Let the care you give be seen: A simple guide for addiction services to shine on CQC inspections

When the knock comes at the door

It’s always the same scene.

Someone comes off the phone, looks a bit pale, and announces:

“CQC are coming next week.”

There’s a pause. The room gets heavier. Someone mutters about finding the policies. A colleague jokes about hiding the kettle.

I’ve been in addiction services for over twenty years. I’ve seen inspections cause full-blown panic. Teams burning out from frantic preparation. Services that deliver excellent care somehow convinced they're failing because they can't tick the right boxes fast enough.

I’ve also seen them pass almost unnoticed, where the teams understood that a CQC inspection isn't something that arrives at your door every few years. It's something that's happening right now, today, in the way you document a safeguarding concern, in how you support a staff member through supervision, in the conversations you have with service users about their care. In the ways you already living the standards every day.

The problem with how we've always done inspections

The CQC only started inspecting specialist substance misuse services in 2015. That’s not long ago. Before that, the sector was mostly invisible in national regulation. When CQC arrived, it borrowed the frameworks from health and social care and applied them to us, with more or less relevance to what our services were actually doing.

This is one of the reasons why, for years, we've treated CQC inspections like exams. Something you cram for. Something that disrupts normal service for weeks beforehand while everyone scrambles to find evidence, update policies and rehearse answers to questions that might never come.

I remember one service I worked with that spent six weeks before their inspection doing nothing but preparation. Clinical time was sacrificed. Staff meetings became evidence-gathering sessions. The quality of care actually dropped because everyone was so focused on proving they delivered good care that they forgot to deliver it.

And the worst part? After all that frantic preparation, the inspection itself felt disconnected from the real work. Inspectors asking about policies while staff were thinking about clients. Evidence folders that looked impressive but had little to do with whether people were actually recovering.

The new Single Assessment Framework adopted in 2023 has changed some of this. They shifted from relying only on static metrics around the Key Lines of Enquiry (Safe, Effective, Caring, Responsive, Well-led) to 34 Quality Statement, in the form of short “we will…” commitments that spell out what good looks like for each of the five questions.

Take S1.1 from the Safe domain: "People are protected from abuse and avoidable harm." That's not asking for a safeguarding policy (though you need one). It's asking: do people in your service actually feel safe? Can you demonstrate that when risks arise, you respond effectively? Do you learn from incidents and near-misses?

The CQC now also uses something they call "intelligent monitoring" - constantly collecting information about your service from multiple sources. Data returns, notifications, complaints, safeguarding reports, even staff satisfaction surveys. They're not waiting for inspection day to start gathering evidence. They're gathering it every day.

Which means the traditional approach - the last-minute scramble, the evidence folder panic, the disruption to normal service - doesn't work anymore. Worse, it never really worked. It just gave us the illusion of control.

Six ways they see you

Many frontline addiction professionals experience CQC as complicated, gloomy, even esoteric. But their process is relatively simple. They gather evidence through six types of lenses. If you prep around these, you’re already winning:

1. What people using your service say about you.

2. What your staff and leaders say about working here.

3. What your partners and commissioners say.

4. What they observe with their own eyes.

5. What’s written down in your policies, audits and governance notes.

6. What results you’re actually achieving.

Think of these as six camera angles on the same film.If all six tell the same good story, you’re in a strong position.If one shows a gap, they’ll zoom in.

Why it matters before they arrive

I know the temptation. “We’ll deal with it when we get the call.”But services that dread CQC the most are often the ones relying on last-minute scrambles.

Here’s the thing: the people you serve can’t afford for you to only get things right during inspection week.

When you work in addiction, the stakes are high every day. People can die if we get it wrong. Others might leave for good if care feels disorganised or unsafe.

The CQC framework, love it or hate it, is essentially a ready-made quality safety net. Use it daily and it will catch the problems before they catch you.

Those six types of evidence force you to close the gap between policy, practice and outcomes.

I saw this play out beautifully with a community addiction service in London. Instead of treating the Quality Statements as an external imposition, they used them as a framework for their own monthly quality assurance meetings. Each month, they'd focus on one or two statements, asking: "How do we know this is happening in our service? What evidence do we see? Where are the gaps?"

Building evidence that lives and breathes

The key insight is this: evidence isn't something you gather for inspections. It's something you generate through good practice, every day.

Let me give you an example.

One of the Quality Statements asks about how services support staff wellbeing and development. In the old system, you might have scrambled to find training records and HR policies. Under the new framework, the evidence is in how you actually support your team.

A service I consulted for last year, documents their supervision differently. Instead of just recording what was discussed, they include a brief note about how the supervisee is feeling, what support they need, and what development opportunities they've identified. Over time, this creates a rich picture of staff wellbeing and development that serves two purposes: it helps managers support their team better and it provides powerful evidence for inspection.

This is what I mean by evidence that lives and breathes. It's not additional work. It's the same work but documented in a way that captures its quality and impact.

The trick is building this into normal practice, not treating it as an extra burden.

Here are some ways services are doing this:

Service user feedback becomes part of every care review. Instead of annual satisfaction surveys that no one reads, brief conversations about what's working and what could be better become part of routine care planning. This generates continuous evidence about the Caring domain while actually improving care.

Incident analysis becomes learning-focused rather than blame-focused. When something goes wrong, teams ask: "What can we learn? How can we prevent this? What does this tell us about our systems?" The analysis gets documented in a way that shows learning and improvement over time.

Team meetings include a standing agenda item: "Evidence of quality." Five minutes each meeting where staff share examples of good practice, discuss challenges, and identify improvements. Over a year, this creates a narrative of continuous improvement that's far more powerful than any policy document.

