CQC Single Assessment Framework (SAF)

The Care Quality Commission (CQC) has made changes to how health and social care services in England are checked. This new method is called the Single Assessment Framework (SAF). It makes the process simpler and focuses more on the people receiving care.

The reason for the new introduction in November 2023 was to make it easier for the Care Quality Commission (CQC) to check the quality of care. The new Single Assessment Framework (SAF) replaces the old separate frameworks with one simple system.

This helps the CQC focus on what really matters to people and better match how care is delivered across different areas. It uses the same five key questions (Safe, Effective, Caring, Responsive, Well-led) to keep things clear and consistent.

The new framework puts people at the centre of care. It focuses on safety, improving services, and making sure care providers work together. ‘I statements’ are used to show what people receiving care should expect.

This approach makes sure the CQC checks what is most important to people while helping care services get better.

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Key Points:

The Care Quality Commission (CQC) introduced the Single Assessment Framework (SAF) in 2024 to evaluate health and social care services in England. Key aspects of the SAF include:

• Five key questions remain: Safe, Effective, Caring, Responsive, and Well-led.
• 34 quality statements replaced the previous Key Lines of Enquiry (KLOEs), aiming to simplify the assessment process.
• A new scoring system was implemented, though it has received negative feedback and is under revision.
• The four-point rating scale (Outstanding, Good, Requires Improvement, Inadequate) was retained.
• The framework emphasizes person-centred care and the real-world impact of services.
• Rollout began in November 2023, with full implementation expected by March 2024.
• The SAF applies to all health and social care services, aiming for a more unified approach.
• A recent review indicated that the CQC has faced challenges in fulfilling its primary purpose with the new framework.
• The SAF aims to simplify regulatory processes, better reflect care delivery across different services, and focus on outcomes rather than just procedural compliance.

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What is the CQC Single Assessment Framework About?

The Care Quality Commission’s (CQC) Single Assessment Framework (SAF) simplifies and standardizes care evaluations across England, replacing the previous Key Lines of Enquiry (KLOEs) with five core questions (safe, effective, caring, responsive, well-led) and quality statements that define good care.

Evidence is gathered from people’s experiences, staff feedback, observations, and outcomes, scored on a 4-point scale (1–4) to assess performance.

Introduced in phases from November 2023 to March 2024, the SAF shifts from one-off inspections to continuous monitoring, enabling regular rating updates and a focus on person-centred care.

Providers access the framework via a dedicated CQC portal, with inspectors using diverse data sources—not just inspections—to evaluate quality, safety, and risks in real time.

Key Points on CQC Single Assessment Framework

The Care Quality Commission (CQC) Single Assessment Framework (SAF) is a new way of checking health and social care services in England. Its aim is to make the process simpler and easier to understand for all types of care services.

Key points about the SAF:

• Five Key Questions: It still asks if services are safe, effective, caring, responsive, and well-led.
• Quality Statements: These replace the old Key Lines of Enquiry (KLOEs) and explain what care providers need to do using 34 “we statements.”
• Evidence Categories: The CQC collects evidence from six areas, including people’s experiences, staff and partner feedback, processes, and outcomes.
• Ratings: The ratings (Outstanding, Good, Requires Improvement, Inadequate) stay the same.
• Person-Centred Care: The SAF focuses on a more detailed and personal look at services.
• Unified Framework: It replaces separate systems with one set of rules for all care services.

The SAF started in November 2023 and will be fully in place by March 2024. Care providers should learn about the new quality statements and update their services to meet the new rules.

The six categories of evidence that the Care Quality Commission (CQC) uses

The CQC Single Assessment Framework uses six areas to collect evidence:

1. People’s experiences with health and care services
2. Feedback from staff and leaders
3. Feedback from partners
4. Observations of care
5. Processes used in care
6. Results of care.

Using these 6 quality checks, CQC can get a complete picture of what a service offers, which makes it better than the KLOE method.

In the past, the CQC would only visit the care provider to check the quality of care delivered. The new CQC framework involves collecting of evidence for quality assessments using both on-site and off-site methods.

These include asking providers for information, looking at online reviews, talking to service users, staff, and leaders, and reviewing national data. The CQC also responds to specific concerns.

CQC will determine the evidence to be used and the technique depending on the service or type of organisation. This means CQC inspectors can focus on the most essential tasks during on-site inspections, such as talking to people receiving care and making observations.

