The Legal Requirement
Under Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, registered providers must notify CQC of certain events "without delay" or within specific timeframes. This is not optional—it's a statutory duty.
Failure to notify CQC of a reportable event is a breach of regulation and can result in:
- Regulatory action: Warning notice, suspension of registration, or cancellation
- Criminal prosecution: Up to £20,000 fine or imprisonment (in serious cases)
- Safeguarding referrals: Potential concerns about your fitness to operate
Events That Must Be Notified Immediately (Same Day)
These events require notification to CQC without delay—normally the same day they occur, or the next working day if they happen out of hours.
Death of a Service User
What: Death of any person using the service, whether in the care home or elsewhere (e.g., hospital).
Why: CQC needs to know about deaths to understand safeguarding and quality patterns.
How: Notify CQC's duty team by phone on 03000 616161, then follow up in writing within 24 hours.
Serious Injury or Unexplained Deterioration
What: Serious injury requiring hospital admission, or unexplained serious deterioration in health or wellbeing requiring medical intervention.
Examples: Fall resulting in fracture, pressure ulcer requiring hospital treatment, sudden unexplained loss of consciousness, severe allergic reaction.
How: Notify CQC by phone, then in writing within 24 hours. Include details of the incident, immediate actions taken, and whether safeguarding has been informed.
Allegation or Discovery of Abuse or Neglect
What: Any allegation or discovery of abuse, neglect, exploitation, discrimination, or inappropriate treatment—by staff, other service users, or external persons.
Examples: Physical abuse, psychological abuse, financial exploitation, sexual abuse, discriminatory language or actions, withholding medication, inadequate personal care.
How: Notify CQC immediately AND make a safeguarding referral to the local authority. The duty team will advise on next steps. Police may be contacted for criminal incidents.
Outbreak of Infection or Contamination
What: Outbreak of infection (e.g., norovirus, C. difficile) or contamination affecting service users.
Threshold: Generally notifiable if 2+ people are affected and linked to your service, or 1+ person if in a vulnerable population (e.g., immunocompromised).
How: Notify CQC and Public Health England (PHE). Implement infection control measures. Document all affected individuals and treatment provided.
Unsafe Staffing Levels or Significant Departure from Plan
What: Actual or potential risk to safety due to significant staffing shortages or departure from your agreed staffing plan.
Examples: Key staff absence without cover, inability to provide planned activities due to staffing, lack of registered nurse when required.
How: Notify CQC explaining the shortfall, mitigation measures you've put in place, and timeline for resolution.
Incident Involving Controlled Drugs
What: Loss, theft, damage, or inappropriate administration of controlled drugs.
Examples: Missing medication, destroyed stock not recorded, staff administering without proper authorisation.
How: Notify CQC, the local police, and the NHS England Serious Incident Framework (if harm occurred). Your medicines regulators (NMC, GMC) will also be involved if professional staff are implicated.
Registered Manager Absence or Breakdown
What: Registered manager ceases to work, becomes ill, or is suspended from duty without immediate replacement.
Why: A registered manager is a legal requirement. Absence must be notified and resolved.
How: Notify CQC immediately. Explain interim arrangements, any deputies in place, and your plan to recruit or reinstate a registered manager.
Events That Must Be Notified Within 24 Hours
These events require written notification to CQC within 24 hours of discovery or occurrence. They don't typically require an immediate phone call but must be logged formally.
Notifiable Safety Incident
Incidents that posed risk but didn't result in serious harm (e.g., near-miss medication errors, falls managed without serious injury, equipment failure identified before use).
Service User Going Missing
Service user who leaves the care home without permission and cannot be accounted for (safeguarding and police will also be contacted).
Complaints Raising Significant Safeguarding or Quality Concerns
Complaints that suggest abuse, neglect, or systemic quality failures (these may also trigger immediate notification depending on severity).
How to Notify CQC
Immediate notification (by phone): Call CQC's duty team on 03000 616161. Available 24/7. Have details ready: your location, what happened, when, who was involved, and what you've done so far.
Written notification (follow-up): Email notification@cqc.org.uk or use the CQC portal. Include:
- Date and time of incident
- Names and roles of people involved
- Detailed account of what happened
- Impact on the service user(s)
- Actions taken immediately and planned actions
- Any external agencies notified (police, safeguarding, PHE)
Common Mistakes Managers Make
Waiting for investigation results before notifying
Notify CQC immediately. An allegation alone is reportable, regardless of whether it's proven.
Thinking minor incidents don't need reporting
Many "minor" incidents are notifiable. When in doubt, notify. It's better to notify and have CQC say it wasn't necessary than to fail to report a notifiable event.
Only telling staff, not telling CQC
Internal incident reporting is good practice, but it's not a substitute for CQC notification. Document the incident, notify CQC, and conduct your internal investigation separately.
Assuming someone else will notify
As a registered provider, it's your legal responsibility. If a staff member reports abuse to safeguarding, you must still notify CQC. Don't assume the local authority will do it.
Notifying without documenting
Keep a log of when CQC was called, who you spoke to, what you reported, and when written confirmation was sent. This protects you if there's later dispute about whether you notified.
Key Takeaways
- Notification requirements are statutory—not optional. Failure to notify is a regulatory breach.
- Seven categories of events trigger immediate notification (same day): deaths, serious injury, abuse allegations, infections, staffing crises, controlled drug incidents, and registered manager absences.
- When in doubt, notify. CQC won't penalise you for reporting an incident that turned out not to be serious. But failing to report something that was reportable can result in regulatory action.
- Document everything: when you notified CQC, who you spoke to, and what you told them. This is your evidence of compliance.
- CQC's duty team can be reached 24/7 on 03000 616161. If it's an emergency (safeguarding, death), call them immediately.