Which incidents must we notify CQC about, and how quickly?

What is a statutory notification?

A statutory notification is the formal way a registered provider tells CQC that something has happened. CQC's notifications page puts it in one line: registered providers must notify CQC about certain changes, events and incidents that affect their service or the people who use it.

That page lists every notification by name. Some are changes to your registered details, such as a new registered manager. Others are events and incidents: a death, a serious injury, an allegation of abuse, police involvement, or something that stops the service running safely. This post is about the second group, because those are the ones a senior carer may have to decide on in the middle of a night shift.

CQC's guidance for providers on notifications is plain about the stakes. It says it is an offence not to notify CQC when a relevant change, event or incident has happened.

Where does the duty actually come from?

Not from the 2014 Regulations that most of your governance work sits under. The incident notifications come from a separate set of rules, the Care Quality Commission (Registration) Regulations 2009. Two of them matter most for adult social care.

Regulation 16 of the 2009 Regulations covers deaths. The registered person must notify CQC without delay of the death of a person using the service while care was being provided, or a death which has, or may have, resulted from the regulated activity. The notification must include a description of the circumstances.

Regulation 18 of the 2009 Regulations covers other incidents. The registered person must notify CQC without delay of the incidents it lists, where they happen while care is being provided or as a consequence of it.

A word of caution on numbering. The 2009 Regulations and the 2014 Regulations each number their regulations separately, so when someone in a meeting says Regulation 18, check which set they mean before you agree with them.

Which incidents must we notify CQC about?

For a care home or home care service, the list in Regulation 18, read alongside Regulation 16 and CQC's own notification pages, comes down to six events. I have kept close to CQC's and the regulation's wording.

What happened	What makes it notifiable	When to notify
A death	The person died while care was being provided, or the death may have resulted from the care or how it was provided	As soon as possible, describing the circumstances
A serious injury	In a health care professional's reasonable opinion, the injury has caused lasting harm, or needs treatment to prevent death or lasting harm	Without delay. If the injury came from an assault, use the abuse form instead
Abuse or an allegation of abuse	Abuse or alleged abuse affecting a person using the service, including where that person is the alleged abuser	Without delay
Police involvement	Any incident reported to, or investigated by, the police	As soon as possible, unless a death, serious injury or abuse form applies
An event that stops safe care	Not enough suitably qualified staff, damage to premises that affects care, or a utility, fire alarm or safety equipment failing for more than 24 hours	As soon as possible
A deprivation of liberty outcome	The outcome of an application, or its withdrawal	Once the outcome is known, not when you apply

The serious injury row needs the most judgement. Regulation 18 defines prolonged pain or prolonged psychological harm as lasting, or likely to last, for a continuous period of at least 28 days. CQC's guidance on Regulation 18 adds examples, including the development after admission of a pressure sore of grade 3 or above. CQC says its lists are not exhaustive, so treat them as a guide to the kind of harm that counts, not a checklist.

How quickly does CQC need to hear?

For most incidents, the regulations do not give a number of hours. Regulations 16 and 18 both use the words without delay. CQC's pages for a death, police involvement and events that stop the service running safely all say you must notify as soon as possible.

The guidance for providers explains how to find the rule for each one. The regulations state the timescales, they depend on the type of notification, and CQC states the timescale on the webpage for each individual notification. So the page for the specific event is where to check, every time. The serious injury and abuse pages do not give one, so for those the regulation's words, without delay, apply.

The one clear exception is a deprivation of liberty application. CQC's DoLS notification page says not to tell it you are making an application. You notify the outcome, or the withdrawal of the application.

In my view, without delay means once the person is safe and you have the basic facts. It does not mean once the investigation has finished, and it does not mean once the family has been told and the paperwork is tidy.

Why do teams get notifications wrong?

The first mistake is waiting for proof. Regulation 18 covers an allegation of abuse, not only abuse that has been proven. CQC's abuse notification page also covers the person using your service as the alleged abuser, which is easy to miss. If you wait for the outcome of an investigation, the notification is late.

The second is choosing the wrong form. CQC's police page says that if a person using your service was affected by a death, serious injury or abuse, you use that specific form rather than the police one. Its serious injury page says an injury that resulted from an assault goes on the abuse form.

The third is assuming the task moves with the delegation. The guidance says a registered person can delegate notifications but is still responsible and accountable for making sure they are submitted correctly, so delegation arrangements must be clear and effective. A manager on leave does not pause the duty.

Then there are medicines errors and personal details. CQC asks you to notify a medicines error only if it causes one of the notifiable events, and to say in the notification that a medicines error was a known or possible cause or effect. It also asks you not to use the person's name, date of birth, NHS number or room number. Use a unique code, and keep a secure record of who it refers to.

The consequences are serious. CQC's guidance on Regulation 18 says it can prosecute for a breach, and can move directly to prosecution without first serving a Warning Notice. In my view, a missed notification also raises a question about governance: whether the provider did not know, or did not act.

How do we make the right call on a night shift?

The team on shift needs a short decision guide, not the regulations. One page is enough, kept where incidents are recorded.

Start with safety. Make the person safe and get the help they need. Then ask which of the six events in the table, if any, has happened. If the answer is yes or maybe, the senior on shift tells the named person who submits notifications that day, and that person checks the CQC page for the specific event and uses the current form. CQC says it updates its forms often, so a form saved to the desktop last year is a risk in itself.

Whatever you decide, write it down. Record what happened, which category you considered, whether you notified, why, who made the decision, and the reference number if you did notify. A recorded reason for not notifying is as useful as a notification, because it shows someone thought about it properly at the time.

Then check the loop each month. Compare your incident log with the notifications you sent. This is a good check for the nominated individual, and my post on what a nominated individual actually does explains where it fits in their oversight.

When is this not the answer?

A notification is not a response to the incident. If someone is at risk, make them safe and follow your local procedures for reporting abuse first. The CQC notification sits alongside that work, not in place of it.

Some things go elsewhere. CQC's guidance points outbreaks of infection to the GOV.UK route for notifiable diseases rather than its own forms.

If CQC has already written to you about a missed notification, or you think enforcement may follow, take advice from a solicitor who knows regulatory law. A consultant can help you fix the system, but not with the legal process.

And if your team already knows the categories, uses the right forms and records every decision, you may not need to change anything. Keep checking it each month.

Where should I start?

Take the last three months of incident records and test each one against the table above. Mark anything that should have been notified and was not, and anything that was notified on the wrong form. That one exercise will tell you whether your system works.

If you would like help, my policy and procedure development work can turn the regulations into a notifications procedure and a one page decision guide your team will use, and my training and development sessions help senior carers make the call with confidence. When you are ready, book some time with me and we can look at your incident records together.