This allows the CQC to build a more complete picture of care quality and focus on the most important aspects during on-site visits.

Explaining the New CQC Approach

This approach helps CQC understand not just if rules are followed, but how well the service is actually working for the people it supports.

1. People’s Experiences with Health and Care Services

This focuses on hearing directly from people who use the services. It includes personal stories, surveys, and feedback about their care.

The aim is to understand how services affect those receiving care.

2. Feedback from Staff and Leaders

This gathers views from staff and managers working in care services. It includes their opinions on the quality of care, challenges they face, and ideas for improvement. This helps understand the service from an insider’s perspective.

3. Feedback from Partners

This collects opinions from external organisations like:

• Other healthcare providers
• Social services
• Community groups
• Commissioners

These partners give insights into how services work together within the healthcare system.

4. Observations of Care

Inspectors watch care being provided to see:

• How staff interact with people
• The quality of care
• If best practices are followed
• The overall care environment

5. Processes Used in Care

This looks at how care is organised and includes:

• Planning care
• Managing risks
• Giving medication
• Following safety rules
• Keeping good records

6. Results of Care

This examines the outcomes of care, such as:

• Improvements in health
• Recovery rates
• Quality of life
• Managing long-term conditions
• Success of treatments

By using all this information, the CQC gains a full picture of care quality, focusing on real results rather than just ticking boxes.

These six categories in the new CQC framework make the checks clearer and fairer. They help gather and review information about the quality of care in an easy way.

The CQC might focus on different areas when checking care. The number of areas they check can change depending on the type of service and how detailed the check needs to be.

How do the six evidence categories affect a care service’s rating?

The six evidence categories (People’s experience, Feedback from staff and leaders, Feedback from partners, Observation, Processes, and Outcomes) are important in deciding the overall rating of a care service under the new CQC Single Assessment Framework.

These six new CQC categories include:

1. People’s experiences with health and care services
2. Feedback from staff and leaders
3. Feedback from partners
4. Observations of care
5. Processes used in care
6. Outcomes of care

Here’s how they affect the rating:

• Evidence scoring: The CQC gives each category a score based on the collected information.
• Quality statement scoring: The scores from each category are added up to create a score for each quality statement.
• Key question rating: The scores from quality statements form a rating for each of the five key questions (safe, effective, caring, responsive, and well-led).
• Overall rating: The ratings for the five key questions are combined to give the care service its overall rating.

The scoring uses a 4-point scale:

• 4: Exceptional care
• 3: Good care
• 2: Care needs improvement
• 1: Poor care

This system gives a more up-to-date and clearer picture of service quality, helping both providers and the public see if care quality is improving.

Understanding the NEW CQC Scoring Method

The new CQC scoring system is simpler and clearer for measuring care quality than the old method.

These are the main parts of the new system:

• Four-point scale: CQC now uses a 1 to 4 scale for each quality check:
  • 4: Shows excellent care
  • 3: Shows good care
  • 2: Shows some problems
  • 1: Shows big problems
• Pyramid structure: The scores are organised into five pyramids based on the five key questions (Safe, Effective, Caring, Responsive, Well-led).

• The CQC still checks services based on five main questions
  • Are the services safe?
  • Are the services effective?
  • Are the services caring?
  • Are the services responsive?
  • Are the services well-led?

• Quality statement scores: Scores are given based on quality statements, and they are added up for each key question.
• Key question ratings: Each key question gets a rating like Outstanding, Good, Requires Improvement, or Inadequate.
• Overall rating: The scores for all key questions are combined to give the overall rating for the service.
• Dynamic ratings: The rating can change over time based on new evidence.
• Transparency: The new system is clearer, helping providers see where they need to improve.
• Future plans: In the future, CQC will publish more detailed reports to show exactly how ratings are decided.

This new system makes it easier for providers to see how well they are doing and where they can do better.

The new CQC Single Assessment Framework is a big change in how healthcare services are checked. It uses a clearer and fairer scoring system to help improve care quality.

The goal is to give care providers useful feedback that shows how well they are doing and where they can improve.

