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Caring · KLOE 3

Independence, choice and control

Are people supported and empowered to maintain their independence, relationships, and choice over their care and plans for the future?

In brief

Independence, choice and control is key line of enquiry 3 under the Caring key question in the Care Quality Commission (CQC) draft adult social care assessment framework (v9, 19 March 2026), currently published for consultation. It covers supporting communication and choice, including lifestyle choices, access to friends and family (visiting rights) and community, supporting relationships and networks, specialist/adaptive equipment, supporting independence, personal goals, activities and wellbeing, dnacpr/respect, advance statements and decisions, end of life and palliative care. CQC describes performance against it at four rating levels: Outstanding, Good, Requires improvement and Inadequate. Each statement and rating characteristic quoted here is reproduced verbatim from CQC's draft; plain-English summaries are HLTH's own.

Key question
Caring
Line of enquiry
KLOE 3 of 3 under Caring
Rating levels
Outstanding, Good, Requires improvement, Inadequate
Source
Adult social care assessment framework, v9 (19 March 2026)
Status
Draft, published by CQC for consultation
Reference
pp. 37–41 of the CQC draft

Scope and topic areas

What this line of enquiry covers

Scope of this key line of enquiry and topic areas include:

  • Supporting communication and choice, including lifestyle choices
  • Access to friends and family (visiting rights) and community
  • Supporting relationships and networks
  • Specialist/adaptive equipment
  • Supporting independence, personal goals
  • Activities and wellbeing
  • DNACPR/ReSPECT, advance statements and decisions
  • End of life and palliative care

Rating characteristics

How CQC describes each rating

The four characteristic sets for this KLOE, best to worst. Every point is CQC's wording, reproduced exactly.

Outstanding

In plain terms: Care is exceptional and consistently better than the Good standard.

  • People feel respected, listened to, and influential when expressing their right to choice.
  • People can meaningfully influence who provides their care and support, how and when.
  • People’s family, friends and unpaid carers feel genuinely welcomed to the service and valued.
  • There is demonstrable evidence that people’s independence and autonomy is genuinely maximised.
  • People feel nurtured and supported to enjoy opportunities and experiences that help them to thrive, and this has a positive impact on their quality of life.
  • The service actively creates opportunities for people to explore new interests and build connections, working in partnership with a wide range of community groups and organisations.
  • The service creatively explores how equipment and technology can enhance independence for individual people.
  • The service and staff are genuinely empathic towards people’s decisions and choices over their care, including choices for the end of their life.
  • There is a clear understanding of people’s decisions for the end of their life and active awareness of action that needs to be taken to make sure people receive the care they requested. Staff are confident in what people want in various scenarios that may occur towards the end of a person’s life.

Good

In plain terms: The service meets the expected standard.

  • People have choice and control over their own care and are empowered to make decisions about their care, support, treatment and wellbeing.
  • People are supported to establish and maintain relationships and networks that are important to them, with access to family, friends, cultural connections, and advocacy support while using the service. When applicable, visiting restrictions are limited to exceptional circumstances in accordance with guidance and legislation.
  • People’s right to privacy and a personal life is appropriately considered and respected, including supporting them to have close and intimate relationships.
  • If people wish to, they are encouraged and enabled to access meaningful activities, hobbies and interests in a personalised way. People are offered meaningful and genuine choices.
  • Staff respect people as autonomous individuals, protecting and promoting their human rights. People are actively supported to enhance their autonomy, have as much control over their lives as possible and develop new or existing skills.
  • People can choose and have the amount of structure, routine and independence they need to live a fulfilled life.
  • Equipment and technology are used to support and maximise people’s independence and experiences of their care and support. People are helped to make choices about adaptive equipment.
  • Where applicable, people are supported to make choices and retain as much control as possible over how spaces are arranged, decorated and used, so that environments are welcoming and personalised.
  • People’s skills, life experience and strengths are discussed with them and those involved in their care, to understand how their short, mid and long-term life choices, goals, ambitions and outcomes can be planned and achieved.
  • When people’s future care preferences are to have greater independence and fewer care interventions, professionals work together to support them to achieve their goals.
  • People are supported to plan for important life changes, including those relating to potential medical and psychological needs, and planning for adulthood. They can have enough time and accessible information to make informed decisions about their future.
  • People can update and change their choices. Decisions are clearly recorded and communicated as needed. The appropriate services are informed and engaged at the right time to achieve these preferences.
  • People are supported to make decisions about end of life preferences and advance decisions if they wish to. People who may be approaching the end of their life are identified to ensure their needs are met, in line with their preferences and choices, and the right support is provided.
  • If people do not wish to discuss the end of their life, steps are taken to establish what to do in an emergency medical situation, with a plan to revisit the subject differently in the future.
  • There is a compassionate and supportive approach towards those close to the person, or staff, before and after a person dies.

