CQC Regulation 9: person-centred care

The regulation: Regulation 9 in full

Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, headed Person-centred care, says in paragraph (1) that “the care and treatment of service users must” “(a) be appropriate, (b) meet their needs, and (c) reflect their preferences.” Paragraph (2) sets the first limit: paragraph (1) “does not apply to the extent that the provision of care or treatment would result in a breach of regulation 11”, the need for consent. Paragraph (3) then lists, “without limiting paragraph (1)”, the things a registered person must do to comply:

1. “carrying out, collaboratively with the relevant person, an assessment of the needs and preferences for care and treatment of the service user”
2. “designing care or treatment with a view to achieving service users’ preferences and ensuring their needs are met”
3. “enabling and supporting relevant persons to understand the care or treatment choices available to the service user and to discuss, with a competent health care professional or other competent person, the balance of risks and benefits involved in any particular course of treatment”
4. “enabling and supporting relevant persons to make, or participate in making, decisions relating to the service user’s care or treatment to the maximum extent possible”
5. “providing opportunities for relevant persons to manage the service user’s care or treatment”
6. “involving relevant persons in decisions relating to the way in which the regulated activity is carried on in so far as it relates to the service user’s care or treatment”
7. “providing relevant persons with the information they would reasonably need for the purposes of sub-paragraphs (c) to (f)”
8. “making reasonable adjustments to enable the service user to receive their care or treatment”
9. “where meeting a service user’s nutritional and hydration needs, having regard to the service user’s well-being”

Paragraphs (4) to (6) set the other limits. If the person is 16 or over and lacks capacity in relation to a matter, paragraphs (1) to (3) “are subject to any duty on the registered person under the 2005 Act”, the Mental Capacity Act 2005; and if Part 4 or 4A of the Mental Health Act 1983 applies, care and treatment “must be provided in accordance with the provisions of that Act”. The “relevant person” is defined in Regulation 2 as “the service user or, where the service user is under 16 and not competent to make a decision in relation to their care or treatment, a person lawfully acting on their behalf”. For adults, the relevant person is the person receiving care.

CQC’s guidance on Regulation 9 states the intention: “to make sure that people using a service have care or treatment that is personalised specifically for them”. On enforcement it says “CQC cannot prosecute for a breach of this regulation or any of its parts, but we can take regulatory action”, and that it “must refuse registration if providers cannot satisfy us that they can and will continue to comply with this regulation”. Regulation 9 applies to every regulated activity in England, from care homes and home care to hospitals and GP practices; this guide reads it for adult social care.

What Regulation 9 asks of a care service in practice

CQC’s guidance on 9(1) sets the standard: “Providers must do everything reasonably practicable to make sure that people who use the service receive person-centred care and treatment that is appropriate, meets their needs and reflects their personal preferences, whatever they might be.” Its summary of the regulation adds that providers “must work in partnership with the person”, and that the person, or someone lawfully acting on their behalf, “must be involved in the planning, management and review of their care and treatment”.

In a care home or home care service, the nine steps in paragraph (3) come down to a small number of things the service does for each person:

• Find out, with the person. An assessment before the service starts and as needs change, carried out with the person rather than about them, so that they are supported in planning their care from the first day (9(3)(a)).
• Plan around what they want. A care plan built to meet their needs and achieve their preferences, including the times they get up and go to bed, who helps them wash, what they eat, how they practise their faith and what they do with their day (9(3)(b)).
• Explain the choices. Information about the options and their risks, in a form the person understands, with someone competent to discuss them (9(3)(c) and (g)).
• Let them decide, and manage what they can. Support to make or take part in decisions “to the maximum extent possible”, and the chance to manage parts of their own care, such as their medicines or personal care, if they want to (9(3)(d) and (e)).
• Ask them about the service. Involving people in how the service is run in so far as it affects their care, and acting on their views (9(3)(f)).
• Adjust. Reasonable adjustments so the person can receive care, for example for sensory impairment, communication needs or a learning disability (9(3)(h)).
• Food and drink with well-being in mind, not only nutrition: CQC’s guidance says people “must have a choice that meets their needs and preferences as far as is reasonably practical”, and that providers must assess each person’s nutritional and hydration needs “to support their wellbeing and quality of life” (9(3)(i)).

Regulation 9 sits beside two neighbours. Regulation 10, dignity and respect, covers privacy, autonomy and independence, and Regulation 9A, added in 2024, covers visiting in care homes, hospitals and hospices. The fundamental standards guide sets out all fourteen.