CQC Ratings	Quality Score
Outstanding	88% – 100%
Good	63% – 87%
Requires improvement	39% – 62%
Inadequate	38% or lower

How the CQC Gathers Evidence

The Care Quality Commission (CQC) collects evidence in different ways to check the quality of care. They use both on-site and off-site methods to make sure they understand how services are running. These is how the CQC gathers evidence for their rating of care homes and other care provider services:

On-Site Activities

• Targeted Visits: Inspectors visit care services to look at how care is given, how staff interact, and the environment.
• Speaking to People: They talk to service users, staff, and leaders to hear their views and experiences.
• Observations: Inspectors watch how care is provided and how staff interact with service users.
• Unannounced Visits: Sometimes, the CQC visits without warning if there are concerns, to gather more information.
• Case Tracking: For local authority care checks, the CQC may follow the care journey of a few people to understand their experiences.

Off-Site Activities

• Provider Information Requests (PIRs): The CQC asks care providers to fill in forms each year with information about their services.
• Online Reviews: They check clinical records and other online information to help them assess care quality.
• National Data Collections: The CQC looks at national data to see trends and check how services measure up to national standards.
• Responding to Concerns: If they get reports, such as whistleblowing or safeguarding concerns, the CQC acts to gather more information.
• Feedback from Users: The CQC collects feedback from people who use the services through forms, comment cards, and events.
• Data Analysis: The CQC uses data to monitor services all the time and make decisions based on this information.
• Insight Model: The CQC uses their Insight model to decide what actions to take based on the evidence gathered.

Publication of Reports

Once the CQC has gathered all the evidence, they publish inspection reports and ratings. This helps the public make choices, guides services to improve, and ensures high-quality care.

How do the quality statements differ from the previous KLOEs

The new Quality Statements from the Care Quality Commission (CQC) are different from the old Key Lines of Enquiry (KLOEs) in several ways:

• Fewer items: The 335 KLOEs have been reduced to just 34 Quality Statements.
• Applies to all services: These Quality Statements now cover all types of care services.
• Focus on results: They focus more on the outcomes (results) rather than how things are done.
• Less detailed: The new statements are not as detailed, giving care providers more freedom to decide how to meet the standards.
• Less repetition: There’s less overlap between different areas, especially in the “Caring” and “Responsive” sections.
• Clearer and shorter: The new statements are easier to understand and use.
• Organised evidence: Each statement is assessed using six main types of evidence.
• “We statements”: The Quality Statements are written from the care provider’s point of view, making expectations clearer.

These changes make the process simpler, clearer, and more consistent for all care services.

What is the Care Quality Commission (CQC) New Assessment?

The new Care Quality Commission (CQC) Assessment Framework (SAF) simplifies assessing health and social care services in England. It focuses on how to offer personalised care and support, meant for people working in health, care, housing, and those who use these services.

Key Points to Learn:

• Five key questions: It still focuses on whether services are safe, effective, caring, responsive, and well-led.
• Quality statements: The SAF replaces the old Key Lines of Enquiry (KLOEs) with 34 “we statements” written from the provider’s point of view.
• Evidence categories: The CQC collects evidence in six areas: people’s experience, feedback from staff, feedback from partners, processes, outcomes, and sector-specific evidence.
• Rating system: The same four ratings (Outstanding, Good, Requires Improvement, Inadequate) are used.
• Person-centred approach: It focuses more on assessing services in a personal and individual way.
• Unified expectations: The framework creates one set of rules for all care services, replacing different rules for different types of care.

The SAF started in November 2023 and will be fully used by March 2024. Care providers should review the new quality statements to make sure their services meet the updated standards.

The CQC 34 “We Statement” for SAF

The Care Quality Commission’s (CQC) Single Assessment Framework (SAF) has 34 “We” statements that are divided into five key questions. These replace the old Key Lines of Enquiry (KLOEs). The summary of these statements, grouped by category:

1. Safe

1. We protect people from abuse and poor treatment.
2. We assess and manage risks to people’s health and safety.
3. We ensure medicines are used safely.
4. We keep environments clean and safe.
5. We learn and improve when things go wrong.

2. Effective

6. We assess needs to provide care that is right for each person.
7. We achieve good results by following best practices.
8. We make sure care is fair and promotes equality.
9. We listen to feedback from people, families, and staff.
10. We ensure staff have the right skills and knowledge.
11. We work with others to provide coordinated care.
12. We use guidelines and evidence to improve care.

3. Caring

13. We treat people with kindness, dignity, and respect.
14. We involve people in decisions about their care.
15. We support people to express their needs and wishes.
16. We protect people’s privacy and respect their dignity.

