The CQC Single Assessment Framework: 34 Quality Statements Your Care Home Must Evidence

In late 2023, the Care Quality Commission began rolling out the Single Assessment Framework (SAF), replacing the inspection methodology that care homes had worked with for nearly a decade. The old five key questions (Safe, Effective, Caring, Responsive, Well-Led) still exist as top-level categories, but underneath them sits a new structure: 9 quality themes containing 34 quality statements, each with defined evidence categories.

The change is not cosmetic. The SAF shifts CQC from periodic inspection to continuous assessment. Evidence is expected to flow to CQC between inspections, not just be presented on the day. For care home managers, this means the old approach of preparing a folder before an announced visit is no longer sufficient.

What changed from the old framework

Under the previous methodology, CQC inspectors arrived, spent one to three days on site, reviewed documentation, spoke to staff and residents, and published a report with ratings against the five key questions. The next inspection might not happen for two or three years.

The SAF changes this model in three significant ways:

• Continuous evidence collection. CQC now gathers evidence between inspections through data analysis, stakeholder feedback, and provider information returns. Your rating can change based on evidence that arrives outside an inspection window.
• Quality statements replace key lines of enquiry. Instead of broad questions like "Is the service safe?", CQC now assesses against specific quality statements such as "People are safe and protected from bullying, harassment, avoidable harm, neglect, abuse, and discrimination."
• Six evidence categories. For each quality statement, CQC considers: people's experience, feedback from staff and leaders, feedback from partners, observation, processes, and outcomes.

The 34 quality statements by theme

What continuous evidence collection means in practice

The shift to continuous assessment is the most significant operational change for care homes. CQC now expects to receive and review evidence between inspections. This evidence comes from multiple sources:

• Statutory notifications. You are already required to notify CQC of deaths, serious injuries, safeguarding concerns, and police incidents. Under the SAF, these notifications are scored against the relevant quality statements in real time.
• Provider information returns (PIRs). Annual self-assessments that require you to describe how you meet each quality statement, supported by evidence.
• People's experience feedback. CQC collects feedback directly from residents, families, and their representatives. This feeds into your assessment independently of what you report.
• Data from partners. Local authority commissioners, NHS organisations, safeguarding boards, and Healthwatch can all submit evidence to CQC about your service.
• Whistle-blower and public feedback. CQC accepts feedback from anyone at any time, and this now contributes directly to your ongoing assessment.

The practical implication is that your evidence portfolio must be maintained continuously, not assembled before inspections. When CQC asks you to evidence how you meet Quality Statement 22 (effective governance processes), you need to be able to produce current documentation immediately, not scramble to pull together a folder.

The documentation burden

Each quality statement requires evidence across multiple categories. For a typical 40-bed care home, maintaining evidence across 34 quality statements means tracking:

• Staff training records across 15 to 20 mandatory training categories for 30 to 60 staff members
• Incident reports, investigation records, and action plans
• Complaints and compliments log with response timelines and outcome tracking
• Clinical audit records (falls, medication errors, pressure ulcers, nutrition, restraint)
• 30 to 50 policies and procedures, each with review dates and version control
• Residents' feedback surveys with analysis and action plans
• Safeguarding referrals, notifications, and outcome records
• Capacity assessments and best interests decisions
• End-of-life care plans and advance decisions
• Staffing rotas, dependency assessments, and safe staffing evidence

Most care homes manage this in a combination of paper files, Excel spreadsheets, Word documents, and their care planning software. The care planning system handles the clinical side. Nobody handles the governance side. That is the gap.

How to prepare

Start by mapping your existing evidence against the 34 quality statements. For each statement, ask: "If CQC asked me to evidence this today, could I produce documentation within an hour?" Where the answer is no, that is a gap to address.

The care homes that handle the SAF well will be those that treat governance documentation as an ongoing system, not a periodic project. That means centralised document management, automated review reminders, audit trails on every change, and the ability to produce a complete evidence portfolio at any time.