What is KLOE and How It Shapes Inspections

KLOE stands for Key Lines of Enquiry, which is the framework in England used by the Care Quality Commission (CQC) to assess the quality of health and social care services. It was first introduced in 2013 as a result a major concern prompted by the Mid Staffordshire NHS Foundation Trust Public Inquiry.

Before the latest introduction of the CQC Single Assessment Framework (SAF), there were approximately 300 Key Lines of Enquiry (KLOEs) used by the Care Quality Commission to assess health and social care services.

These KLOEs were detailed prompts under the five key questions—Safe, Effective, Caring, Responsive, and Well-led—and served as focal points during inspections to evaluate compliance and care quality.

📚Enquire Now: Mock CQC Inspection ( Free Quote)

Understanding KLOE Better

As mentioned above, the Key Lines of Enquiry (KLOEs) were created by the Care Quality Commission (CQC) in 2013. The goal was to make sure that health and social care services provided safe, effective, and high-quality care while encouraging ongoing improvement.

KLOEs were specific questions and prompts used by the CQC to check the quality of services. They helped inspectors see if services were Safe, Effective, Caring, Responsive, and Well-led—these are the five main areas that the CQC focuses on.

Each KLOE looked at different parts of care and how services were run, making sure that inspections were fair and consistent for all types of care providers, such as hospitals, care homes, GP practices, and more.

What are the 5 KLOEs in CQC?

The Care Quality Commission (CQC) uses five Key Lines of Enquiry (KLOEs) to assess care services in England.

These are:

• Safe: Checks if care, staff, and visitors are protected from harm and abuse.
• Effective: Looks at whether care, treatment, and support lead to good results, improve quality of life, and are based on evidence.
• Caring: Evaluates if staff treat people with kindness, respect, and dignity.
• Responsive: Checks if services are organised to meet the needs and preferences of those receiving care.
• Well-led: Assesses leadership and management to ensure high-quality care, innovation, and a culture of fairness.

These KLOEs form the basis for CQC inspections and are still important for evaluating the quality of care services in England, even within the Single Assessment Framework.

Goals of Key Lines of Enquiry (KLOE)

The Key Lines of Enquiry (KLOE) framework was created by the Care Quality Commission (CQC) to:

• Ensure Good Care: KLOEs made sure health and care services gave safe, effective, and kind care to everyone.
• Make Providers Responsible: KLOEs helped care providers stay responsible for safety, care, and leadership.
• Guide Inspections: KLOEs gave inspectors a clear and fair way to check care services.
• Encourage Improvement: KLOEs pushed care providers to always look for ways to get better and improve their ratings.
• Protect People: KLOEs helped keep people receiving care safe from harm, abuse, and neglect.
• Support Good Practices: KLOEs encouraged using the best methods and research to give the best care and results for people.

These goals helped the CQC check care services to make sure they are safe, good, and provide good care for everyone.

Breaking Down KLOEs

Each of the five key questions contains numerous specific KLOEs that inspectors use to assess services.

The Five CQC Key Questions

The CQC looks at five big questions to check how good a care service is:

1. Safe – Are people kept safe from harm and abuse?
2. Effective – Does the care help people get better and feel well?
3. Caring – Are staff kind, respectful, and understanding?
4. Responsive – Does the service meet each person’s own needs?
5. Well-Led – Is the service run well with good leadership and teamwork?

These questions help decide how good a care service is and what rating it gets.

Knowing these help provide a detailed framework for evaluation. Let’s dig further:

Safe (S1-S6)

• S1: How do systems, processes, and practices safeguard people from abuse?
• S2: How are risks to people assessed and their safety monitored and managed so they are supported to stay safe and their freedom is respected?
• S3: Do staff have all the information they need to deliver safe care and treatment to people?
• S4: How does the provider ensure the proper and safe use of medicines?
• S5: How well are people protected by the prevention and control of infection?
• S6: Are lessons learned and improvements made when things go wrong?

