Ratings: adult social care services

After an inspection, we rate services for the quality of care across our five key questions: are they safe, effective, caring, responsive and well-led?

We award ratings on a four-point scale: outstanding, good, requires improvement or inadequate.

It is a legal requirement for providers to display their ratings.

Ratings characteristics

Our rating is based on an assessment of the evidence we gather using the key lines of enquiry (KLOEs) in the assessment framework for adult social care. Inspectors refer to the ratings characteristics for each key question and use their professional judgement to decide on the rating, drawing evidence from four sources of information:

• our ongoing relationship with the provider
• ongoing local feedback and concerns
• pre-inspection planning and evidence gathering
• evidence from the inspection visit.

When deciding on a rating at key question level, the inspection team asks:

• Does the evidence demonstrate a potential rating of good?
• If yes – does it exceed the standard of good and could it be outstanding?
• If no – does it reflect the ratings characteristics for requires improvement or inadequate?

This link between KLOEs, the evidence gathered under them, and the rating judgements lie at the heart of our approach to ensuring consistent, authoritative, robust judgements on the quality of care. A service does not have to demonstrate every rating characteristic in the assessment framework for us to give a rating. This is particularly true for outstanding and inadequate. For example, if we find just one of the characteristics of inadequate, and it has a significant impact on the quality of care and people’s experiences, this could lead to a rating of inadequate. Even services rated as outstanding are likely to have areas for improvement. In the same way, providers do not need to demonstrate every one of the characteristics of good to achieve that rating.

Inspection teams use the ratings characteristics as a guide, not as a checklist or an exhaustive list. They take into account best practice and recognised guidelines, and assure consistency through CQC’s quality control process.

With the introduction of the revised assessment framework in November 2017, some key lines of enquiry have moved to different key questions. This means that key question and overall ratings for a service may change at the next inspection, even if no significant changes are found. Any change in a rating is consistent with improvements made to our assessment framework, and give a better picture of the quality and safety of the service.