When we talk about Care Quality Commission (CQC) compliance, we often talk about the legal Regulations. It is vital to remember that these regulations are the Fundamental Standards – the legal baseline of safety and quality below which care must never fall.
Regulation 18: Staffing is one of the most common areas where care services fail. But what does non-compliance mean for your service, and what can you do to ensure you are never in breach and are firmly on an improvement journey?
The True Cost of Non-Compliance
The CQC takes a flexible approach based on risk, assessing the likelihood and impact of harm. A minor staffing issue might only lead to a negative comment in your report or a lower score for that quality statement. At worst, it can lead to serious enforcement action—such as warning notices, fines, or even the urgent cancellation of your service registration.
Waiting for an inspection to find out you are failing is a dangerous strategy. You need everyday oversight to spot issues before an inspector does.
The Ripple Effect: Linked Fundamental Standards
Staffing failures rarely happen on their own and are often indicators of more systemic issues. If you breach Regulation 18, inspectors will immediately look at other related fundamental standards to see how deep the problems go, and whether the staffing concern impacts on any other fundamental standards. The main ones that CQC has identified are:
- Regulation 19 (Fit and Proper Persons Employed): Safe and robust recruitment
- Regulation 12 (Safe Care and Treatment): Where gaps in training, competency and staff numbers create immediate safety risks
- Regulation 17 (Good Governance): Where missing records or quality improvement activity show a lack of leadership and management control
Practical Strategies for Safe, Effective Staffing
Under any CQC inspection framework, inspectors judge your service based on ‘evidence’. This means good intentions do not count— only tangible things that you have done and can demonstrate that you have done count. To keep your service compliant, you must build simple, strong workflows that generate clear audit trails.
Some examples of this could be:
- Keep Training and Competency Up to Date: Lapsed training is an instant concern for CQC, so you need a rolling training programme that covers mandatory training, such as BLS and Safeguarding Adults and Children as well as relevant clinical skills, such as cervical screening updates. You will need a live training matrix showing completion dates – and make sure that clinical staff are working within their scope of practice!
- Encourage Teamwork and Collaboration: Create an environment where staff work together and feel confident knocking on a doctor’s door when it is appropriate to do so. When teams communicate well and support each other, outcomes are invariably better for patients, and staff also feel more supported. You need to show that staff are aware of what is going on at the service and can confidently raise ideas and suggestions, through meeting minutes, 1:1 and appraisal records. A staff board showing photos of staff social events shows that you are going the extra mile, too
- Meet Every Requirement in Schedule 3: To comply with Regulation 19, every staff file must strictly follow Schedule 3 of the Regulations. This is the legal checklist that details everything you must hold before a candidate starts. You must have personnel files for each member of staff showing everything required including DBS, references, work history for example. Make sure that locum staff have the checks you would expect of permanent staff. And if you have staff employed by the PCN, make sure you can evidence that they have the required checks in place too
- Active Performance Management: Set up a clear supervision structure and annual appraisals. Do not avoid formal disciplinary action when it is needed. You need signed, dated supervision logs, appraisal notes, and clear disciplinary records that show you address poor performance swiftly to keep patients safe
What to Do If You Breach the Fundamental Standard?
If you find a staffing breach, or you think there has been a breach or even an incident, act immediately. Be honest with yourself. It always best to find an issue internally than wait for a regulator to find a concern. Always record what you found and the actions you took to address the problem.
If CQC have found a breach, or an issue with staffing, send them a detailed action plan showing how you will fix the shortfall and take immediate steps to keep your service users safe. Fast, transparent action backed by clear evidence is the best way to rebuild trust with the regulator.