CQC Regulation 18: staffing

The rule: Regulation 18 in full

Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 is headed “Staffing”, and every provider registered with the Care Quality Commission (CQC) in England must meet it, whether it runs a residential care home, a domiciliary care agency providing personal care, a supported living service, a mental health service, a GP practice or a hospital. The full text, from Regulation 18 on legislation.gov.uk, is short:

• 18(1): “Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed in order to meet the requirements of this Part.”
• 18(2): “Persons employed by the service provider in the provision of a regulated activity must– (a) receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform, (b) be enabled where appropriate to obtain further qualifications appropriate to the work they perform, and (c) where such persons are health care professionals, social workers or other professionals registered with a health care or social care regulator, be enabled to provide evidence to the regulator in question demonstrating, where it is possible to do so, that they continue to meet the professional standards which are a condition of their ability to practise or a requirement of their role.”

So there are three parts: enough of the right people, deployed (18(1)); the support and development those people receive (18(2)(a) and (b)); and keeping professionals' registration live (18(2)(c)). CQC reads “this Part” as all the other regulatory requirements in that part of the Regulations, so Regulation 18 is the standard that makes the rest possible. The text has been unchanged since 1 April 2015. The Regulations are made under the Health and Social Care Act 2008, and regulation 3(3) says “an activity is only a regulated activity if it is carried on in England”; Wales, Scotland and Northern Ireland have their own regulators and rules.

CQC's page Regulation 18: Staffing (last updated 16 May 2025) explains each part and describes itself as “the guidance providers must have regard to”. Its summary of the intention is that providers “deploy enough suitably qualified, competent and experienced staff to enable them to meet all other regulatory requirements”, and it adds the words the regulation does not use: staff “to meet the needs of the people using the service at all times”. Under section 25 of the Health and Social Care Act 2008, that guidance is taken into account in CQC's decisions and in proceedings, although failing to follow it “does not of itself make a person liable to any criminal or civil proceedings”. Read the verbs: where this guide quotes “should”, the guidance says should; where it quotes “must”, it says must.

Enough of the right people, deployed: Regulation 18(1)

Regulation 18(1) requires “sufficient numbers” of staff and sets no ratio. Neither the regulation nor CQC's guidance on it gives a number of staff per resident, a minimum for night shifts or a dependency tool to use. What CQC's guidance asks for instead is a method:

• “Providers should have a systematic approach to determine the number of staff and range of skills required in order to meet the needs of people using the service and keep them safe at all times.” The approach “must reflect current legislation and guidance where it is available”.
• In working out numbers and skills, providers “should consider the different levels of skills and competence required to meet those needs, the registered professional and support workers needed, supervision needs and leadership requirements”.
• “Staffing levels and skill mix must be reviewed continuously and adapted to respond to the changing needs and circumstances of people using the service.”
• “There should be procedures to follow in an emergency that make sure sufficient and suitable people are deployed to cover both the emergency and the routine work of the service.”

Readers looking for a ratio will not find one in professional guidance either. CQC's Safe and effective staffing quality statement lists the Nursing and Midwifery Council's “Safe staffing guidelines” and the Royal College of Nursing's “Staffing Levels” as best practice guidance it expects providers “to be aware of and follow” under staffing levels and skills mix, and neither sets a staff-to-resident ratio. They inform the systematic approach; they do not replace it.

In practice, the evidence for 18(1) that a provider can put in front of an inspector is rarely one document. It is usually a needs or dependency assessment that explains how the numbers were reached, the planned rota set beside what actually happened, how much bank and agency cover was used and why, the skill mix on each shift (who could give medicines, who was trained to use the hoist, who was in charge), and what happened when a gap opened at short notice: who noticed, who was called, who came, and what the people on shift were told. The last of those is where the “procedures to follow in an emergency” are tested, and it is the part least often written down.

When staffing becomes a threat to the service itself, a second duty applies. Registration Regulation 18(2)(g) makes notifiable “any event which prevents, or appears to the service provider to be likely to threaten to prevent, the service provider's ability to continue to carry on the regulated activity safely”, including “(i) an insufficient number of suitably qualified, skilled and experienced persons being employed for the purposes of carrying on the regulated activity”. That notification goes to CQC “without delay”.

