The Care Quality Commission’s (CQC) approach to regulating adult social care is changing yet again. Following substantial criticism of the implementation of the single assessment framework (the SAF), the CQC is rebuilding its regulatory model, increasing assessment activity and testing a more sector-specific approach. For providers, the important point is that this is a period of transition: the current assessment framework remains in use while a revised adult social care framework and methodology are refined and piloted.

The five familiar key questions remain at the heart of regulation, is the service:
• Safe.
• Effective.
• Caring.
• Responsive.
• Well-led?

The four ratings also remain as: Outstanding, Good, Requires improvement and Inadequate.

What is changing is the framework underpinning those questions, the way evidence is examined and the route by which inspectors reach and explain their judgements.

In this blog we examine the main changes, what has not changed and how social care providers can prepare without falling into the trap of preparing only for inspection.

A move back to sector-specific regulation
The CQC introduced the SAF in 2024 with the intention of creating greater consistency across health and care. In practice however, providers and inspectors reported that a single cross-sector model could be difficult to interpret and did not always reflect the reality of different services. Independent reviews also identified problems with the clarity of the framework, its implementation and the supporting technology.

The CQC has therefore developed separate draft frameworks for adult social care, mental health care, primary and community care, and hospitals. For adult social care, this should allow inspection questions and rating descriptions to be more closely aligned with the processes of care, risks and outcomes that matter in care homes, supported living and homecare. The draft adult social care framework is still being refined, so providers should follow published CQC updates rather than treating draft material as final.

At Bettal, we are cautioning providers not to imagine that this change is simply a return to the old system of regulation and inspection. It is clear from what we know so far, that the CQC’s intention is to retain useful elements of the current approach, including a stronger focus on people’s experiences, while restoring greater sector expertise and clearer expectations to the process.

Quality statements are becoming structured questions
Under CQC’s proposals, the current quality statements will be replaced by key lines of enquiry framed as structured questions. These questions are intended to make it clearer what inspectors will explore and what providers need to demonstrate. The draft framework still sits beneath the five key questions, but its language is designed specifically for adult social care.

CQC also proposes to publish rating characteristics showing what outstanding, good, requires improvement and inadequate care may look like in the sector. This should give providers and inspectors a better understanding of how the rating awarded has been derived from the evidence, regulatory compliance elements of inspection and outcomes noted and is clearly something providers have been asking for https://www.cqc.org.uk/about-us/improving-how-we-work/0826-update.

For managers, clearer rating characteristics should make internal quality assurance processes easier to design and undertake. Instead of asking whether a policy exists, providers can ask what people actually experience, whether staff practice is consistent and what evidence shows that the service is meeting the characteristics of good or better care – this makes the process more outcome focussed.

There remains the danger that providers will again turn the structured questions into checklists. A question may help organise evidence, but it does not replace professional judgement which sits more squarely at the centre of the new regime. Inspectors will look to see whether systems work in practice and whether they produce safe, person-centred outcomes not just whether a box has been ticked.

For example, a medicines audit is not meaningful simply because it is completed each month. The useful evidence is that discrepancies are identified, investigated and corrected; staff learning follows; repeat errors reduce; and people receive their medicines safely and as intended.

Scoring is expected to be removed
The consultation response supported removing numerical scoring from the assessment methodology and making rating judgements directly at key-question level. This reflects concerns that scores could imply a level of precision that was not always supported by the evidence or easily understood by providers and the public.

For providers, this means that chasing a calculated score is unlikely to be a sound preparation strategy. Self-assessment should instead set out a coherent account of quality under each key question, identifying strengths, areas for improvement, regulatory risks and the impact on people. Care leaders should be able to explain why their evidence supports their conclusion, not merely present a spreadsheet to an inspector.

People’s experiences will carry greater weight
The CQC’s direction of travel with the new framework places increased emphasis on people’s experiences and real-world outcomes. In its programme for returning to older good-rated adult social care services, the CQC says it will spend more time speaking with people, visitors, professionals, staff and leaders, and observing care where possible. Records and documents are then used proportionately to test and substantiate what inspectors hear and see.

Providers should therefore strengthen everyday methods for listening to people, including those who communicate non-verbally, have fluctuating capacity, use advocates or are less likely to complete a survey. Feedback should be representative, acted upon and connected to changes in the service – that is lessons learnt.

A file can look immaculate while a person accessing care feels rushed, excluded or unsafe. Equally, a good conversation is not enough if records contradict practice. Strong services bring the two together: people accessing care describe how they are in receipt of good care, observations support their account and records confirm that care is planned, monitored and improved.

Build an evidence trail from governance to outcomes
Inspection readiness is strongest when evidence can be followed from governance systems to staff practice and then to the experience of the person accessing care. A policy should inform a procedure; the procedure should be understood by staff; supervision, observation and audits should test whether it is followed; and the result should be visible in safer or better care.

Good quality assurance therefore triangulates different sources of evidence. For staffing, this might include:
• Dependency or workload information.
• Rotas.
• Recruitment records.
• Induction reality and records.
• Competency checks.
• Staff feedback.
• Incidents and lessons learnt.
• Missed calls
• The views of people receiving care.

No single document tells the whole story.

Care providers should also avoid presenting a falsely perfect picture. A well-led service knows where it needs to improve, records decisions, assigns responsibility, checks completion and evaluates whether the action made a difference. Honest, effective improvement is stronger evidence than an assurance that nothing ever goes wrong.

Prepare for transition, not speculation
The CQC is piloting and testing the revised assessment method between June and October 2026, with final evaluation planned for this November. Pilot assessments run alongside, rather than instead of, existing inspections. Participation is voluntary, and pilot judgements have no legal standing and do not affect a provider’s rating or regulatory status.

Until the CQC publishes and commences the final approach, providers remain accountable under the current framework and regulations. Wholesale rewriting of systems to match every draft phrase would waste time and could destabilise arrangements that already work.

A sensible preparation plan is to review the draft adult social care questions against existing governance, identify gaps that affect quality now, and monitor CQC announcements for the final framework and implementation timetable. Based on the evidence emerging to date from the review, care providers should continue to prioritise the fundamentals: safe staffing, safeguarding, medicines, consent, person-centred care, complaints, equality, leadership, learning and reliable oversight.

Summary
The inspection regime is changing, but the foundations of good social care are not. The CQC will continue to ask whether services are safe, effective, caring, responsive and well-led, and whether people experience care that meets their needs, protects their rights, dignity, choice and wellbeing.

For us at Bettal, the central message is to prepare through attention to everyday quality. Listen to people, observe practice, know your risks, test your systems and act when evidence shows that improvement is needed. A provider that can demonstrate this cycle clearly will be better placed for both the current regime and the one that follows.

Bettal works with adult social care providers to strengthen quality assurance, compliance and service improvement. Our digital systems and practical guidance help care organisations evidence good practice, prepare for inspection, manage risk and maintain continuous improvement.

If you are a social care provider and are looking for ongoing support with policies, procedures and inspection preparation, browse our website or get in touch:

Email: info@bettal.co.uk
Telephone: 01697741411

Peter Ellis MA MSc BSc(Hons) RN
Consultant
Bettal Quality Consultancy