KLOE stands for key line of enquiry. For nearly a decade, KLOEs were how the Care Quality Commission asked its questions: a numbered set of enquiries sitting under each of the five key questions, with prompts underneath and a description of what each rating looked like. If you managed a care home between 2015 and 2023, you built your audits around them. They are gone. CQC replaced the key lines of enquiry with quality statements under the single assessment framework, and the numbering you memorised no longer exists. This guide explains what the KLOEs were, why they were replaced, what replaced them, and how each old KLOE maps onto the new quality statements, so you can update your audit tools without starting again.
The short answer
KLOEs were the key lines of enquiry CQC used from 2015 until the single assessment framework replaced them. In adult social care there were around two dozen, numbered S1 to S6 under safe, E1 to E7 under effective, C1 to C3 under caring, R1 to R3 under responsive and W1 to W5 under well-led. Each KLOE was a question, each had prompts, and each had ratings characteristics describing outstanding, good, requires improvement and inadequate. They were replaced by 34 quality statements written in the first person, such as "we work with people to understand what being safe means to them". The five key questions did not change, the evidence CQC wants has barely changed, and almost every KLOE has a direct descendant among the quality statements. If your policies and audits still say KLOE, they are not wrong in substance but they are out of date in language, and inspectors now expect you to talk about quality statements and evidence categories.
What does KLOE stand for?
Key line of enquiry. The plural is usually written KLOEs, sometimes KLoEs. A key line of enquiry was a question CQC committed to asking of every provider of a given type, published in advance, so that inspection was consistent between inspectors and predictable for providers. The publication was called the key lines of enquiry, prompts and ratings characteristics, and there was a separate version for each sector: adult social care, hospitals, GP practices and so on.
The idea was simple and, for its time, radical. Before 2014, providers could not reliably predict what an inspector would ask. The KLOE document told you, in advance, the questions and roughly what a good answer looked like.
Where the KLOEs came from
CQC introduced the five key questions in 2013 and 2014 under a new inspection model, following the Francis report into Mid Staffordshire. Ratings returned, specialist inspectors were appointed, and the key lines of enquiry were published so that judgements were made against a stated framework rather than an inspector's preference.
The KLOEs were revised in 2017, with a slimmed-down set and a stronger focus on well-led, and that 2017 and 2018 edition is the one most managers remember. It ran until the single assessment framework began replacing it from late 2023.
The anatomy of a KLOE
Each KLOE had three parts, and confusing them is why some managers found the system heavy going.
- The key line of enquiry itself. A single question, for example S4: how are people's medicines managed so that they receive them safely?
- The prompts. A list of sub-questions the inspector might use, for example whether medicines are stored and disposed of safely, whether staff are trained and competent, and whether the person is supported to be as independent as possible with their medicines.
- The ratings characteristics. A description of what outstanding, good, requires improvement and inadequate looked like for that key question, written as paragraphs rather than scores.
The prompts were guidance, not a checklist, though almost every provider treated them as a checklist and built audit tools that worked through them one by one.
The adult social care KLOEs in full
This is the set most care home managers worked to. Numbering varied slightly between editions and sectors, so treat this as the practical list rather than a legal text.
Safe
- S1: how do systems, processes and practices safeguard people from abuse?
- S2: how are risks to people assessed and their safety monitored and managed, so they are supported to stay safe and their freedom is respected?
- S3: how does the service make sure that there are sufficient numbers of suitable staff to support people to stay safe and meet their needs?
- S4: how are people's medicines managed so that they receive them safely?
- S5: how well are people protected by the prevention and control of infection?
- S6: are lessons learned and improvements made when things go wrong?
Effective
- E1: are people's needs and choices assessed and care delivered in line with current legislation, standards and evidence-based guidance?
- E2: how does the service support staff to carry out their roles effectively?
- E3: how are people supported to eat and drink enough to maintain a balanced diet?
- E4: how well do staff, teams and services work together to deliver effective care and support?
- E5: how are people supported to live healthier lives and access healthcare services?