Effective (E1-E7)

• E1: Are people’s needs and choices assessed and care, treatment, and support delivered in line with current legislation, standards, and evidence-based guidance to achieve effective outcomes?
• E2: How does the service make sure that staff have the skills, knowledge, and experience to deliver effective care, support, and treatment?
• E3: How are people supported to eat and drink enough to maintain a balanced diet?
• E4: How well do staff, teams, and services within and across organisations work together to deliver effective care, support, and treatment?
• E5: How are people supported to live healthier lives, have access to healthcare services, and receive ongoing healthcare support?
• E6: How are people’s individual needs met by the adaptation, design, and decoration of premises?
• E7: Is consent to care and treatment always sought in line with legislation and guidance?

Caring (C1-C3)

• C1: How does the service ensure that people are treated with kindness, respect, and compassion, and that they are given emotional support when needed?
• C2: How does the service support people to express their views and be actively involved in making decisions about their care, support, and treatment as far as possible?
• C3: How is people’s privacy, dignity, and independence respected and promoted?

Responsive (R1-R4)

• R1: How do people receive personalised care that is responsive to their needs?
• R2: How are people’s concerns and complaints listened to and responded to and used to improve the quality of care?
• R3: How are people supported at the end of their life to have a comfortable, dignified, and pain-free death?
• R4: How does the service routinely listen and learn from people’s experiences, concerns, and complaints?

Well-Led (W1-W8)

• W1: Is there a clear vision and credible strategy to deliver high-quality care and support, and promote a positive culture that is person-centred, open, inclusive, and empowering, which achieves good outcomes for people?
• W2: Does the governance framework ensure that responsibilities are clear and that quality performance, risks, and regulatory requirements are understood and managed?
• W3: How are the people who use the service, the public, and staff engaged and involved?
• W4: How does the service continuously learn, improve, innovate, and ensure sustainability?
• W5: How does the service work in partnership with other agencies?
• W6: Is there a culture of high-quality, sustainable care?
• W7: Are there robust systems and processes for learning, continuous improvement, and innovation?
• W8: How does the service promote equality, inclusion, and wellbeing?

Additional KLOEs for Services for People with a Learning Disability or Autism

• Could your service do more to identify and overcome barriers that can stop people with a learning disability or autism from using your service?
• What reasonable adjustments does your service make for people with a learning disability or autism?
• How does your service make sure that people with a learning disability or autism and their families are fully involved in decisions about their care?
• How does your service make sure staff understand how to support people with a learning disability or autism properly?
• How does your service check that restraint is used only when absolutely necessary and in the least restrictive way possible?
• How does your service monitor if people with a learning disability or autism are having a good quality of life?

These 34 KLOEs questions form the basis for CQC inspections across health and social care services in England.

The Inspection Process

When CQC inspectors visit, they collect evidence in these ways:

• Watching how care is provided in your service.
• Looking at care records and documents.
• Talking to people who use the service, their families, and your staff.
• Checking data and performance results.

This information helps them give ratings for each of the five key areas (Safe, Effective, Caring, Responsive, Well-led).

The 4-ratings are: Outstanding, Good, Requires Improvement, or Inadequate. These ratings are then used to give an overall score for the service.

The CQC has expanding the way it gathers and uses six ways to collect information for assessments. The new method involves also looking at:

• Feedback from people using the service
• Input from staff and leadership
• Feedback from partners
• Direct observation of care
• Reviewing processes and systems
• Checking the results and outcomes of care

Why KLOEs Matter

For care providers, the Key Lines of Enquiry (KLOEs) offer several important benefits:

• They make it clear what good care looks like.
• They help providers check themselves and keep improving.
• They show what is working well and what needs to improve.
• They make sure all care services are checked in the same way.

For people using services and their families, KLOEs make sure care providers meet important safety and quality standards. They explain what to expect from care services and give a clear way to check how good the care is.

Does CQC still use KLOEs?