Assessment, the care plan and the record

CQC’s guidance on 9(3)(a) is specific about the assessment. Each person, or someone lawfully acting on their behalf, “must be involved in an assessment of their needs and preferences as much or as little as they wish to be”. Assessments “must take into account current legislation and consider relevant nationally recognised evidence-based guidance”, should be carried out “by people with the required levels of skills and knowledge”, and “should include all their needs, including health, personal care, emotional, social, cultural, religious and spiritual needs”. They should also look for conditions that are common in particular groups and lead to poor outcomes if missed, such as “continence support needs and dementia in older people, and diabetes in certain ethnic groups”.

Assessment is not a one-off. The guidance says assessments “should be reviewed regularly and whenever needed throughout the person’s care and treatment”, including “when they transfer between services, use respite care or are re-admitted or discharged”, and that reviews “should make sure that people’s goals or plans are being met and are still relevant”. Where care is shared with other services, providers should take account of information from all relevant teams.

On the plan, the guidance on 9(3)(b) is the closest Regulation 9 comes to a checklist:

• “A clear care and/or treatment plan, which includes agreed goals, must be developed and made available to all staff and others involved in providing the care.”
• “Where relevant, the plan should include ways in which the person can maintain their independence.”
• “Plans should include an agreed review date.”
• “Staff providing care must be kept up to date with any changes to a person’s needs and preferences.”

And on the record, the guidance on 9(3)(d) makes the link to good governance explicit: “A record must be kept of all assessments, care and treatment plans, and decisions made by people who use the service and/or those acting on their behalf. See Regulation 17 (Good governance).” Regulation 17 requires an accurate, complete and contemporaneous record for each person, which the CQC record-keeping guide covers. The difference is that Regulation 9 says what the record must show: that the person was asked, what they said, what was decided with them, and that the care follows it. A care plan written fluently in the third person, with no trace of the person’s own words, is complete under Regulation 17 and weak evidence under Regulation 9.

When preferences cannot be met: consent, capacity and other people

Person-centred care does not mean every preference is met. CQC’s guidance on 9(3)(b) accepts that “there may be times when a person’s needs and preferences can not be met”, and sets out what must happen then: providers “must explain the impact of this to them and explore alternatives so that the person can make informed decisions”, and “when any preferences about the choice of care and treatment can not be met, providers must fully explain why”. The explanation “should show how the provider has considered the impact of this on the person”. When planning to meet one person’s preferences, providers should also take account of “any impact this may have on other people using the service”.

Consent comes first. The guidance on 9(2) says meeting needs “does not mean that care and treatment should be given if it would act against the consent of the person using the service”, and Regulation 11 governs consent itself. Where a person’s preferences may not meet their needs and they lack mental capacity or are detained, providers “must act in accordance with the Mental Capacity Act 2005 and/or the Mental Health Act 1983”.

Where a person lacks capacity to make a specific decision and no one has lawful authority to make it for them, the guidance says “their best interests must be established and acted on in accordance with the Mental Capacity Act 2005”, and “other forms of authority such as advance decisions must also be taken into account”. CQC’s summary adds that providers must make sure decisions are made by those with the legal authority to make them, and must work within the Mental Capacity Act, “which includes the duty to consult others such as carers, families and/or advocates where appropriate”. A family member’s view is part of that consultation; it becomes the decision only where the family member has the legal authority to make it. The mental capacity assessment records guide covers what to write down.

In practice the records that show this part of Regulation 9 working are the ones that explain a gap: the preference recorded, the reason it could not be met, the alternative offered, and the person’s response. They are also the records most often missing, because the conversation happened at the bedside or on the phone and nobody wrote the outcome down.

How CQC assesses person-centred care

Under CQC’s single assessment framework, Regulation 9 is the main regulation behind the person-centred care quality statement under the responsive key question, with Regulations 10, 11, 12 and 14 to “also consider”. The statement reads: “We make sure people are at the centre of their care and treatment choices and we decide, in partnership with them, how to respond to any relevant changes in their needs.” CQC says it means that “people’s care plans fully reflect their physical, mental, emotional and social needs, including those related to protected characteristics under the Equality Act”, and that people and those close to them “are regularly involved in planning and making shared decisions about their care and treatment”. Its subtopics are care planning, needs and preferences, and empowerment and decision making.

Regulation 9 is also behind the assessing needs quality statement under effective, alongside Regulation 12: “We maximise the effectiveness of people’s care and treatment by assessing and reviewing their health, care, wellbeing and communication needs with them.” That statement expects that “assessments are up-to-date and staff understand people’s current needs” and that “people’s care needs are routinely reviewed”. Each statement carries “I statements” written from the person’s side, such as “I am in control of planning my care and support. If I need help with this, people who know and care about me are involved.”

