Evidencing Duty of Candour Under the CQC Assessment Framework
Duty of candour is assessed through how openly providers respond when something goes wrong. The CQC quality statements on openness and learning require services to show that people are informed, supported and treated honestly after incidents or harm.
This must be evidenced through clear CQC assurance records that connect incident response, apology, investigation and learning. The CQC inspection and governance knowledge hub supports providers to organise candour evidence clearly.
Why this matters
Open communication is central to trust. When people or families are not informed clearly, confidence can be damaged even where the provider has acted to reduce risk.
Inspectors and commissioners expect providers to evidence honesty, apology and follow-up. Duty of candour must be visible in records, not handled informally or left to memory.
A practical framework for duty of candour evidence
Providers should evidence candour through incident records, communication logs, apology notes, investigation findings, outcome letters and governance review.
The strongest evidence shows what was shared, when it was shared, who was involved and what changed as a result of learning.
Operational Example 1: Candour After a Fall With Injury
Step 1: The senior support worker records the fall, injury, immediate care provided and professional advice requested in the incident reporting system.
Step 2: The registered manager reviews the incident, confirms duty of candour applies and records the decision in the candour assessment log.
Step 3: The registered manager contacts the person or representative, explains known facts, offers an apology and records the conversation in the communication record.
Step 4: The deputy manager investigates relevant care records, staffing notes and risk assessments, recording findings in the incident investigation file.
Step 5: The registered manager shares the outcome and agreed actions, records questions raised and updates the service improvement tracker.
What can go wrong is that the clinical response is recorded but open communication is unclear. Early warning signs include family uncertainty, delayed contact or missing apology evidence. Escalation involves nominated individual oversight. Consistency is maintained through a candour checklist.
Governance: Incident records, candour logs, communication notes and investigation outcomes are reviewed monthly by the registered manager. Action is triggered by delayed communication, missing apology records, incomplete investigations or repeated harm themes.
Evidence & Outcomes: The baseline issue was inconsistent candour recording after injury. Measurable improvement included faster communication and clearer action tracking. Evidence sources include care records, audits, feedback and staff practice observations.
Operational Example 2: Candour After a Medication Error
Step 1: The medicines lead records the medication error, immediate action taken and clinical advice sought in the medicines incident form.
Step 2: The registered manager checks whether the person was affected, records the candour decision and notes the rationale in the incident file.
Step 3: The registered manager informs the person or representative, explains the error clearly and records the apology in the duty of candour log.
Step 4: The medicines lead completes a staff practice review, records learning in the competency file and updates the medicines action plan.
Step 5: The quality lead reviews follow-up medicines audits, checks for repeat errors and records learning outcomes in governance minutes.
What can go wrong is that medicines errors are corrected but not explained openly. Early warning signs include missing communication notes, repeated MAR gaps or staff uncertainty. Escalation may include competency restrictions and professional advice. Consistency is maintained through candour screening for medicines incidents.
Governance: Medicines incident forms, candour decisions, competency records and audit outcomes are reviewed monthly by the registered manager. Action is triggered by repeated errors, missing candour assessment, delayed follow-up or incomplete learning evidence.
Evidence & Outcomes: The baseline issue was variable candour decisions after medicines errors. Measurable improvement included clearer rationale and fewer repeat errors. Evidence includes care records, audits, feedback and observed medicines practice.
Operational Example 3: Candour Following Missed Care
Step 1: The care coordinator identifies missed care from monitoring alerts, records the missed support and immediate welfare contact in the visit exception log.
Step 2: The registered manager assesses the impact on the person, records unmet need or distress and confirms whether duty of candour applies.
Step 3: The registered manager contacts the person or representative, explains what happened, apologises and records the discussion in the candour communication record.
Step 4: The scheduler reviews rota allocation and monitoring failures, records the cause in the missed care investigation note and proposes prevention action.
Step 5: The provider lead reviews reliability data after the action, records whether missed care reduced and notes assurance findings in the quality report.
What can go wrong is that missed care is treated only as a scheduling issue. Early warning signs include repeated late alerts, distressed calls or informal cover arrangements. Escalation involves commissioner notification and senior rota oversight. Consistency is maintained through impact-based candour review.
Governance: Visit exception logs, candour records, investigation notes and reliability data are reviewed monthly by the quality lead. Action is triggered by repeated missed care, unmet need, poor communication or lack of improvement.
Evidence & Outcomes: The baseline issue was limited evidence of open communication after missed care. Measurable improvement included faster apology records and reduced repeat failures. Evidence sources include care records, audits, feedback and staff practice records.
Commissioner expectation
Commissioners expect providers to communicate openly when care falls short. They want evidence that people are informed, apologies are made and corrective actions are followed through.
They also expect candour evidence to connect with quality reporting where incidents affect safety, dignity or continuity. Strong records show transparency and leadership accountability.
Regulator / Inspector expectation
Inspectors expect duty of candour practice to be visible in records and culture. They may compare incident files, communication logs, complaints, safeguarding records and governance minutes.
Strong evidence shows honesty, apology and learning. Weak evidence appears when providers investigate internally but do not evidence open communication with people affected.
Conclusion
Evidencing duty of candour under the CQC assessment framework requires providers to show openness when things go wrong. Communication, apology and follow-up must be recorded clearly.
Governance strengthens this assurance. Incident reviews, candour logs, investigation files and action trackers help leaders confirm that people are informed and learning is completed.
Outcomes are evidenced through care records, audits, feedback and staff practice. These sources show whether people were supported, risks reduced and repeat failures prevented.
Consistency is maintained through candour screening, named responsibility, communication records and routine governance review. When embedded properly, duty of candour evidence supports inspection readiness, commissioner trust and transparent care delivery.