Safe · KLOE 2
Managing risks during care and treatment
Is care for each individual person planned and monitored to identify and manage risks, emergencies, and deterioration?
CQC wording, secondary and specialist hospital care draft v0.6, pages 5 to 7.
Draft, not the current assessment framework
CQC's secondary and specialist hospital care draft v0.6, published March 2026. The current quality statements remain in use.
CQC draft scope
What this proposed KLOE covers
Scope of this key line of enquiry and topic areas include:
- Managing deterioration and emergencies
- NEWS, MEWS and PEWS
- Clinical risk (including risk assessments)
- Clinical records
- Restrictive practice
- Managing periods of increased demand
- Virtual wards and remote care
How would this apply to your service?
The draft applies one framework across secondary and specialist hospital care, but useful evidence depends on your service and people.
Source: CQC, Hospitals (secondary and specialist care) assessment framework, draft v0.6, 19 March 2026, pages 5 to 7. Contains public sector information licensed under the Open Government Licence v3.0.
CQC draft rating characteristics
How the draft describes each rating
These are CQC's draft characteristics. CQC says rating characteristics guide judgements, they are not a mechanical checklist.
Outstanding
- The service is an exemplar in consistently applying person-centred care, where risks for each individual person are understood and managed.
- Staff work collaboratively within an exemplary culture to anticipate and expertly manage deterioration, emergencies and clinical risks safely. Identifying risk is proactive and continuous, using innovative and evidence-based approaches.
- For people with more than one condition or diagnosis, risk assessments are consistently co-produced and strengthened by timely input from all relevant specialist disciplines. This ensures that complex and overlapping needs are understood and managed with exceptional rigour and compassion.
- People, their families and carers are fully informed and enabled to take positive risks to maximise their control over their care and support. They are also actively involved in managing their own risks along with their families and carers.
- Staff actively seek out people’s concerns about the safety of their care. They listen to people, take appropriate steps to address the concern, and keep them fully informed throughout.
- The service proactively seeks out new and creative solutions to safely and effectively manage periods of increased demand.
- Where applicable, remote care is used in an innovative and creative way to minimise risks and promote person-centred care
- The service proactively seeks out new and creative solutions and best practice to ensure that people live with as few restrictions as possible and can provide evidence to support this. Where causes of deterioration lie elsewhere in the system, the service works with partners to resolve this.
Good
- Specific risks to an individual person are well understood, and each person’s care is monitored and assured.
- The service proactively identifies and manages deterioration, emergencies and clinical risks to reduce potential harm.
- The service takes a balanced and proportionate approach to risk that supports people and respects the choices they make about their care and treatment. Individual risk assessments are complete, up-to-date and proportionate.
- Where people have more than one condition, risk assessments are joined up.
- People, their families and carers are informed about and involved in the delivery and management of their care and individual treatments, including the potential risks and side effects.
- People, their families and carers feel listened to when they raise concerns about the safety of their care. Where applicable, arrangements are in place for people to escalate their concerns about deterioration and to seek a second opinion.
- The service has procedures to mitigate the risks associated with increased demand. These are implemented effectively to reduce risks to people’s care and treatment.
- People’s care plans and clinical records are accurate and kept-up-to date to allow the safe delivery of care and treatment. They reflect any foreseeable risks and how these should be managed.
- Where applicable, remote care is managed safely and effectively to minimise risks and reduce potential harm.
- The service only ever uses restrictive practices as a last resort and only where it is lawful and legitimate. It reports any use of restrictive practices and has a strategy to reduce their use.
Requires improvement
- Specific risks to individual people are only partially or not always understood, and people’s care is not always well-monitored and assured.
- Management of deterioration, emergencies and clinical risks to reduce risk of harm or exposure to the risk of harm may be inconsistent.
- Risk assessments exist but may not be proportionate and do not always fully take into account people’s choices. This may lead to unnecessary restrictions or gaps in safety.
- Where people have more than one condition or diagnosis, their risk assessments are not always joined up.
- People, their families and carers do not always feel listened to when they raise concerns about the safety of their care. Where applicable, arrangements are not always in place for people to escalate their concerns about deterioration and to seek a second opinion.
- Any procedures to mitigate the risks associated with increased demand are not always implemented effectively.
- People’s care plans and clinical records may be incomplete or generic and do not always cover foreseeable risks and how they should be managed. Where applicable, arrangements for remote care are not always managed safely and effectively to minimise risks and reduce potential harm.
- The approach to imposing restrictions on people is not always proportionate and there may be examples of inappropriate use of restraint. Staff may lack knowledge to consistently identify unlawful restrictive practice, and their skills (where necessary) in de-escalation techniques may be limited.
- Staff do not always work to avoid the need for restrictive practices. The service does not consistently report use of restrictive practices and there is limited strategy to reduce their use.
Inadequate
- Risks to individual people are not understood or are ignored, leaving people exposed to avoidable harm.
- Deterioration, emergencies and clinical risks are not well managed.
- The service does not mitigate risks effectively or appropriately. Individual risk assessments are not always in place. People’s choices about care and treatment are not listened to or taken into account.
- Where people have more than one condition or diagnosis, their risk assessments are not joined up.
- People, their families and carers do not feel listened to when they raise concerns about the safety of their care. Their voices are ignored or dismissed. Where applicable, there are no arrangements for people to escalate their concerns about deterioration and to seek a second opinion.
- There are no plans to mitigate the risks associated with periods of increased demand
- Care plans and clinical records are missing, incomplete or inaccurate and do not predict foreseeable risks.
- Where applicable, arrangements for remote care are not managed safely and effectively to minimise risks and reduce potential harm.
- The approach to imposing restrictions on people is disproportionate. Restraint is used in place of other more appropriate options. Staff lack knowledge to identify unlawful restrictive practice and do not have skills (where necessary) in de-escalation techniques.
- Staff do not work to avoid the need for restrictive practices. The service does not report use of restrictive practices and there is no strategy to reduce their use.
Want to know how your service would fare?
Book a mock inspection run against the draft KLOEs, or call 020 8090 5346 to speak to one of our experts.