Care Home Compliance: Beyond CQC Inspections

When care home managers think about compliance, the Care Quality Commission (CQC) is usually the first — and sometimes the only — regulator that comes to mind. CQC inspections rightly command attention, but focusing exclusively on CQC creates dangerous blind spots. The reality is that care homes are subject to oversight from multiple regulators, each with their own requirements, inspection powers and enforcement sanctions.

A care home that scores “Good” or “Outstanding” with the CQC can still face enforcement action from the fire service, prosecution by the HSE, improvement notices from the local authority Environmental Health Officer (EHO), or sanctions from the Medicines and Healthcare products Regulatory Agency (MHRA). This guide covers the full compliance landscape for UK care homes — everything beyond the CQC inspection that you need to get right.

The Regulatory Landscape for Care Homes

Understanding which regulators have oversight of your care home is the starting point for comprehensive compliance.

Care Quality Commission (CQC)

The CQC regulates health and social care services in England. It inspects care homes against five key questions: Are they safe? Are they effective? Are they caring? Are they responsive? Are they well-led? CQC has the power to issue warning notices, impose conditions on registration, suspend registration and, in the most serious cases, cancel registration entirely.

For detailed guidance on preparing for CQC inspections, see our article on CQC inspection preparation.

Fire and Rescue Service

The local fire and rescue service enforces the Regulatory Reform (Fire Safety) Order 2005 in care homes. Fire safety in care homes is a particularly critical issue because residents may have limited mobility, cognitive impairment or sensory loss — making evacuation significantly more challenging than in other premises.

Health and Safety Executive (HSE)

The HSE enforces workplace health and safety legislation in care homes. This includes the Health and Safety at Work etc. Act 1974, the Manual Handling Operations Regulations 1992, the Control of Substances Hazardous to Health Regulations 2002 (COSHH), and many other regulations. HSE inspectors can visit unannounced and have extensive enforcement powers.

Local Authority Environmental Health

Environmental Health Officers (EHOs) from the local authority enforce food safety and food hygiene legislation in care homes. They also have a role in infectious disease control and may inspect premises in relation to legionella and other environmental health matters.

Medicines and Healthcare Products Regulatory Agency (MHRA)

The MHRA regulates medicines and medical devices. Care homes that store, administer or dispose of medicines must comply with relevant regulations and guidelines.

Fire Safety in Care Homes

Fire safety deserves particular attention because the consequences of fire in a care home can be catastrophic, and because the regulatory requirements have been significantly strengthened in recent years.

The Fire Safety (England) Regulations 2022

Following the Grenfell Tower tragedy and the subsequent inquiry, the Fire Safety (England) Regulations 2022 introduced new duties for responsible persons in buildings containing two or more domestic premises. While primarily targeted at residential buildings, care homes are also affected.

Sprinkler Requirements

One of the most significant recent developments is the requirement for automatic fire sprinkler systems. Since March 2025, all new-build care homes in England must be fitted with automatic fire sprinkler systems. This requirement was introduced through amendments to Approved Document B of the Building Regulations.

Existing care homes are not currently required to retrofit sprinklers, but the fire and rescue service strongly recommends it, and many local authorities and commissioning bodies now include sprinkler systems in their commissioning specifications. The National Fire Chiefs Council (NFCC) has called for mandatory sprinkler retrofitting in all existing care homes, and further regulatory changes may follow.

Fire Risk Assessment

Every care home must have a suitable and sufficient fire risk assessment, carried out by a competent person and reviewed regularly. The fire risk assessment must address:

• Sources of ignition — Kitchen equipment, laundry dryers, electrical systems, smoking materials, candles, battery-charging equipment
• Sources of fuel — Bedding, furniture, clothing, medical supplies, cleaning materials, stored oxygen
• People at risk — Residents with mobility impairment, cognitive impairment, sensory loss or behaviour that increases fire risk
• Preventive measures — Detection, alarm, suppression, compartmentation, fire doors, emergency lighting
• Emergency procedures — Evacuation strategies (progressive horizontal evacuation, stay-put policies where appropriate), personal emergency evacuation plans (PEEPs) for each resident, staff training and fire drills

Evacuation Planning

Care home evacuation is fundamentally different from evacuation in other premises. Many residents cannot evacuate independently, and a full simultaneous evacuation is often neither practical nor safe. Most care homes use a progressive horizontal evacuation strategy — moving residents from the affected fire compartment to an adjacent safe compartment, rather than immediately to the outside.