4. Responsive

17. We tailor care to meet people’s needs and preferences.
18. We handle complaints well and learn from them.
19. We make sure services are easy to access and inclusive.
20. We help people move smoothly between services.
21. We learn from incidents to improve safety.
22. We adapt services to meet changing needs.

5. Well-Led

23. We have a clear plan for providing high-quality care.
24. We encourage a culture of safety, learning, and improvement.
25. We make sure there is good leadership and responsibility.
26. We involve communities in planning services.
27. We aim to reduce inequalities in care.
28. We support and value our staff through training.
29. We use resources in an efficient and sustainable way.
30. We work in partnership to provide joined-up care.
31. We act on feedback and data to improve services.
32. We operate openly and honestly.
33. We follow legal standards and obligations.
34. We lead with integrity and transparency.

The 34 “we statement” helps ensure care is consistent, clear, and focused on improving the quality of life for those receiving care. For more details, you can refer to the CQC’s official SAF guidance.

What are the main benefits of the new CQC Single Assessment Framework?

So in terms of benefits, these are the things the SAF offers

The new CQC Single Assessment Framework (SAF) has several benefits:

• Simpler System: It replaces many frameworks with one, so all services are checked the same way.
• Fairer Assessments: Using the same rules for all services makes evaluations more accurate.
• Less Paperwork: A simpler process saves time for both care providers and inspectors.
• Focus on Results: It looks at real-life outcomes and person-centred care instead of just ticking boxes.
• Clearer Rules: The new quality statements make it easier for providers to understand what is expected.
• Up-to-Date Ratings: The SAF ensures ratings reflect current service quality.
• Better Evidence Use: It gathers information from multiple sources to give a balanced score.
• More Transparency: Providers can see exactly how their ratings are worked out.

These changes aim to make care checks fairer, clearer, and focused on what matters most to people.

What challenges have care providers faced with the new SAF framework?

The Care Quality Commission (CQC) has received mixed feedback on its new Single Assessment Framework (SAF).

Stakeholders generally support the simplicity of the framework, which now includes only 34 topic areas across five key questions.

However, some have found the language too complex, prompting the CQC to review and simplify the wording of quality statements.

Providers and other care delivery organisations have also shared their feedback. They noted that the SAF has made the assessment process simpler and more dynamic, aiming to better reflect how care is delivered.

However, the scoring system has faced criticism, with some providers expressing dissatisfaction with the initial implementation of the SAF.

There have been challenges raised about CQC processes, highlighting significant concerns among providers regarding the framework’s execution.

Overall, the framework aims to make things clearer and reduce red tape, but there are still problems with how it is being carried out, which has caused some care providers to be unhappy.

📌Related: A Simple Guide to CQC Inspections for Care and Nursing Homes

List of CQC Framework Feedback

The Care Quality Commission (CQC) has received mixed feedback about the new framework. Providers and stakeholders have raised several concerns:

• Consistency and Clarity: Some providers have pointed out inconsistencies in inspections, with inspectors not always clear about what to look for. This has led to uneven inspections.
• Provider Information Request (PIR): Providers find the PIR process time-consuming and often receive little feedback afterwards, causing frustration.
• Inspector Knowledge: There are worries about inspectors’ knowledge in specific areas like dementia and learning disabilities, which can impact the quality of inspections.
• Standardisation of Inspections: Providers believe that the number of people spoken to during inspections should be standardised for a balanced view.
• Independent Oversight: Some providers feel that an independent body should oversee the CQC and handle appeals.
• Transformation Programme: Although initially supportive, providers are dissatisfied with the lack of consultation and piloting before the rollout of the new framework in 2023.
• Quality Statements: The limited number of quality statements used for inspections is seen as unhelpful, as it doesn’t provide a full picture of a service’s quality.
• Outcome Measures: There is a call for more focus on outcomes rather than process measures, with suggestions for the CQC to work with providers and academics to develop these measures.
• Report Delays and Value: Providers feel reports take too long to produce and often don’t reflect the immediate feedback given after inspections, leading to a perception of poor value for money.

Despite these concerns, the CQC has acknowledged the need for change and is working to improve the framework by simplifying the process and providing a clearer service history.

📚Available Courses:

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At Caring for Care, we know how important it is to be ready for a CQC inspection. Our mock CQC tests are made to help care home managers and staff practice and get ready for the real inspection.

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For more information or to book a mock CQC test, contact us at:

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