CQC Regulation 18: staffing, supervision and support

What is CQC Regulation 18?

Regulation 18, staffing, requires providers to deploy enough suitably qualified, competent, skilled and experienced staff, and to give them the support, training, professional development, supervision and appraisal they need for their role. CQC does not set a fixed supervision frequency, so set one in your policy, keep records and show that supervision leads to real support.

Good supervision is the part most managers find hardest to fit into a busy week. The free Manager’s Playbook has 15-minute routines for exactly that.

Regulation 18 or a “Regulation 18 notification”?

Two different rules share the number, and they are easy to mix up.

• Regulation 18 of the Regulated Activities Regulations 2014 is about staffing. It is the subject of this article.
• Regulation 18 of the CQC (Registration) Regulations 2009 is about notifying CQC of incidents without delay: serious injuries, abuse or allegations of abuse, incidents reported to or investigated by the police, and events that stop the service running safely, including not having enough suitably qualified, skilled and experienced staff. CQC can prosecute for failing to notify.

If you searched for a “Regulation 18 notice”, you probably mean the second one.

What Regulation 18 says, part by part

• 18(1), staffing levels. “Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed” to meet the fundamental standards.
• 18(2)(a), support. Staff must receive the support, training, professional development, supervision and appraisal they need to do their job.
• 18(2)(b), qualifications. Staff must be enabled, where appropriate, to gain further qualifications for their work.
• 18(2)(c), registered professionals. Nurses, social workers and other registered professionals must be enabled to show their regulator that they still meet its standards, for example through revalidation.

CQC cannot prosecute for a breach of Regulation 18, but it can take regulatory action, and staffing problems often show up in other findings too.

Staffing levels: what CQC expects

CQC does not set staffing ratios. In its own words, it “can’t tell care providers how many members of staff they need”, but if the evidence suggests staff can’t meet people’s needs, it will take action. Its guidance asks for a systematic approach:

• A way of working out how many staff, and which skills, you need to meet people’s needs and keep them safe at all times.
• Staffing levels and skill mix reviewed continuously as people’s needs change.
• A plan for emergencies that covers both the emergency and the routine work.

On site, inspectors talk to people, relatives, staff and visiting professionals, watch how staff respond to people, and check whether the rota matches the staff on duty. They also consider the building: a home on several floors with long corridors needs staff where people are.

Supervision and appraisal: what CQC expects

CQC’s guidance on Regulation 18 sets out what support looks like:

• An induction programme that prepares staff for their role.
• Training needs assessed at the start of employment and reviewed at appropriate intervals.
• Supervision until staff can show they are competent to work unsupervised, then appropriate ongoing or periodic supervision to keep that competence.
• Regular appraisal from an appropriately skilled and experienced person, with development needs planned and supported.
• Training for all staff in how to interact appropriately with people with a learning disability and autistic people, at a level that fits their role.
• First aid training for people working in adult social care.
• Clinical or professional supervision for registered professionals, in line with their regulator.

CQC’s draft framework for adult social care asks under its safe staffing key line of enquiry whether there are “enough qualified, skilled and experienced staff who receive adequate support, supervision and development”. Its draft rating descriptions show the difference between levels. At Good, there are induction, supervision and appraisal processes that help staff develop and improve the service. At Outstanding, supervision is described as “an empowering process” where reflective practice and learning are shared priorities. At Requires improvement, supervision or support is not consistent.

How often? CQC sets no fixed frequency. Choose one that fits your service, write it in your policy and record when a session slips and why. A workable starting point is a one-to-one every six to eight weeks, more often for new starters, plus an annual appraisal.

10 questions for a useful supervision

1. What’s working well for you at the moment?
2. What has been hard since we last met?
3. How are the people you support? Has anything changed for anyone?
4. Is anything worrying you, including about someone’s safety?
5. What training or support would help you most right now?
6. What feedback have you had from people, families or colleagues?
7. Who has helped you this month, and who have you helped?
8. How are you, honestly? Are you getting your breaks?
9. What would you change about how we work?
10. What will each of us do before we next meet?

Open with one specific thank-you for something the carer did since your last meeting. It sets the tone, and it is the moment people remember when an inspector later asks whether they feel valued.

How to evidence Regulation 18

• Staffing decisions. Your dependency or staffing tool, how often you review it and what changed when people’s needs did.
• Rotas against actual cover. Planned and worked shifts, agency use and how you cover sickness.
• Induction records. Including the Care Certificate for new care workers, and a local induction for agency staff.
• A training matrix with dates. What is due, what is done and what you are doing about gaps.
• A supervision matrix. Sessions due, done and missed, with reasons and the actions agreed.
• Competency checks. Medicines, moving and handling and any specialist care.
• Professional registration. Nurses’ registration and revalidation dates checked and recorded.

In home care, add spot checks during visits and how you match carers’ skills to people’s needs. In supported living, show how staff who work alone get support and supervision between visits.

How the evidence builds itself

Supervision is easier when you have something specific to talk about. In CareKudos, recognition from colleagues, managers and families builds up over the month, so you start every one-to-one with real examples. Each carer can download a professional portfolio of their achievements, recognition and values, which helps at appraisal time. The monthly anonymous Staff Voice survey shows how the team feels, and the Advance plan adds signals when someone may be at risk of leaving.

CareKudos does not replace your rota, training system or supervision records. It adds the evidence that staff are supported and valued, which sits under Regulation 18 and the Well-led key question.

Questions managers ask