Support, training, supervision and appraisal: Regulation 18(2)(a)

Regulation 18(2) applies to “persons employed”, and the Regulations define employment widely. Regulation 2 includes employment under a contract of service, an apprenticeship, a contract for services or “otherwise than under a contract”, which covers a shared lives agreement, an agreement with a temporary work agency “for the supply of an agency worker”, and “arrangements for persons to provide their services voluntarily”. Agency workers and volunteers are within Regulation 18(2), so their induction, training and supervision are the provider's responsibility too.

CQC's guidance on 18(2)(a) sets out what that support looks like:

• Providers “must ensure that they have an induction programme that prepares staff for their role”.
• Training, learning and development needs “must be carried out at the start of employment and reviewed at appropriate intervals during the course of employment”.
• “Where appropriate, staff must be supervised until they can demonstrate required/acceptable levels of competence to carry out their role unsupervised”, and staff “should receive appropriate ongoing or periodic supervision in their role to make sure competence is maintained”.
• Providers “must ensure that all staff receive training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role”.
• Staff should be supported to take part in “Statutory training”, “Other mandatory training, as defined by the provider for their role”, any additional training needed to carry out regulated activities, and other learning and development, which “includes first aid training for people working in the adult social care sector”.
• “All learning and development and required training completed should be monitored and appropriate action taken quickly when training requirements are not being met.”
• Staff “should receive regular appraisal of their performance in their role from an appropriately skilled and experienced person”, and health, social and other care professionals “must have access to clinical or professional supervision as required”.

Three things follow for anyone searching for CQC's mandatory training list. First, there is no single list from CQC: “mandatory” training is “as defined by the provider for their role”, and Regulation 18 itself names no course. Second, “statutory training” means training other laws require, such as health and safety training under regulation 13 of the Management of Health and Safety at Work Regulations 1999 and fire safety training under article 21 of the Regulatory Reform (Fire Safety) Order 2005. Third, one topic is read into Regulation 18 by statute: section 181 of the Health and Care Act 2022, in force from 1 July 2022, requires the regulations to oblige providers to ensure each person working for them “receives training on learning disability and autism which is appropriate to the person's role”, and until the first such regulations come into force, the 2014 Regulations are to be read “as if regulation 18 of the 2014 regulations contained such requirements”. The Oliver McGowan code of practice sets the standards that training must meet in content and delivery, and “became final on 6 September 2025”.

The evidence for 18(2) is usually the induction record for each new starter, the training matrix with its completion dates and the audits of it, supervision and appraisal notes, and what was done when someone fell behind, since CQC's guidance expects training to be “monitored and appropriate action taken quickly when training requirements are not being met”. The regulation says “appraisal” and “supervision”, and CQC's guidance says “regular appraisal” and “ongoing or periodic supervision”; neither sets a frequency in law. The topics most providers treat as mandatory, with refresher periods and how to keep the training records, are in the care home training matrix guide; how often to supervise and what the notes should contain is in the supervision records guide.

Qualifications, professional registration and where Regulation 19 begins

Regulation 18(2)(b) and (c) are about careers as well as compliance. CQC's guidance says providers “must not act in a way that prevents or limits staff from obtaining further qualifications that are appropriate to their role”, and “must support staff to obtain appropriate further qualifications that would enable them to continue to perform their role”. Where registration with a professional body is a requirement of the role – a registered nurse, a social worker, an occupational therapist – providers “must make sure that staff are able to meet the requirements of the relevant professional regulator throughout their employment, such as requirements for continuing professional development”. Staff “should be supported to join Accredited Voluntary Registers if they wish”, and providers “must have appropriate systems in place to support this, such as revalidation and meeting codes of practice”.