- E6: how are people's individual needs met by the adaptation, design and decoration of premises?
- E7: is consent to care sought in line with legislation and guidance, including the Mental Capacity Act?
Caring
- C1: how does the service ensure that people are treated with kindness, respect and compassion, and given emotional support when needed?
- C2: how does the service support people to express their views and be involved in decisions about their care?
- C3: how are people's privacy, dignity and independence respected and promoted?
Responsive
- R1: how do people receive personalised care that is responsive to their needs?
- R2: how does the service listen and learn from people's experiences, concerns and complaints?
- R3: how does the service support people at the end of their life to have a comfortable, dignified and pain-free death?
Well-led
- W1: is there a clear vision and credible strategy, and a positive culture that is person-centred, open, inclusive and empowering?
- W2: does the governance framework make responsibilities clear and ensure quality, risk and regulatory requirements are understood and managed?
- W3: how does the service engage and involve people, the public and staff, considering their equality characteristics?
- W4: how does the service continuously learn, improve, innovate and ensure sustainable care?
- W5: how does the service work in partnership with other agencies?
Why CQC replaced the key lines of enquiry
Three reasons, and it helps to understand them because they explain what the new framework is trying to do.
First, the KLOEs were different for every sector, so a care home, a GP practice and a hospital were assessed against different questions with different numbering. CQC wanted one framework for everyone it regulates.
Second, KLOEs were tied to the inspection visit. A rating came from a visit and then sat unchanged for years, sometimes many years, while the service changed. CQC wanted to gather evidence continuously and update judgements without always needing a full inspection.
Third, the ratings characteristics were narrative, which made judgements hard to compare and hard to explain. CQC wanted numerical scoring so that a provider could see exactly where it fell short.
What replaced KLOEs: the single assessment framework
The single assessment framework keeps the five key questions and replaces the KLOEs with 34 quality statements. Each statement is a short sentence written from the provider's point of view, such as "we make sure there are enough qualified, skilled and experienced staff". Each is assessed using six evidence categories and scored from 1 to 4. The scores roll up into a percentage for each key question, and the percentage determines the rating.
Roll-out began in late 2023 and was paused and revised after independent reviews in 2024 found problems with how CQC was operating it, so the detail of scheduling, scoring and how often assessments happen has continued to change. The structure of five key questions and quality statements has not. A full walkthrough is in the guide to the single assessment framework and quality statements.
The 34 quality statements at a glance
| Key question | Number | Quality statements |
|---|---|---|
| Safe | 8 | Learning culture; safe systems, pathways and transitions; safeguarding; involving people to manage risks; safe environments; safe and effective staffing; infection prevention and control; medicines optimisation |
| Effective | 6 | Assessing needs; delivering evidence-based care and treatment; how staff, teams and services work together; supporting people to live healthier lives; monitoring and improving outcomes; consent to care and treatment |
| Caring | 5 | Kindness, compassion and dignity; treating people as individuals; independence, choice and control; responding to people's immediate needs; workforce wellbeing and enablement |
| Responsive | 7 | Person-centred care; care provision, integration and continuity; providing information; listening to and involving people; equity in access; equity in experiences and outcomes; planning for the future |
| Well-led | 8 | Shared direction and culture; capable, compassionate and inclusive leaders; freedom to speak up; workforce equality, diversity and inclusion; governance, management and sustainability; partnerships and communities; learning, improvement and innovation; environmental sustainability |
KLOE to quality statement: the mapping
This is the table most managers need. It takes each old key line of enquiry and shows where its content now sits. A few KLOEs split across two statements and a few statements have no KLOE ancestor at all, which tells you where CQC has raised its expectations.