Each resident must have a Personal Emergency Evacuation Plan (PEEP) that is reviewed whenever their mobility or cognitive status changes. Staff must be trained in the use of evacuation equipment — ski sheets, evacuation chairs, carry sheets — and this training must be practised regularly.

COSHH Compliance in Care Homes

The Control of Substances Hazardous to Health Regulations 2002 (COSHH) apply to all workplaces where employees may be exposed to hazardous substances. In care homes, the main sources of exposure are:

Cleaning Chemicals

Care homes use a wide range of cleaning and disinfection products, many of which contain hazardous substances. Bleach, quaternary ammonium compounds, alkaline degreasers and acid-based limescale removers all present risks including skin irritation, respiratory sensitisation and chemical burns.

Key requirements:

• Maintain COSHH assessments for every hazardous product used
• Keep safety data sheets (SDS) accessible for all products
• Provide appropriate PPE — gloves, aprons, eye protection where needed
• Train staff on safe handling, dilution rates and emergency procedures
• Store chemicals securely, away from food preparation areas and resident access
• Never decant chemicals into unlabelled containers

For a comprehensive guide to COSHH compliance, see our article on COSHH regulations: a practical guide.

Medications

While medicines themselves are regulated separately, the handling of hazardous medicines (particularly cytotoxic drugs administered to some residents) may fall within COSHH scope. Care homes should assess the risks from handling, administering and disposing of hazardous medications.

Biological Agents

Care workers may be exposed to biological agents through contact with body fluids, infected wounds, contaminated laundry and waste. COSHH requires employers to assess these risks and implement appropriate controls — including hand hygiene, PPE, safe sharps disposal and laundry procedures.

Manual Handling in Care Homes

Manual handling injuries are one of the most common workplace injuries in the care sector. The Manual Handling Operations Regulations 1992 require employers to avoid hazardous manual handling where reasonably practicable, assess the risks where it cannot be avoided, and reduce the risk as far as reasonably practicable.

Patient Handling

Moving and handling residents is the highest-risk manual handling activity in care homes. This includes:

• Assisting residents to stand, sit or transfer between surfaces
• Repositioning residents in bed
• Supporting residents during bathing and toileting
• Assisting with mobility (walking, wheelchair transfers)
• Moving residents in emergencies (fire evacuation)

Key controls:

• Carry out individual moving and handling assessments for each resident, reviewed regularly as their condition changes
• Provide appropriate equipment — hoists (ceiling-tracked and mobile), slide sheets, transfer boards, profiling beds, bath hoists
• Ensure all care staff receive competency-based moving and handling training, with practical elements, not just theoretical instruction
• Never allow manual lifting of residents — the “no lifting” policy is now standard practice across the UK care sector
• Monitor staff for signs of musculoskeletal injury and respond proactively

Medication Management

Medication errors in care homes are a significant patient safety concern. While medication management falls primarily under CQC regulation and the oversight of pharmacy professionals, several aspects have broader regulatory implications.

Storage and Security

Controlled drugs must be stored in compliance with the Misuse of Drugs (Safe Custody) Regulations 1973 — in a locked, wall-mounted controlled drugs cabinet within a locked room. Other medicines must be stored securely, at the correct temperature, and separated from other substances.

Administration Records

The Medicines and Healthcare products Regulatory Agency (MHRA) and the National Institute for Health and Care Excellence (NICE) guideline SC1 (Managing medicines in care homes) set out expectations for medication administration records (MARs). These must accurately record every medicine administered, refused or omitted, with signatures, dates and times.

Disposal

Unused or expired medicines must be disposed of safely, typically through a licensed pharmaceutical waste contractor. Care homes must maintain records of medication disposal.

Food Hygiene and Safety

Care homes that prepare and serve food to residents are food businesses and must comply with food safety legislation, including Regulation (EC) No 852/2004 (retained in UK law) and the Food Safety and Hygiene (England) Regulations 2013.

Food Hygiene Rating

Care homes are subject to food hygiene inspections by the local authority EHO and receive a food hygiene rating. A low rating can have serious reputational consequences and may trigger concern from the CQC, commissioners and families.

HACCP-Based Procedures

Care homes must implement food safety management procedures based on Hazard Analysis and Critical Control Point (HACCP) principles. The Food Standards Agency’s Safer Food, Better Business pack is widely used in care homes as a practical HACCP framework.

