Do I need to register with CQC or Ofsted?

Three groups of people ask us this

Plenty of good businesses operate in this sector without registering, entirely lawfully. Plenty of others are registered when they did not need to be, and are carrying the cost and the inspection risk for nothing.

And a third group — the one this page is really for — started outside the line and crossed it without noticing.

Carrying on a regulated activity without being registered is a criminal offence. Not a fine on a sliding scale, not a compliance matter to tidy up later. That is why the line is worth understanding properly rather than approximately.

CQC defines it as personal care provided to people who cannot provide it for themselves because of old age, illness or disability, in the place where they are living at the time. That covers someone's own home, supported living, extra care housing and Shared Lives arrangements.

In practice it means physical assistance with, or supervising and prompting someone through, the things that are difficult to do for yourself when you are unwell or frail. Washing. Dressing. Toileting. Eating and drinking.

If your service does any of that, in someone's home, on an ongoing basis, you are almost certainly looking at registration.

The drift

Here is how it actually goes wrong, and it is nearly always the same story.

You set up a companionship service. Properly non-regulated, properly outside the line, and you checked. One of your regulars has a fall. Nothing serious, but for a few weeks she cannot manage the shower on her own, and your carer is already there twice a week, and she trusts her, and the family asks.

Nobody makes a decision. There is no meeting. Your carer helps her into the shower on a Tuesday because it would be strange not to.

You are now providing personal care without being registered.

That is the drift, and it is why this is worth thinking about before it happens rather than after. It never arrives as a business decision. It arrives as a kindness, one client at a time, and by the time it is visible it has been going on for months and it is in your notes.

An introductory agency matches a client with a care worker. If the agency's involvement genuinely ends at the introduction, it does not need to register — even though personal care is being delivered by the person introduced.

The test CQC applies is whether the agency keeps an ongoing role in the direction or control of the care. Things that suggest you do: monitoring the quality of the care itself and using that to advise on how it is delivered; managing rotas or arranging cover when a worker is absent, rather than simply making another introduction; charging on an ongoing basis rather than a one-off introduction fee; changing active care plans; and imposing requirements on the workers, such as supervision, uniforms or particular systems.

Things that stay on the safe side: vetting a worker once, charging a single introduction fee, and asking whether the person was happy with the introduction service rather than with the care.

The reason this is difficult in practice is that the ongoing-role indicators are the same things a conscientious operator instinctively wants to do. Checking the care is going well is exactly what a decent person would do — and it is one of the things that brings you inside the line.