| Old KLOE | Now covered by | What changed in emphasis |
|---|---|---|
| S1 Safeguarding from abuse | Safeguarding | Stronger focus on people understanding what being safe means to them, and on closed cultures |
| S2 Risks assessed and safety managed | Involving people to manage risks; safe environments | Risk must be managed with the person, not for them; positive risk-taking is expected |
| S3 Sufficient numbers of suitable staff | Safe and effective staffing | Now covers recruitment, deployment, training and competence in one statement |
| S4 Medicines managed safely | Medicines optimisation | Optimisation, not just administration: outcomes, reviews and reducing unnecessary medicines |
| S5 Prevention and control of infection | Infection prevention and control | Largely unchanged, with visiting and the balance against wellbeing added |
| S6 Lessons learned when things go wrong | Learning culture | Broader: openness, duty of candour, and whether learning actually changes practice |
| No direct equivalent | Safe systems, pathways and transitions | New emphasis on admissions, discharges and moving between services |
| E1 Needs assessed, evidence-based care | Assessing needs; delivering evidence-based care and treatment | Split into two, with assessment and delivery scored separately |
| E2 Staff supported to carry out their roles | Safe and effective staffing (safe); workforce wellbeing and enablement (caring) | Staff support has moved partly into caring, which surprises people |
| E3 Eating and drinking enough | Supporting people to live healthier lives; assessing needs | Nutrition is now part of health and wellbeing rather than a standalone enquiry |
| E4 Staff, teams and services working together | How staff, teams and services work together | Almost word for word the same |
| E5 Healthier lives and access to healthcare | Supporting people to live healthier lives | Stronger expectation on annual health checks and health inequalities |
| E6 Premises adapted and designed for needs | Safe environments | Moved from effective into safe |
| E7 Consent and the Mental Capacity Act | Consent to care and treatment | Unchanged in substance, still one of the weakest areas in care homes |
| No direct equivalent | Monitoring and improving outcomes | New: what difference your care actually makes, measured |
| C1 Kindness, respect and compassion | Kindness, compassion and dignity | Unchanged |
| C2 People involved in decisions | Independence, choice and control; listening to and involving people | Split between caring and responsive |
| C3 Privacy, dignity and independence | Treating people as individuals; independence, choice and control | Individuality given its own statement |
| No direct equivalent | Responding to people's immediate needs | New: whether staff notice and act on distress, pain and discomfort in the moment |
| R1 Personalised, responsive care | Person-centred care; care provision, integration and continuity | Continuity of care is now scored in its own right |
| R2 Listening and learning from complaints | Listening to and involving people | Complaints now sit with feedback and involvement, not as a separate enquiry |
| R3 End of life care | Planning for the future | Broader than end of life: advance planning of all kinds |
| No direct equivalent | Providing information; equity in access; equity in experiences and outcomes | New: accessible information and health inequalities are scored directly |
| W1 Vision, strategy and culture | Shared direction and culture; capable, compassionate and inclusive leaders | Split into culture and leadership capability |
| W2 Governance framework | Governance, management and sustainability | Financial and workforce sustainability added |
| W3 Engaging and involving people and staff | Freedom to speak up; workforce equality, diversity and inclusion | Speaking up and staff equality each scored separately |
| W4 Continuous learning and improvement | Learning, improvement and innovation | Unchanged in substance |
| W5 Working in partnership | Partnerships and communities | Extends to the local community, not just other agencies |
| No direct equivalent | Environmental sustainability | Entirely new for most care homes and commonly overlooked |
What genuinely changed
Four things are different in practice. Assessment is continuous rather than event-based, so notifications, complaints, local authority information and what families tell CQC all feed the evidence base between visits. Scoring is explicit, so you can see which statement dropped you into requires improvement. Some quality statements have no KLOE ancestor, and those are where most homes are weakest: safe systems and transitions, monitoring outcomes, equity of access and experience, providing accessible information, and environmental sustainability. And the language moved from third person to first person, which is not cosmetic: the statements describe what you say you do, so the assessment becomes a test of whether that claim is true.
What did not change
The five key questions are the same. The regulations are the same, because the fundamental standards sit in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and were never part of the KLOE framework. The four ratings are the same. And the evidence an inspector asks a care home for is very largely the same: care plans, risk assessments, MAR charts, training records, audits, complaints, safeguarding referrals, notifications and what people and staff say. If you had good evidence against the KLOEs, you have good evidence now. The guide to the fundamental standards covers the regulations that sit underneath all of it.
