Do supported living services need CQC registration?

Written By Tiffany Nelson

Sometimes. The honest answer is that "supported living" is not a regulated activity but what you do inside is.

Let me be straight with you. I see this question get answered badly in both directions. Some providers assume they must register because they work with vulnerable adults. Others assume they need nothing because the people they support have tenancies. Both can be wrong.

The test is personal care, not the label

The law does not mention supported living. It regulates activities. The one that matters here is "personal care", set out in Schedule 1 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Personal care covers physical assistance with eating or drinking, toileting, washing or bathing, dressing, oral care, and the care of skin, hair and nails. It applies to people who cannot do these things for themselves because of age, illness or disability, and it is provided where they live.

The definition in regulation 2 also includes prompting, but only prompting together with supervision, and only where the person cannot decide for themselves to do the task without it. CQC's glossary says supervision normally means direct observation of the action as it happens. It does not normally include encouraging someone, or checking afterwards.

So the first question is simple. Do your staff physically assist people with these tasks, or prompt and supervise them as described? If yes, you are providing personal care. If you only help with cleaning, cooking, shopping, budgeting or emotional support, you are not.

CQC's own guidance on supported living says this directly: providers that do not deliver personal care are not required by law to register.

What you need to register for

If you do provide personal care, the next question is which activity you register for. There are two possibilities.

Personal care. This is the usual answer for supported living. The person has a tenancy or licence with a housing provider. They have a separate agreement for their support.

Accommodation for persons who require nursing or personal care. This is the care home activity. It applies where accommodation and care are provided together as one package.

CQC's guidance on housing with care is clear that the deciding factor is separation. It says it will register only the personal care provider where there are separate legal agreements for the housing and the care. It also says the two must not be provided as a single package under one agreement.

How CQC looks at separation

CQC does not use one test. It looks at the whole picture. Its guidance points to indicators such as these:

  • Separate contracts for housing and care, with nothing that restricts the person's choice of care provider.

  • The person can stop their care or change provider without losing their home.

  • Decisions on rent, notice to quit and the occupancy agreement are made by the housing provider, not the care provider.

  • Staff cannot enter the person's home without authorisation or reasonable notice.

And the warning signs:

  • The same legal entity provides both housing and care, with no clear separation.

  • The person has to accept care from that provider, or a partner company, to keep the accommodation.

  • The occupancy agreements are not genuine or valid.

One point surprises people. Having a different company for each does not settle it. CQC's guidance says separate providers do not necessarily mean the service is not a care home. Two linked organisations working as a combined package can both be caught.

What about the landlord?

A housing-only landlord does not need CQC registration for that role. CQC's guidance says it has no power to regulate accommodation that is not provided together with personal care as a package. It also says a concierge or property management service alone is unlikely to fall within scope.

That does not mean the premises are ignored. The care provider is still responsible for delivering safe care in that setting.

What happens if you get it wrong

Carrying on a regulated activity without registration is an offence under section 10 of the Health and Social Care Act 2008. It is not a paperwork problem. If you are providing personal care and have not registered, you need to stop and take advice before you take on another person.

A note on learning disability services

In my experience, this is where the line gets blurred. A service can start with a few hours of "support" and drift into personal care as someone's needs change. Staff begin supervising a person while they wash, or helping with dressing. Nobody revisits the registration question.

I would build a check into your reviews. Each time a support plan changes, ask whether the personal care definition is now met. If it is, you need to be registered before it continues.

I would also look hard at your contracts. If the care provider and housing provider are connected, can you show that the person genuinely has a choice? An inspector, or a registration officer, will ask.

What CQC asks you to send

Once you know you need to register, the documents are the next hurdle. For a supported living application, CQC asks for the documents everyone must send, plus four more:

  • Business plan and financial forecast

  • Evidence of legal occupancy

  • Service user guides

  • Staff training plan

You must also complete the additional form for personal care providers.

Notice the third item on that list. Evidence of legal occupancy is where the separation question stops being theory. If your tenancy or licence arrangements are tied to your care, this is where it shows.

If you support autistic people or people with a learning disability, CQC also wants your positive behaviour support policy and your restraint policy. You complete a further form for these services too.

CQC says you should not send some documents with your application, but keep them ready in case an inspector asks. They include your duty of candour policy, whistleblowing policy, risk management policy, a sample care contract, a sample care plan, and staffing structure and rotas. If you cannot produce them when asked, your application may be delayed.

If you plan to offer other services as well, such as home care, send the documents for each service and cover all of them in your documents.

If you are unsure which activity applies, settle that before you apply. Applying for the wrong one is one of the more avoidable reasons for delay.

If you would like a second opinion on whether your service needs to register, get in touch: contact.

Tiffany Nelson has 15 years' experience in adult social care, from care and support roles through to operational management and quality assurance. She has been on both sides of a CQC inspection.

Sources

Tiffany Nelson https://www.tiffanynelsonconsulting.co.uk/
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