Run a care home or other residential care service

This guide is for providers of accommodation with personal or nursing care — care homes and nursing homes — and for domiciliary care delivered in people's own homes. In England these are regulated activities: the provider and (in most cases) a registered manager must be registered with the Care Quality Commission before the service operates. Children's homes are different: residential care for children is regulated by Ofsted under the Care Standards Act 2000, not the CQC — as is supported accommodation for looked-after 16 and 17-year-olds (since 28 October 2023 under the Supported Accommodation (England) Regulations 2023).

In Scotland register with the Care Inspectorate, in Wales with Care Inspectorate Wales, and in Northern Ireland with RQIA — each nation's process is covered by its own guide, routed at the end.

A. Register with the right regulator

Match the activity to the regulator: accommodation with nursing or personal care, and personal care in people's own homes, are CQC regulated activities in England. There is no application fee; annual fees for care and nursing homes are banded by the number of places at each location, while domiciliary and other community social care pays a base fee plus an amount per service user. A nursing home also registers for treatment of disease, disorder or injury, and must ensure registered-nurse cover at all times.

B. Appoint your registered manager

Most providers must have a registered manager in day-to-day charge, registered with the CQC in their own right. There is no statutory qualification, but the CQC expects the qualifications, competence, skills and experience for the role — the Level 5 Diploma in Leadership and Management for Adult Care is the sector benchmark.

C. Recruit safely — enhanced DBS checks

Care work with adults or children is regulated activity under the Safeguarding Vulnerable Groups Act 2006: every member of care staff needs an enhanced DBS check with a barred-list check before starting, and it is an offence to employ a barred person. Recruitment files must hold a full employment history with any gaps explained.

D. Mental capacity and deprivation of liberty

Where residents may lack capacity, the Mental Capacity Act 2005 framework governs assessments and best-interests decisions. If a resident who lacks capacity is deprived of their liberty in a care home, you must obtain authorisation through the Deprivation of Liberty Safeguards from the local authority — DoLS remains the operative regime; the Liberty Protection Safeguards are not in force.

E. Safeguarding adults at risk

Safeguarding enquiries under section 42 of the Care Act 2014 are a local authority duty — your duties are to protect service users from abuse and improper treatment (Regulation 13), report concerns to the local authority, and cooperate fully with enquiries.

F. Fire safety and premises

Fire safety in residential care is designed around residents who often cannot self-evacuate: your fire risk assessment under the Regulatory Reform (Fire Safety) Order 2005 must address dependency, staffing levels at night and progressive horizontal evacuation. The fire and rescue authority enforces the Fire Safety Order; the CQC assesses fire safety under the fundamental standards and shares concerns with the fire service.

G. Protect care records and data

Care records, care plans and medication records are special-category health data — register with the ICO, pay the data protection fee and apply heightened safeguards to how records are stored, shared and retained.

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