Key areas include:

• Temperature control — cooking, cooling, reheating, hot holding, cold storage
• Cross-contamination prevention — colour-coded chopping boards, separate storage for raw and cooked foods
• Staff hygiene — handwashing, protective clothing, fitness to work
• Allergen management — particularly critical in care homes where residents may have multiple dietary requirements
• Cleaning schedules — documented cleaning programmes for the kitchen and food service areas

For more on food safety compliance, see our guide to food safety compliance and HACCP.

Infection Prevention and Control

The COVID-19 pandemic brought infection prevention and control (IPC) in care homes into sharp focus, but IPC requirements existed long before the pandemic and extend well beyond respiratory infections.

Key IPC Requirements

• Hand hygiene — Adequate handwashing facilities, alcohol gel dispensers and training on the “five moments” of hand hygiene
• PPE — Risk-assessed provision of gloves, aprons, masks and eye protection
• Laundry — Separation and handling of infected laundry in accordance with HSE and public health guidance
• Waste — Correct segregation and disposal of clinical waste, including sharps
• Cleaning — Enhanced cleaning schedules for high-touch surfaces and during outbreaks
• Outbreak management — Documented procedures for managing outbreaks of infection, including notification to public health authorities
• Staff vaccination — While mandatory COVID-19 vaccination for care home staff was introduced and subsequently revoked, care homes are still expected to promote flu and COVID-19 vaccination among staff

IPC Audits

CQC inspectors pay close attention to IPC during care home inspections, and IPC is a key element of the “Safe” domain. However, Public Health England (now the UK Health Security Agency) and local health protection teams also have a role in inspecting and advising on IPC in care homes, particularly during outbreak situations.

Legionella Management

Legionella bacteria can grow in water systems that are not properly maintained, causing Legionnaires’ disease — a potentially fatal form of pneumonia. Care home residents are particularly vulnerable because of their age and underlying health conditions.

Legal Requirements

The HSE’s Approved Code of Practice L8 — Legionnaires’ Disease: The Control of Legionella Bacteria in Water Systems — sets out the requirements for managing legionella risk. Care homes must:

• Appoint a responsible person for legionella control
• Carry out a legionella risk assessment of the water system, reviewed at least every two years or when there are significant changes
• Implement a written scheme of control based on the risk assessment
• Monitor water temperatures:
  • Hot water storage at 60°C or above
  • Hot water at outlets reaching 50°C within one minute
  • Cold water below 20°C
• Flush little-used outlets weekly
• Clean and disinfect water tanks, showerheads and other components on a scheduled basis
• Keep records of all monitoring, maintenance and corrective actions

Common Care Home Legionella Risks

Care homes often have complex water systems with long pipe runs, multiple outlets and fluctuating occupancy in certain rooms — all of which increase legionella risk. En-suite rooms that are temporarily unoccupied are a particular concern, as stagnant water in unused outlets provides ideal conditions for legionella growth.

Staff Training Records

Across all of these compliance areas, one common thread is the requirement to demonstrate that staff have been adequately trained. Different regulators will ask for evidence of training in different areas:

• CQC: Safeguarding, mental capacity, DoLS, person-centred care, medications
• Fire service: Fire safety, evacuation procedures, use of fire equipment
• HSE: Manual handling, COSHH, first aid, health and safety induction
• EHO: Food hygiene, allergen awareness
• IPC: Hand hygiene, PPE use, outbreak management

Maintaining comprehensive, up-to-date training records across all of these areas — for every member of staff, including agency workers — is a significant administrative challenge. It is also one of the most common areas of non-compliance identified across all regulatory inspections.

For guidance on managing training records effectively, see our article on training record management for UK businesses.

Bringing It All Together

The compliance burden on care homes is substantial, and it extends far beyond what the CQC inspects. Fire safety, COSHH, manual handling, food hygiene, infection control, legionella management, medication safety and staff training all fall within the scope of different regulators — each with their own inspection regimes, enforcement powers and expectations.

Managing all of this with paper-based systems, spreadsheets and filing cabinets is increasingly untenable. The volume of assessments, inspections, training records and compliance documentation required across a single care home — let alone a multi-site organisation — demands a more systematic approach.

Simplify Your Care Home Compliance

Digital compliance platforms can help care home managers bring all of their regulatory obligations together in one place — from fire safety checklists and COSHH assessments to training records and inspection schedules. Real-time dashboards show you where you stand across every compliance area, automated reminders ensure nothing is missed, and a complete audit trail gives you confidence when any regulator walks through the door.

Explore how Digital Checklists can standardise your inspection and audit programme, how our Training LMS can keep every staff member trained and certified, how COSHH Assessments can simplify your chemical safety management, and how Risk Assessments can ensure your hazard controls are always current.