Regulation 18 is often confused with the staffing rule next to it. Regulation 19, fit and proper persons employed, is about who is recruited and kept on; Regulation 18 is about how many people are deployed and how they are trained and supported. Side by side with the governance rule:

• Regulation 17, good governance: the systems that assess, monitor and improve quality and safety, and the records that show it. Training and staffing oversight is governance evidence; see the Regulation 17 guide.
• Regulation 18, staffing: sufficient numbers and skill mix, deployed when and where they are needed; induction, training, supervision, appraisal, further qualifications and professional registration kept current.
• Regulation 19, fit and proper persons employed: staff must “be of good character”, have “the qualifications, competence, skills and experience which are necessary for the work”, and be able, after reasonable adjustments, to do the work by reason of their health; “recruitment procedures must be established and operated effectively” to ensure it; staff must hold any professional registration the law requires; and where someone no longer meets the criteria, the registered person must take “such action as is necessary and proportionate” and, for a registered professional, inform their regulator. Since 15 January 2024, regulation 19(3A) has said that unless regulation 4, 6 or 7 applies, the full employment history in paragraph 7 of Schedule 3 is not required for a volunteer.

The two meet at the point where a training or supervision record shows someone is not competent. Regulation 18 asks what support they received and whether it was enough; Regulation 19 asks what the provider did once it was clear they could not do the job.

How CQC assesses and enforces Regulation 18

A breach of Regulation 18 is not a criminal offence. Regulation 22 lists the fundamental standards whose breach is an offence – regulations 11, 16(3), 17(3), 20(2)(a) and (3) and 20A, and regulations 12, 13(1) to (4) and 14 where the failure results in avoidable harm, a significant risk of it, or a loss of money or property – and Regulation 18 is not among them. CQC's guidance says: “CQC cannot prosecute for a breach of this regulation or any of its parts, but we can take regulatory action.” It also says “CQC must refuse registration if providers cannot satisfy us that they can and will continue to comply with this regulation.”

The regulatory action follows CQC's enforcement policy (last updated 25 June 2026). To require improvement, CQC uses “Action Plan requests (previously called Requirement Notices)”, Warning Notices and, for NHS trusts and foundation trusts, Section 29A Warning Notices. An Action Plan request “does not constitute an enforcement action”, but “failure to send us the requested report within a set timescale is an offence”. To force improvement, it can impose, vary or remove conditions of registration, suspend or cancel registration, use urgent procedures, or apply special measures, which are “usually triggered by ratings of inadequate care, rather than by individual breaches of regulations”. Breaking a condition imposed for a staffing breach is itself an offence, even where the breach that led to the condition was not.

Two further routes reach prosecution. CQC's offences page says that where the evidence about a regulation it cannot prosecute “also demonstrates a breach of another regulation that is identified as an offence, then CQC may also decide to prosecute against the regulation for that other offence” – for example Regulation 12, safe care and treatment, where short staffing results in avoidable harm or a significant risk of it. And failing to make a Registration Regulation 18 notification is an offence under regulation 25 of the Registration Regulations: CQC's guidance on Registration Regulation 18 says it “can move directly to prosecution without first serving a warning notice”, and its penalties and fines page sets a fixed penalty for failing to make required notifications of £1,250 for a provider and £625 for a registered manager.

At an assessment or inspection, CQC currently looks at staffing under the Safe and effective staffing quality statement, part of its single assessment framework: “We make sure there are enough qualified, skilled and experienced people, who receive effective support, supervision and development. They work together effectively to provide safe care that meets people's individual needs.” Its subtopics are safe recruitment (including DBS), staffing levels and skills mix, skills and qualifications and revalidation, learning, development and competency, support and supervision, performance management, and volunteers and unpaid carers. It expects safe recruitment for “all staff, including agency staff and volunteers”.

That framework is due to change, but has not yet. In its initial response to the Better regulation, better care consultation (25 March 2026), CQC said its new frameworks will use “a set of new supporting key lines of enquiry” instead of quality statements, to “clearly indicate the areas we look at during assessments and inspections”, that it will “remove scoring”, and that it will “no longer make formal judgements below the level of our 5 key questions”. Its August 2026 update says it is still “testing and piloting our draft assessment frameworks across all sectors” and gives no date for the change. Regulation 18 itself is unaffected either way: the framework changes how CQC looks, not what the law requires.

The staffing decisions that are made by message

Most of the decisions Regulation 18 is judged on are not made in a rota system. A carer messages the senior at six in the morning to say she is ill. The senior posts the shift in the bank staff group and waits to see who answers. The registered manager decides at nine at night to book agency cover, and the nurse in charge messages the agency worker which residents need two staff to transfer and who to ask about medicines. A deputy confirms from the floor that a new starter has been observed using the hoist and can now do it unsupervised.

