CQC Safe Key Question: A Practical Preparation Guide

Under the Safe key question, CQC considers whether people are protected from abuse and avoidable harm. Safety should be visible in people's everyday experience, staff practice, records, leadership decisions and the way the service learns when something goes wrong.

CQC is piloting changes to its assessment method during 2026, but its published framework continues to use the five key questions. Providers should use this guide alongside the current CQC framework and the evidence guidance for their exact service type.

Understand the current Safe quality statements

CQC's published framework groups safety under quality statements. The statements assessed and evidence requested can vary by service type, assessment purpose and identified risk.

• Learning culture.
• Safe systems, pathways and transitions.
• Safeguarding.
• Involving people to manage risks.
• Safe environments.
• Safe and effective staffing.
• Infection prevention and control.
• Medicines optimisation.

Protect people while respecting their choices

Safe care is person-centred. Risk assessments should reflect what matters to the person, their communication needs, strengths and informed choices, as well as foreseeable harm. Restrictions must have a lawful basis and be the least restrictive available option.

• Use accessible safeguarding information and explain how people can raise concerns.
• Train staff to recognise, respond to, record and escalate possible abuse or neglect.
• Work with local safeguarding partners and follow agreed referral procedures.
• Review risks after incidents, changes in need, transitions or concerns.
• Apply the Mental Capacity Act and best-interest processes to decision-specific situations.
• Check whether risk controls support rather than unnecessarily remove independence.

Make staffing, premises and infection controls work in practice

• Calculate staffing from people's current needs, dependency, activities and known risks.
• Complete robust recruitment checks and verify skills before unsupervised work.
• Use induction, competency assessment, supervision and refresher training effectively.
• Monitor missed or late calls, agency use, turnover, sickness and unfilled shifts.
• Maintain equipment, utilities, fire precautions and environmental risk controls.
• Audit infection-prevention practice, supplies, cleaning and outbreak arrangements.

Demonstrate safe medicines and care transitions

• Record each person's medicines accurately, including allergies and support needs.
• Assess staff competence for every medicines task they perform.
• Use clear arrangements for ordering, storage, administration, disposal and reconciliation.
• Review errors, omissions, refusals and as-required medicines for patterns and learning.
• Share accurate information when people move between services or return from hospital.
• Clarify responsibilities with prescribers, pharmacies, families and partner services.

Create evidence of a genuine learning culture

1. 1Make it straightforward for people and staff to report incidents, near misses and concerns.
2. 2Investigate proportionately and establish contributory system factors, not only individual error.
3. 3Meet safeguarding, notification and duty-of-candour responsibilities.
4. 4Agree actions with owners and realistic completion dates.
5. 5Share learning with everyone affected, including people using the service where appropriate.
6. 6Re-audit practice and outcomes to confirm that the improvement has worked.