From sources of evidence to evidence categories
Under the KLOEs, inspectors gathered whatever evidence they judged relevant. Under the single assessment framework there are six named evidence categories, and for adult social care CQC uses the ones that apply to the statement being assessed.
- People's experience of health and care services: what residents and families say, surveys, complaints and compliments
- Feedback from staff and leaders: what your team says, including through speaking-up routes
- Feedback from partners: the local authority, the integrated care board, GPs, district nurses, commissioners
- Observation: what an inspector sees in the home, including mealtimes and interactions
- Processes: your policies, care plans, risk assessments, audits and records
- Outcomes of care: what actually happened for people as a result
Two of these are outside your direct control, which is the point. A home that is excellent on paper and poor in the lounge scores badly. The evidence inspectors ask for under each key question goes through this statement by statement.
Scoring: what replaced the ratings characteristics
Each quality statement is scored from 1 to 4. Roughly, 4 means evidence shows an exceptional standard, 3 means a good standard, 2 means shortfalls, and 1 means significant shortfalls. The scores for the statements assessed under a key question are converted to a percentage, and the percentage falls into a band that gives the rating for that key question.
The practical effect is that one weak statement no longer sinks a whole key question in the way a narrative judgement sometimes did, but two or three weak statements will. It also means you can do the arithmetic yourself, which is the basis of a decent self-assessment.
Why your policies still say KLOE
Most care home policy suites were written or last reviewed when KLOEs were current, and policy templates bought from a supplier often still carry the old numbering. Audit tools are worse, because managers built them locally and they are rarely reviewed.
This matters less than people fear and more than they think. An inspector will not fail you for the word KLOE in a document footer. But an audit tool structured around S1 to W5 will systematically miss the statements that have no KLOE ancestor, and those are exactly the ones where homes are scoring 2.
Updating your audit tools: a practical method
- List every audit you currently run and what it covers.
- Tag each audit against the quality statements it produces evidence for, using the mapping table above.
- Find the statements with no audit against them. In most homes that is safe systems and transitions, monitoring outcomes, equity in access and experience, providing information, and environmental sustainability.
- Decide for each gap whether you need a new audit or whether existing records already hold the evidence and nobody is pulling it together.
- Rewrite the headings of your audit tools in quality statement language, keeping the questions that still work.
- Add a scoring column of 1 to 4 to each audit so your internal language matches CQC's.
- Put the whole thing into a quarterly cycle rather than doing it once.
A worked example: Priya's medicines audit
Priya is a deputy manager in a 42-bed nursing home. Her medicines audit was built around S4 and its prompts: storage, temperature, administration, records, controlled drugs, disposal, training. It is a good audit and it took her two years to refine.
She keeps all of it and adds three things. First, outcomes: how many residents had a medicines review in the last twelve months, and what changed as a result. Second, involvement: which residents self-administer, who was asked, and what the risk assessment says. Third, a 1 to 4 score with a sentence of justification. The audit is now evidence for medicines optimisation, involving people to manage risks and monitoring and improving outcomes, rather than just for S4. It took her an afternoon.
A worked example: Marcus and the statements nobody audits
Marcus manages a six-bed learning disability service. He scores himself honestly against all 34 statements and finds four he cannot evidence at all. He has no record of how people move between his service and hospital, no measured outcomes beyond incident counts, nothing in an accessible format for two residents who use symbols, and nothing at all on environmental sustainability.
He fixes three of them in a month: a one-page transition record for every hospital admission and discharge, an easy-read version of the complaints process and the weekly menu, and a simple outcomes measure for each resident's goals reviewed monthly. Sustainability takes longer, but writing down what the service already does, from food waste to travel, gets him from nothing to something defensible.
Self-assessment against quality statements
Do it quarterly, with the deputy and a senior carer in the room so you are not marking your own homework alone. Take each statement, ask what evidence exists, score it 1 to 4, and write one line of justification and one action where the score is below 3.