Making it sustainable without burning out

The biggest fear I hear from leaders is that this approach will create more work for already stretched teams. But the opposite is true, if you do it right.

The key is integration, not addition. Instead of creating new systems for evidence gathering, you embed it into existing processes. Supervision, team meetings, care reviews, incident reports - these all become opportunities to generate the evidence you need while doing the work you're already doing.

I worked with a small residential service that was convinced they couldn't manage this approach because they were already at capacity. We started small. We identified three Quality Statements that aligned with their biggest challenges: supporting people through crises, staff development, and family involvement.

For each statement, we identified one small change to how they documented existing work. Crisis interventions included a brief reflection on what worked and what could be improved. Supervision records included a note about staff development needs and achievements. Family meetings included feedback about the service that got recorded and reviewed.

Six months later, they had rich evidence across all three areas. But more importantly, their practice had improved. They were learning from crises more systematically. Staff development was more targeted and meaningful. Family involvement was more effective because they were paying attention to what families found helpful.

The workload hadn't increased. The quality had.

The culture shift that matters most

But here's the real transformation: when you approach inspection readiness this way, you stop thinking about quality as something external that gets imposed on you. You start thinking about it as something internal that you're always working to improve.

This changes everything. Staff stop seeing quality assurance as bureaucracy and start seeing it as professional development. Service users stop feeling like they're being asked to perform for inspectors and start feeling like their feedback actually matters. Leaders stop feeling defensive about inspection and start feeling proud of the evidence they can share.

I remember visiting that London service I mentioned earlier, six months after they'd started using Quality Statements to structure their team meetings. The difference in atmosphere was palpable. Staff were talking openly about challenges and improvements. There was a sense of collective ownership of quality that I'd never seen before.

When their inspection finally came, it almost felt anticlimactic. The inspectors found a service that could articulate its strengths and challenges clearly, demonstrate learning and improvement over time, and show genuine care for both service users and staff. The inspection became a conversation rather than an interrogation.

Starting where you are, with what you have

If you're reading this thinking "This sounds good in theory, but we're barely keeping our heads above water," I understand. Most addiction services are under enormous pressure. Staff shortages, complex caseloads, funding uncertainty - it all makes quality improvement feel like a luxury you can't afford.

But that's exactly why this approach works. You don't need additional resources to document good practice differently. You don't need more time to embed reflection into existing processes. You don't need perfect systems to start building better evidence.

You can start tomorrow with one Quality Statement that matters most to your service right now. Pick something you're already working on - maybe safe discharge planning, or supporting people through withdrawal, or staff supervision.

Look at how you currently document this work. Ask yourself: does this documentation capture what we're actually achieving? Does it show learning and improvement over time? Does it tell the story of quality care?

If not, make one small change. Add one question to your care reviews. Include one reflection prompt in your supervision template. Create one space in your team meetings for sharing good practice.

Then build from there, gradually, sustainably, without burning out your team or compromising care.

On the day of the inspection

If you’re nervous, remember this:

Inspectors aren’t mind readers. If you don’t show it, it doesn’t exist.If you don’t explain it, they won’t guess.

Answer their question. Point to your examples. Let the evidence do the talking.

Focus on 3 key talking points: “what we’re proud of”, “how we keep people safe”, “how we learn”.

And please, don’t actually hide the kettle.

How ratings and scores work now

CQC now shows percentage scores alongside the four ratings.

• Outstanding: 88–100%

• Good: 63–87%

• Requires improvement: 39–62%

• Inadequate: ≤38%

  
  

Practical tip: if you’re near a threshold (e.g., 62–63%), focus your action plan on the handful of Quality Statements dragging your score.

After the inspection: two fast processes that matter

1. Factual Accuracy (FAC) — deadline: 10 working days from the email with your draft report. Use it to correct facts (with evidence) and fill missing context tied to the time of the assessment. Changes here can shift ratings before publication.

2. Ratings Review — after publication, you have 15 working days to request a review only if CQC didn’t follow its rating process (it’s not a re-inspection of the evidence). Keep it crisp (500 words per service).

3. 
   

Turn the report into a sharp action plan

Read it like this:

• Key question by key question (Safe → Well-led). Note the Quality Statements where narrative/evidence was weak.

• Cross-check with your own evidence - where are the thinnest proof points?

• Find your swing items: 3–5 doable fixes that would move a score (e.g., complete a medicines audit cycle;; create a “you said, we did” email, email a monthly learning bulletin).

  
  

Design your plan in one page:

• Problem (as CQC framed it) → Root cause → Action (owner/date) → Evidence it happened → Outcome you’ll show (metric or story).

• Report quarterly to your quality assurance meeting and your board; partner with lived experience reps to verify changes.

  
  

Some final thoughts

CQC is not the point.

This isn't really about inspections. It's about building services that know their own quality, that learn from their own experience, and that can articulate their impact with confidence.

Services that operate this way use inspections as opportunities to showcase excellent work and identify areas for further improvement. They create cultures of continuous learning that attract and retain good staff, deliver better outcomes for service users and maintain the support of commissioners and funders.

Most importantly, they do work that feels meaningful and sustainable, even in challenging times.

The inspection isn't coming. It's already here. In every interaction you have with service users, every supervision conversation, every team meeting, every difficult situation you navigate together. The question isn't whether you're ready for inspection. The question is whether you're building the kind of evidence, culture, and practice that makes great care visible.

Because when you do that, inspection readiness takes care of itself.

Try this this week:

Pick one of the six evidence types and ask: “If CQC came tomorrow, what’s the strongest proof we could give for this?”

If it’s thin, fix it now, not for CQC, but for the people counting on you.