Welcome to the first edition of ‘Did You Know?’, Hempsons’ new publication designed to keep you informed about the latest legal developments, legislation, and noteworthy case law across our sectors.

We are excited to launch our first edition with a spotlight on the Care Quality Commission (CQC). In future editions, we will explore topics such as procurement, employment, inquests, and more, ensuring you stay well-informed about the latest advancements in these areas.

We hope you find the articles in this edition both interesting and useful. If you need any legal assistance, have questions, or wish to discuss any of the issues covered, we would be delighted to hear from you.

In the current climate, with the myriad of changes to the way services are inspected, the lack of clarity in systems and processes, and ongoing issues with the IT system, it can feel as though there is no winning against CQC. Providers are increasingly faced with;

• a lack of transparency support and communication from inspectors
• draft inspection reports that do not accurately reflect the service and
• unjustified threats of enforcement action

However, as providers, you have the power and ability to challenge CQC where you feel it has not acted fairly, or in line with its duties as a regulator. If the sector doesn’t point out where there is a problem, CQC cannot improve.

See below our quick reference guide to the different avenues available to providers when challenging CQC:

• Where CQC have made inaccurate judgements of your service; use the factual accuracy process and point out the mistakes in your draft report within 10 working days (guide)
• Where CQC have proposed enforcement action; use the Representations or Appeals process to challenge their proposal and keep your service open within 28 days (guide)
• Where CQC have behaved unprofessionally, made administrative mistakes, or failed to follow its own systems and processes; use their complaints process within 1 year (guide)

All of these processes are there to enable CQC to stop, investigate its practices and rectify any errors that might be harmful to you and your service. They provide protection for services against action that is not proportionate or justified. Many of these are not complex or difficult processes, and are designed to enable providers to raise issues; the more this is done, the  more opportunity there is for CQC to examine its practice and make positive change!

We have had a client querying whether a provider can register two services at the same address for the same regulated activity.

The CQC website confirms that there is no need to register both services. This is because rather than registering the services, the CQC registers the regulated activities. Therefore there is no need for a second condition to allow a provider to carry on the same RA at/from the same location.

The Health and Social Care Act 2008 is also silent on this issue.

Nevertheless, there is no policy on the CQC website that prevents you from doing so if you feel that is best for your business structure.

One benefit of registering each service separately is that it would protect the individual ratings of each service. For example, if only one service was registered at the location and it was rated as inadequate, this would bring down the rating for both services. However, a consequence of this approach to note is that the provider would need to pay the annual fees for both locations, rather than just the one.

Lessons from R (Cygnet Health Care) v Care Quality Commission [2025] EWHC 1 (Admin)

A recent High Court ruling has brought renewed attention to the issue of apparent bias in Care Quality Commission (CQC) investigations and enforcement actions. The case involved a CQC inspector who had previously been detained as a patient in a Cygnet facility and was later appointed to conduct inspections at several different Cygnet sites. This raised questions about whether a fair-minded observer would perceive a risk of bias in the regulatory process.

The High Court ruled that apparent bias did exist, particularly as the inspector’s prior connection with Cygnet Health Care had not been fully assessed in line with CQC’s own conflict-of-interest policy. However, despite the finding of apparent bias, the court held that this did not automatically compel the withdrawal of the CQC’s decisions, as all but one enforcement decision would stand. The case serves as a reminder that apparent bias does not require proof of actual bias – only that a reasonable observer would question impartiality.

For care providers, this highlights the importance of transparency and procedural fairness in regulatory processes. Maintaining confidence in the inspection framework is essential to ensuring effective oversight and high care standards.

Key considerations for providers during a CQC Investigation

When facing a CQC inspection or enforcement action, providers should be proactive in understanding regulatory processes and safeguards. The following considerations can help ensure a fair and transparent approach:

1. Conflicts of Interest Checks: Providers should review the background of inspectors involved in their case. If there is any concern about an inspector’s impartiality, providers should raise it at the earliest opportunity.
2. Transparency and Due Process: Maintaining accurate records of interactions with the CQC can support transparency. If concerns arise, formal documentation will help ensure that any challenges are well-evidenced.
3. Challenging Decisions When Necessary: While the courts may not always overturn CQC decisions due to apparent bias, they will scrutinise the process. Providers should be aware of their rights to seek further review if necessary.
4. Regular Policy Reviews: Providers should periodically assess their own compliance and governance procedures to ensure alignment with regulatory expectations. This proactive approach can help mitigate risks and supports engagement with regulators.

By fostering transparency, due diligence, and open communication, care providers can engage confidently with the regulatory process while maintaining the highest standards of care.

CQC now assess all health and social care services by reference to the Single Assessment Framework (“SAF”).

The SAF comprises 34 quality statements which judge your compliance against the Fundamental Standards of Care which are set out in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (“the Regulations”).

The quality statements are divided into the 5 domains of Safe, Effective, Caring, Responsive, and Well Led, and points are awarded by CQC against each quality statement to determine whether your service is Inadequate, Requires Improvement, Good or Outstanding.

How you achieve the points is a lot like point scoring in an exam at school. The best quality evidence that demonstrates to CQC your compliance with a quality statement will score you the best score of 4 for outstanding.

Preparation is key. Hempsons has prepared a toolkit for social care providers which aims to support you in understanding what CQC are looking for from each quality statement. It explains what the quality statement means, tells you the kind of evidence CQC are looking for, and links each of the Regulations, to help you understand the standards you are required to achieve.

Alongside the toolkit, Hempsons also offer training, that helps bring each quality statement to life and inform your evidence gathering process.

We are offering an exclusive discount for Care England and partner care association members.

Find out more about the toolkit and how to order it.

Service providers (whether individual, a partnership, or an organisation as the legal entity) must be registered with CQC for each and every regulated activity provided, or intended to provide, unless an exception or exemption applies.

Failure to properly register regulated activities is a criminal offence and can result in CQC prosecutions of an unlimited fine and or a sentence of up to 12 months imprisonment.

All regulated activities are set out in Schedule 1 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (“the Regulations”). If general exceptions and exemptions set out in Schedule 2 of the Regulations do not apply, you must be registered with CQC.

Remember, any activity which is ancillary or in relation to the regulated activity will be treated as part of that activity, whether or a permanent basis or otherwise, broadening the threshold for registration.

Stop and think:

1. Does or will this amount to a regulated activity?
2. Can I rely upon an exception or exemption?
3. Who will be responsible for directing and controlling the Regulated Activity?
4. Which location/s will it apply to?

If you need advice upon whether your intended service provision requires registration, or how to make changes to an existing registration contact our dedicated social care team.

At Hempsons, we have a long history of assisting health and social care providers in navigating their interactions with the CQC and its regulatory framework. Our dedicated team of legal experts is led by Philippa Doyle, whose extensive experience within the CQC provides her with a deep understanding of the regulator’s operations. This expertise ensures that our advice and support for providers is practical and comprehensive, promoting a balanced approach to compliance and excellence in care.

Our CQC solicitors can assist with:

• Advice on compliance with CQC regulations and standards
• Guidance on the evidence categories and their application to your service
• Assistance with inspection preparation, including audits, incident learning, and care record reviews
• Support in responding to outcomes, including action plans and follow-up measures
• Help with Factual Accuracy Challenges, Ratings Reviews, and complaints

For more information about our CQC services, plus a range of free resources including webinars, podcasts, and blogs, visit our CQC page.