Be honest. A self-assessment where everything is a 3 is useless, and an inspector who sees it will trust nothing else you show them. The homes that do best are the ones that can say, unprompted, which two statements are their weakest and what they are doing about them.
What an inspector asks now
You will not be asked about KLOEs. You will be asked things like: how do you know people feel safe here? Show me how this person was involved in the decision about their bedrail. What outcomes have improved for people in the last six months, and how do you know? Who has raised a concern with you in the last year and what happened? How do you make information accessible to the person in room 4 who does not read?
These are quality statement questions, and the answer is always a specific example with a record behind it. Generalities score 2. The article on preparing for a CQC inspection sets out how to have that evidence ready.
What happens to your old KLOE-based rating
Ratings given under the old framework remain published until a new assessment replaces them. That means many homes still display a rating produced against KLOEs, and some of those ratings are years old. If yours is out of date and you have improved, you can ask CQC about a reassessment, and you should also make sure your own evidence shows the improvement clearly. The guide on what to do after a requires improvement rating covers that process, and how to read a CQC report helps you see what an older KLOE-era report was actually saying.
KLOEs outside England
CQC regulates in England only. If you run services in Wales, Scotland or Northern Ireland, the key lines of enquiry never applied to you. Care Inspectorate Wales works to the regulations and national minimum standards under the Regulation and Inspection of Social Care (Wales) Act 2016, the Care Inspectorate in Scotland uses the Health and Social Care Standards and its own quality framework with six-point grades, and RQIA in Northern Ireland inspects against its own standards. Providers operating across borders need separate evidence structures, and mapping one to another is a real piece of work rather than a renaming exercise.
The reviews of 2024 and what may change next
Two independent reviews in 2024 were critical of how CQC had implemented the single assessment framework, particularly its IT platform, the loss of sector expertise among inspectors, and the lack of transparency in scoring. CQC accepted the findings and has been making changes, including increasing inspection activity and revisiting how scores are produced and published.
The lesson for managers is not to build your quality system around a regulator's current paperwork. Build it around whether people are safe, well cared for and getting what they want from life, keep the evidence in a form you can produce quickly, and relabel it when the regulator relabels its framework. Homes that did that in 2023 found the change from KLOEs to quality statements took a week. Homes that had built everything around KLOE numbering found it took months.
Talking to staff without the old language
Care staff never really used KLOE numbers, and that is an advantage. Teach the five key questions, because they are memorable and unchanged, and teach a handful of quality statements that apply to their work in plain terms: we learn when things go wrong, we involve people in decisions about risk, we treat people as individuals, we make sure people can speak up.
What an inspector wants from a care worker is not framework knowledge. It is a specific answer to a specific question about a real resident. A worker who can explain why Jordan has a lap belt, who agreed it, when it was reviewed and what was tried first is producing better evidence than any policy.
A 90-day plan to move off KLOEs
- Weeks 1 to 2. Print the 34 quality statements. Score yourself 1 to 4 against each with your deputy, honestly, and note what evidence you used.
- Weeks 3 to 4. Map your existing audits and records to statements. Identify statements with no evidence source.
- Weeks 5 to 8. Fix the gaps that can be fixed with existing records: transitions, accessible information, outcomes, speaking up.
- Weeks 9 to 10. Rewrite audit headings and add 1 to 4 scoring. Retire KLOE numbering from your documents.
- Weeks 11 to 12. Gather feedback from residents, families, staff and partners, because two evidence categories depend on it and you cannot produce it on the day.
- Ongoing. Repeat the self-assessment quarterly and take the lowest two statements to your governance meeting each time.
Where your records do the work
Most of the evidence for the quality statements is already in your daily records, care plans, incidents, medicines records, audits and training log. The difficulty is pulling it together by statement rather than by folder. A care management system that tags records to quality statements, as Kiwi does through its compliance and evidence reporting, turns a two-day exercise into a report. The system is not the evidence, though. The practice is.
Common mistakes
- Renaming without rethinking. Changing the heading from S4 to medicines optimisation while auditing exactly the same things misses the outcomes element entirely.