In March 2026, in its initial response to the Better regulation, better care consultation, CQC said it will replace its quality statements with key lines of enquiry and remove scoring. It is piloting the new approach from June to October 2026, and no date for it to take effect had been published when this guide was written; until then, CQC asks providers to keep using its current guidance, so the statements above are the ones it assesses against. Regulation 9 itself is unaffected. The evidence categories guide explains how inspectors gather and score evidence. For Regulation 9 the evidence usually includes:

• pre-admission or initial assessments showing who took part and what the person said they wanted
• care plans with agreed goals, the person’s preferences in their own words where possible, and a review date
• records of decisions the person made, choices explained to them, and preferences that could not be met with the reasons
• mental capacity assessments and best-interests decisions where they apply
• evidence of reasonable adjustments, such as accessible information or communication aids
• feedback from people and families, and what changed as a result: CQC’s guidance on 9(3)(f) says “providers must be able to demonstrate that they took action in response to any feedback”

Inspectors also test it directly, by talking to people and watching care. A plan that says a resident likes to sleep late is evidence only if, at nine in the morning, nobody is getting him up.

The preference that was said in a message

Much of what a service learns about a person’s preferences never arrives at an assessment meeting. It arrives as a message.

A daughter texts the unit lead on a Sunday: her father always hated being shaved by anyone but himself, and would much rather a man helped him with personal care. A home care client’s son messages the care co-ordinator that his mother has stopped wanting the early call because she sleeps badly. A carer posts in the staff group chat that the new resident in room 12 cried at lunch and said she has not had food from home since she arrived. Each of those is information Regulation 9 requires the service to act on, and CQC’s guidance on 9(3)(f) expects the service to be able to show it acted.

What usually happens is that someone reads the message, makes a mental note, and the care plan is updated later, or not at all. When an inspector, a family or a safeguarding enquiry asks when the service knew, the answer is on a personal phone, in an app the provider cannot open, belonging to a member of staff who may since have left.

ComplyChat gives those conversations a channel the provider owns. A mobile number verified by SMS is the identity, so families and bank staff without a work account can take part, everyone in a channel is told it is on the record, and messages are recorded on the server as they are sent. On paid plans the lasting record files into the provider’s own Microsoft 365 once the tenant is connected, under its own retention rules. It is not a care planning system and it does not update a care plan; it keeps the message that should have changed one.

A question for the next leadership or governance meeting: when a family tells this service something about a person’s wishes by message, how does it reach the care plan, and could we show that it did?

Questions people ask

What does CQC regulation 10 say?

Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 says “Service users must be treated with dignity and respect”, which includes ensuring their privacy, supporting their autonomy, independence and involvement in the community, and having due regard to protected characteristics under the Equality Act 2010. CQC lists Regulation 10 as one to “also consider” under the person-centred care quality statement, alongside Regulation 9.

What is the difference between Regulation 9 and Regulation 9A?

Regulation 9 is the general duty to provide person-centred care; Regulation 9A is a specific duty about visiting and accompanying in care homes, hospitals and hospices. Under Regulation 9A, unless there are exceptional circumstances, people staying in a care home “must be facilitated to receive visits” and “must not be discouraged from taking visits out of that care home”, and arrangements must have regard to the person’s care plan and involve relevant persons.

What are the 9 domains of care and support outlined in the Care Act 2014?

The nine are the areas of well-being in section 1 of the Care Act 2014: personal dignity; physical and mental health and emotional well-being; protection from abuse and neglect; control over day-to-day life; participation in work, education, training or recreation; social and economic well-being; domestic, family and personal relationships; suitability of living accommodation; and the individual’s contribution to society. The duty to promote well-being falls on the local authority; Regulation 9 is the separate duty on the registered care provider.

What are CQC regulations?

CQC regulations are the legal requirements CQC enforces for registered health and social care providers in England, above all the fundamental standards, Regulations 9 to 20A of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, with the notification duties in the Care Quality Commission (Registration) Regulations 2009. Regulation 9, person-centred care, is the first of the fundamental standards.

Official guidance and your next step

The primary sources are Regulation 9 on legislation.gov.uk; CQC’s guidance on Regulation 9, which providers must have regard to and which is the most useful single page on the subject; and the person-centred care and assessing needs quality statements, each with the best-practice guidance CQC expects providers to follow. Quotations are from those pages as published on 3 October 2026.

This guide is a summary for providers registered in England, not legal advice about a particular person’s care, an inspection or enforcement action.

Then do one thing: pick three people your service supports, read their care plans, and for each one find a preference recorded in their own words, the date it was last reviewed with them, and one thing that changed because they asked. Where you cannot find all three, you have found where to start.