Requires improvement

In plain terms: The service is not yet Good and has areas that must improve.

  • The service does not appropriately support or enable people to have as much choice and control over their care as possible. People cannot meaningfully engage in decisions about their care, support and treatment and the outcomes they want to achieve.
  • People’s social needs are not fully understood, and they are not supported to meet these needs.
  • People at times face unreasonable or avoidable barriers or restrictions on access to their family, friends and community. When applicable, relatives and friends are not always welcome when visiting the service or are unclear about the reasons for any restrictions.
  • The service does not appropriately consider people’s right to privacy and right to have a personal life, including intimate relationships, and how it supports them.
  • The service does not consistently support people to follow their interests, access meaningful activities or hobbies, or they are not encouraged to take part in social activities or maintain personal or community relationships.
  • Appropriate equipment and/or technology is not routinely available to support people’s independence.
  • Where applicable, people are not well supported to make choices or retain control over how spaces are arranged and used.
  • People are not engaged and supported in planning for the future where it is appropriate and expected that the service would do this. This includes planning for important life changes and future care needs.
  • People’s decisions about their future care needs are not appropriately re-assessed and reviewed with them. Their wishes are not consistently recorded or acted on.
  • People are not consistently supported to make decisions about end of life care and advance decisions when they wish to.
  • Some staff do not appreciate the need for good end of life care, and they do not consistently respond soon enough or involve the correct healthcare professionals. Support, equipment and medicines are not consistently provided in a timely way. People’s diverse preferences (including those arising from protected equality characteristics) are not always considered or acted on, or choices are not respected.
  • The service does not consistently adopt a compassionate and supportive approach towards those close to the person, or staff, before and after a person dies.

Inadequate

In plain terms: Performance is well below the expected standard; enforcement may follow.

  • People do not have meaningful choice and control about their care, support, treatment and wellbeing.
  • People’s social needs are not adequately considered or met.
  • The service unreasonably restricts people’s access to their family, friends and community. When applicable, visiting restrictions have been put in place without communicating with those using the service or those close to them who are affected.
  • If people have raised concerns about the service, they have been asked to leave. Friends and family have been prevented from visiting if they have raised concerns.
  • People are not listened to, and they are not supported to express their views or pursue their interests. Staff do not use accessible ways to communicate or make sure that people have understood them.
  • The service does not consider or respect people’s right to privacy and a personal life, including intimate relationships. People are inappropriately discouraged or restricted in this area of their life.
  • The service does not meet people’s individual needs in relation to maintaining interests and hobbies, maintaining relationships or contact with the local community.
  • Appropriate adaptive or specialised equipment is not available to give people independence in the service where required.
  • Where applicable, people are not supported to make choices or influence how spaces are arranged or used.
  • The service fails to support people to plan for the future. This includes understanding and considering people’s views on their future care needs and life events.
  • People’s wishes and decisions about their future care needs are not adequately recorded or are not acted on.
  • People are not supported to make decisions about end of life care and advance decisions when they wish to.
  • The service does not involve healthcare professionals, in response to people’s individual end of life needs and preferences.
  • There is no consideration of diverse needs for end of life care, including religious beliefs and individual preferences, or these are not respected. There is a generic approach for all people, which doesn’t reflect their choices.
  • The service does not adopt a compassionate and supportive approach towards those close to the person, or staff, before and after a person dies.

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