- Ignoring the new statements. Transitions, outcomes, equity and sustainability have no KLOE ancestor and are where homes lose marks.
- Waiting for an inspection to self-assess. Assessment is continuous now, so your evidence has to be too.
- Scoring yourself 3 everywhere. It signals either dishonesty or a lack of insight, and insight is what well-led is measuring.
- Forgetting the feedback categories. Partner and staff feedback cannot be produced retrospectively.
- Still teaching KLOEs in induction. New staff should learn the current framework, not the historic one.
Final conclusion
Key lines of enquiry did a useful job for nearly a decade, and they are finished. The five key questions survive, the regulations survive, and almost every KLOE has a direct descendant among the 34 quality statements, so the work you did against the old framework is not wasted. What you need to do is map your audits across, find the handful of statements that have no KLOE ancestor and no evidence in your home, score yourself honestly against all 34 each quarter, and drop the old numbering from your paperwork so your team learns the current language. Do that and the next framework change, whenever it comes, will be a relabelling exercise rather than a crisis. If you want to see how records, audits and evidence map to quality statements in one place, book a demo.
Frequently asked
What does KLOE stand for?
KLOE stands for key line of enquiry. Key lines of enquiry were the numbered questions the Care Quality Commission used under each of the five key questions from around 2015 until the single assessment framework replaced them, published alongside prompts and ratings characteristics so providers knew what would be asked.
Are KLOEs still used by CQC?
No. CQC replaced the key lines of enquiry with 34 quality statements under the single assessment framework, which began rolling out in late 2023. The five key questions of safe, effective, caring, responsive and well-led remain, but the KLOE numbering no longer exists and inspectors do not refer to it.
How many KLOEs were there in adult social care?
Around two dozen in the edition most managers used: six under safe, seven under effective, three under caring, three under responsive and five under well-led. Each had prompts underneath it and a set of ratings characteristics describing what outstanding, good, requires improvement and inadequate looked like.
What replaced the KLOEs?
Quality statements. There are 34 of them, written in the first person as commitments such as we make sure there are enough qualified, skilled and experienced staff. Each is assessed using up to six evidence categories and scored from 1 to 4, and those scores produce the key question ratings.
Do I need to rewrite my KLOE-based audits?
You need to remap them rather than rewrite them. Most KLOE content survives inside a quality statement, so keep the questions that still work, change the headings, add a 1 to 4 score, and then build something new for the statements that have no KLOE ancestor, such as safe systems and transitions, monitoring outcomes, equity and environmental sustainability.
Which quality statements have no old KLOE equivalent?
Safe systems, pathways and transitions; monitoring and improving outcomes; responding to people's immediate needs; providing information; equity in access; equity in experiences and outcomes; and environmental sustainability. These are the areas where care homes most often have no evidence at all, because nothing in the old framework prompted them to collect it.
Will my old KLOE-era rating still be published?
Yes. Ratings awarded under the previous framework stay published until a new assessment replaces them, so many homes still display a rating produced against key lines of enquiry. If your rating is out of date and your service has improved, raise it with your inspector and make sure your own evidence shows the improvement clearly.
Did KLOEs apply in Wales, Scotland and Northern Ireland?
No. CQC regulates in England only. Care Inspectorate Wales, the Care Inspectorate in Scotland and RQIA in Northern Ireland each use their own standards and grading systems, so providers operating across more than one nation need separate evidence structures rather than a renamed version of the same one.
Sources
- Care Quality Commission: single assessment framework and quality statements
- Care Quality Commission: key lines of enquiry, prompts and ratings characteristics for adult social care (withdrawn)
- Care Quality Commission: evidence categories and scoring under the single assessment framework
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014
- Health and Social Care Act 2008, and the Care Quality Commission (Registration) Regulations 2009
- Department of Health and Social Care: independent review of the Care Quality Commission by Dr Penny Dash, 2024
- Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry (Francis report), 2013
- Care Inspectorate Wales, Care Inspectorate Scotland and RQIA inspection frameworks
