsistently. And evidence outside of inspection visits — feedback from people, partner agencies, ongoing notifications — was used inconsistently across regions.

The Single Assessment Framework was designed to fix three things specifically: shift the focus from process to outcome, make assessment continuous rather than periodic, and use a wider range of evidence in a more transparent and consistent way.

What Stayed the Same

The five key questions remain unchanged. CQC still assesses every service against:

• Safe: people are protected from abuse and avoidable harm
• Effective: people's care, treatment, and support achieve good outcomes
• Caring: staff involve and treat people with compassion, kindness, dignity, and respect
• Responsive: services are organised so they meet people's needs
• Well-Led: leadership, management, and governance assure high-quality, person-centred care

The four ratings — Inadequate, Requires Improvement, Good, and Outstanding — also remain unchanged. What has changed underneath is how CQC reaches those ratings.

What Replaced KLOEs: Quality Statements

Under the Single Assessment Framework, KLOEs and prompts have been replaced by Quality Statements. These are short, plain-English statements describing what good care looks like from the perspective of the people receiving it.

For example, under Safe, Quality Statement S1.1 reads: "We work with people to understand what being safe means to them and work with our partners to develop the best way to achieve this." Under Well-Led, W1.2 reads: "Leaders have the integrity, skills and abilities to lead effectively, and they understand and keep to relevant law and regulations."

Each Quality Statement maps to one of the five key questions and represents an outcome that a well-run service should be able to demonstrate. Providers are not expected to memorise the Quality Statements. They are expected to operate at a standard that, when assessed, would allow CQC to conclude the statement is being met.

Quality Statements are grouped into themes such as learning culture, safe systems, safeguarding, involving people in decisions, workforce wellbeing, and governance. The themes give a sense of where CQC's focus has shifted relative to the KLOE era — there is more emphasis on involvement, learning, and outcome than there used to be.

How CQC Gathers Evidence: The Six Categories

The most operationally significant change in the Single Assessment Framework is how evidence is gathered. CQC now uses six evidence categories, all of which feed into a single assessment:

1. People's experience of the service: direct feedback from service users, families, and carers — gathered via surveys, interviews, complaints data, and other sources.
2. Feedback from staff and leaders: what your workforce says about working in your service — collected through surveys, anonymous channels, and on-site conversations.
3. Feedback from partners: what local authorities, GPs, hospitals, commissioners, and other partners say about your service.
4. Observation: what CQC sees during inspection visits or remote observation, including the lived experience of being in or interacting with the service.
5. Processes: your policies, procedures, governance systems, and the documents that describe how your service is intended to run.
6. Outcomes: the actual results for people using your service — improvements in independence, wellbeing, safety, and other measurable indicators.

Crucially, no single category dominates. A well-written policy that is not followed will be exposed because feedback, observation, and outcomes will tell a different story. Strong outcomes without governance will be exposed because the process category will reveal the gap. CQC is triangulating, not auditing.

Continuous Assessment Replaces the Inspection Cycle

Under the previous system, a service might be inspected once every two or three years and rated based on that visit. Between inspections, the rating did not change unless something serious happened.

The Single Assessment Framework moves to a continuous model. CQC gathers evidence between inspections — through statutory notifications, partner intelligence, public feedback, national datasets, and other ongoing sources — and can update its view of a service at any time. Where this evidence raises concerns, CQC can prioritise an earlier inspection. Where evidence is positive and stable, formal inspection visits may be less frequent.

The practical implication is that compliance has to be a continuous state, not something you prepare for in the weeks before an announced visit. Services that operate at standard year-round will fare better than those that scramble in response to inspection notifications.

The Scoring System

Under the Single Assessment Framework, CQC uses a transparent scoring system. Each Quality Statement that applies to a service is scored on a four-point scale:

• 1 — evidence shows significant shortfalls
• 2 — evidence shows some shortfalls
• 3 — evidence shows a good standard
• 4 — evidence shows an exceptional standard

The Quality Statement scores are aggregated to produce a score for each key question, and the key question scores aggregate to the overall rating. The four overall rating bands correspond directly to the scores: Inadequate (1), Requires Improvement (2), Good (3), and Outstanding (4).

The aggregation logic is published. Weak performance in one Quality Statement can pull down the score for an entire key question if it is significant. This makes it harder to mask weaknesses with strengths elsewhere — which is one of the framework's deliberate design goals.

What This Means for Domiciliary Care Providers

For domiciliary care agencies, three implications matter most. First, evidence is multi-sourced now: your service users' feedback, your staff's experience, and your partners' views all carry weight alongside your documents. Second, outcomes carry more weight than ever — being able to demonstrate measurable difference in people's lives is central to a strong rating. Third, the continuous model means there is no longer a quiet period between inspections — your governance has to be active every week.

None of this means policies stop mattering. They are still one of the six evidence categories and the foundation of the others. But policies must now be living documents that genuinely describe how your service runs, not generic templates filed in a folder.

For the practical detail of which policies map to which Quality Statements and what inspectors look for under each, see how your policies should reflect the Single Assessment Framework.

Related articles