Those messages are the evidence of the “procedures to follow in an emergency”, of who was deployed and why, and of supervision until competence was shown. When CQC asks how last month's short-staffed night was covered, the honest answer is often in a WhatsApp group on the phones of the people who were there. An end-to-end-encrypted consumer app is built so that the provider cannot see or keep those messages, and when a senior leaves or changes phone, the trail goes with them.

ComplyChat provides channels for those work conversations, with everyone added told that the channel is on the record, and a mobile number verified by SMS as the identity, so bank, agency and night staff with no work account can be in the same channel as the manager. Messages are recorded on the server as they are sent, and on paid plans, once the provider's Microsoft 365 tenant is connected, conversations are kept there, under the retention schedules the provider already runs. ComplyChat does not do rostering, care planning or training management, and it does not keep the training matrix; those stay in the systems built for them.

A question for the next management meeting: for the last shift you covered at short notice, could you show an inspector who was asked, who said yes and what they were told when they arrived?

Questions people ask

What is regulation 18?

In care, Regulation 18 usually means the staffing fundamental standard in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: “Sufficient numbers of suitably qualified, competent, skilled and experienced persons must be deployed”, and staff must receive “appropriate support, training, professional development, supervision and appraisal”. A different Regulation 18, in the Care Quality Commission (Registration) Regulations 2009, requires providers to notify CQC “without delay” of incidents such as abuse or allegations of abuse, police incidents and events that threaten safe running.

What is regulation 19 according to CQC?

Regulation 19 is “Fit and proper persons employed”: staff must be of good character, have “the qualifications, competence, skills and experience which are necessary for the work”, and be able by reason of their health to do it, and “recruitment procedures must be established and operated effectively” to ensure that. Regulation 19 is about who you recruit and keep; Regulation 18 is about how many you deploy and how you train and support them.

Does CQC set staffing ratios for care homes?

No. Regulation 18 requires “sufficient numbers” and sets no ratio, and CQC's guidance asks for “a systematic approach to determine the number of staff and range of skills required”, with staffing levels and skill mix “reviewed continuously”.

What training is mandatory under CQC regulation 18?

Regulation 18 requires training “as is necessary to enable them to carry out the duties they are employed to perform” without listing topics. CQC's guidance asks providers to support “Statutory training” (training other laws require, such as health and safety and fire safety training), “Other mandatory training, as defined by the provider for their role”, and first aid training in adult social care. The one topic read into Regulation 18 by statute is learning disability and autism training, under section 181 of the Health and Care Act 2022.

Is breaching regulation 18 an offence?

No. Regulation 18 is not among the offences in Regulation 22, and CQC says it “cannot prosecute for a breach of this regulation or any of its parts, but we can take regulatory action”, from an Action Plan request and warning notices to conditions, suspension or cancellation of registration. CQC may still prosecute under another regulation, such as Regulation 12 where avoidable harm results, and failing to send a Registration Regulation 18 notification is a separate offence.

Does regulation 18 apply to agency staff and volunteers?

Yes. In the 2014 Regulations “employment” includes an agreement with a temporary work agency “for the supply of an agency worker” and “arrangements for persons to provide their services voluntarily”, so Regulation 18(2)'s training, supervision and support duties reach agency workers and volunteers. CQC's quality statement expects safe recruitment for “all staff, including agency staff and volunteers”.

Official guidance and your next step

The primary sources are Regulation 18 itself; CQC's guidance on Regulation 18, which is short enough to read in full and is the text providers must have regard to; and the Safe and effective staffing quality statement, which lists the best practice guidance behind it. For learning disability and autism training, read the Oliver McGowan code of practice. Quotations are from those pages as published on 21 October 2026.

This guide is a summary for providers in England, not legal advice about a particular assessment, inspection or enforcement action. The CQC fundamental standards guide sets Regulation 18 among the other regulations and the five key questions.

Then do one thing: pick the last three shifts that ran short or were covered at short notice, and for each write down how the gap was found, who filled it, whether they had the skills the shift needed, and where the record of that decision is now. If any answer is “on someone's phone”, that is the gap to close first.