No. The CQC no longer uses KLOEs. From April 1st, 2023, the Care Quality Commission (CQC) replaced the old Key Lines of Enquiry (KLOEs) and prompts with new quality statements in their updated inspection framework.

However, as of May 22, 2024, the core KLOEs, which focus on safety, effectiveness, caring, responsiveness, and leadership, still apply to care homes.

The CQC’s new approach maintains the five key questions but now uses quality statements to assess services. These statements have replaced the KLOEs, prompts, and ratings characteristics.

While the KLOEs are gradually being phased out, they remain relevant in certain contexts with the latest updates.

Importance of Key Lines of Enquiry (KLOEs)

The Key Lines of Enquiry (KLOEs) were an important tool used by the Care Quality Commission (CQC) to check and regulate health and social care services in England.

This is why they were so important:

• Ensuring High-Quality Care: KLOEs helped check if services were safe, effective, caring, responsive, and well-led, making sure they met high standards for the people using them.
• Promoting Accountability: KLOEs set clear rules for care providers, making them responsible for keeping to the standards and giving person-centred care.
• Guiding Inspections: Inspectors used KLOEs to gather information during inspections, making sure the checks were fair and consistent.
• Encouraging Improvement: KLOEs pointed out areas that needed to improve, encouraging providers to make their services better and follow best practices for better ratings.
• Protecting Service Users: KLOEs made sure that people receiving care were safe from harm, abuse, or neglect, while still being treated with respect and dignity.
• Fostering Person-Centered Care: KLOEs encouraged care to be designed around each person’s needs and preferences, making services more flexible and responsive.
• Supporting Leadership and Governance: KLOEs focused on leadership, helping providers create a culture of openness, innovation, and responsibility.

Single Assessment Framework (SAF) vs. Key Lines of Enquiry (KLOEs)

In summary, KLOEs were important for keeping high standards in health and social care services, ensuring safety, effectiveness, and kindness, while encouraging continuous improvement in the sector.

Here is how they are different

The Single Assessment Framework (SAF) is a big change from the old Key Lines of Enquiry (KLOEs) system that the Care Quality Commission (CQC) used.

Main Structure:

KLOEs:

• Based on 5 key questions: Safe, Effective, Caring, Responsive, and Well-led.
• Had 34 specific lines of enquiry under these questions.
• Mainly for full inspections.

SAF:

• Based on 6 evidence categories: People’s experience, Safe care, Care needs, Leadership, Teams & equipment, and Working with others.
• Uses quality statements instead of questions.
• Made for ongoing assessment, not just inspections.

How They Assess:

KLOEs:

• Focused on inspections at certain times.
• Provided ratings: Outstanding, Good, Requires Improvement, Inadequate.
• Relied mostly on planned, on-site visits.
• Often had gaps between inspections.

SAF:

• Allows for continuous assessment and monitoring.
• Still gives ratings, but in a more flexible way.
• Uses many different sources of evidence all the time.
• Lets the CQC respond quickly when needed.

Gathering Evidence:

KLOEs:

• Evidence collected mainly during inspections.
• Focused on observations and checking documents.
• Did not analyse data between inspections.

SAF:

• Collects evidence from many sources all the time.
• Puts more weight on people’s experiences.
• Uses feedback, data, and specific assessments.
• Makes better use of digital tools and real-time data.

Focus and Priorities:

KLOEs:

• More about processes.
• Applied the same way across services.
• Wasn’t very flexible for different types of services.

SAF:

• More focused on outcomes.
• Focuses on equality, health issues, and working together.
• Flexible for different services and local needs.
• Encourages teamwork between providers.

How It Works in Practice:

KLOEs:

• Took a lot of preparation for each inspection.
• Inspections were often a big task for services.
• Could disrupt service delivery.

SAF:

• Aims to make assessments easier and more focused.
• Targets resources where there are risks.
• Encourages quality improvement in daily work.
• Provides more consistent assessments across services.