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Effective · KLOE 2

Evidence-based care and equitable outcomes

Is care, support and treatment delivered in line with legislation, evidence-based standards and good practice, to achieve equitable and good outcomes?

In brief

Evidence-based care and equitable outcomes is key line of enquiry 2 under the Effective key question in the Care Quality Commission (CQC) draft adult social care assessment framework (v9, 19 March 2026), currently published for consultation. It covers good practice guidance and standards, equitable outcomes, monitoring and improving individual outcomes (including quality of life outcomes), nutrition and hydration, service accreditation schemes. 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
Effective
Line of enquiry
KLOE 2 of 4 under Effective
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. 24–27 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:

  • Good practice guidance and standards
  • Equitable outcomes
  • Monitoring and improving individual outcomes (including quality of life outcomes)
  • Nutrition and hydration
  • Service accreditation schemes

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.

  • There is an embedded culture which encourages the adoption of innovative and evidence-based approaches to support the delivery of high-quality care and outcomes. This results in improvements that are sustained over time.
  • The service works in partnership with others and keeps up-to-date with new research and development to make sure staff follow good practice. Where possible, the service also contributes to the development of good practice and good leadership with other agencies.
  • People’s outcomes, including their quality of life, are consistently good and regularly exceed expectations. Any barriers that prevent equitable outcomes are overcome by acting on information, proactively listening and responding to people’s experiences of discrimination or inequality, and then allocating resources and embedding continuous learning and innovation.
  • People are fully involved in planning their meals with staff and have a variety of suitable and high-quality food options to choose from each day.
  • Staff encourage people to eat and drink using innovative approaches and positive relationships that consider people’s diverse needs and preferences, for example if people are reluctant or have difficulty eating or drinking.
  • The service continually improves over time and works towards, and achieves, relevant accreditation schemes.

Good

In plain terms: The service meets the expected standard.

  • People receive care, support and treatment aligned to recognised good practice standards.
  • Staff and leaders understand the current legislation, standards and good practice relevant to their service and apply these effectively. They have good systems to ensure they keep up-to-date and embed this in their service.
  • People understand how current ‘good practice’ is relevant to their outcomes, and they are involved in planning how this is reflected in their care, support and treatment.
  • The service understands what people expect from their care and what good outcomes look like for them. These outcomes are regularly achieved.
  • The service empowers people to understand their legal rights to equity of care and outcomes. Staff recognise barriers that prevent equity. Information is collected and acted on, and resources are allocated, to reduce these barriers and improve people’s outcomes.
  • There is a rigorous approach to monitoring the effectiveness of people’s care, support and treatment and the service takes action to continuously improve it.
  • Staff monitor and evaluate outcomes related to people’s health and quality of life, including those linked to their aspirations and skill development, and act to improve them when possible.
  • People’s nutritional and hydration needs are met in line with current standards and good practice guidance. Where applicable, there is positive feedback from dietetic professionals that the service asks for their advice and applies it properly.
  • People are supported to plan and manage their dietary needs and associated risks, including risks of poor nutrition, dehydration, swallowing problems and other medical conditions that affect their health.
  • Staff are aware of individual preferences in relation to eating and drinking and there is flexibility when needed or requested. There are good quality food choices and these respect individual wishes, including those relating to sensory, cultural, religious and ethical preferences.

Requires improvement

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

  • The service doesn’t always recognise, understand or implement current relevant recognised good practice guidance, legislation and standards and it is not always reflected in people’s care, support and treatment.
  • The service doesn’t routinely support people in understanding what good practice means for them and their outcomes. This can mean people have a limited understanding of the expected outcomes of their care.
  • Not all people feel enabled to fully give their views or they feel that their rights are not respected in relation to their experience and outcomes of their care. This is particularly the case where people feel they are treated inequitably based on their protected equality characteristics.
  • Staff and leaders do not have a good understanding of the people using their service who are most likely to experience discrimination and inequality in experience or outcomes. The service will miss opportunities or does not consistently take appropriate steps to promote and provide equitable experiences or outcomes for people.
  • The service does not adequately monitor and evaluate the effectiveness of people’s care, support and treatment consistently. Opportunities to improve care can be missed, or people do not have the best possible outcomes from their care.
  • People’s nutritional needs are not always met in line with relevant standards and good practice.
  • People may not always get enough to eat or drink or be supported to get enough to eat and drink.
  • People are not consistently supported to eat a healthy, balanced diet because options are limited, and not all the food provided is appropriate to meet people’s nutritional needs.
  • The service does not routinely involve people in planning their meals and does not act on people’s feedback about their food.
  • People’s cultural, ethical and religious needs in relation to food or drink are not well understood.
  • The service does not sufficiently monitor or manage the risks associated with eating and drinking, including poor hydration and nutrition and swallowing difficulties.
  • The service does not routinely request or enable access to dietary and nutritional specialists when needed.

Inadequate

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

  • Care, support and treatment does not reflect current recognised guidance, standards and good practice, meaning people receive, or are at risk of receiving, poor or unsafe care.
  • People are not involved in or told about good practice. They are at risk of or experience poor outcomes from their care as a result. The service does not adequately monitor and evaluate the effectiveness of people’s care, support and treatment
  • The service fails to identify people most at risk of discrimination and inequitable experiences or outcomes. There is no proactive action to promote equity, and opportunities to address barriers are consistently missed.
  • The service does not ensure that people have enough to eat and drink throughout the day. Drinks, meals and snacks are restricted. Food is not adequately nutritious.
  • The service does not involve people in decisions about what they eat and drink. Specialist dietary needs and those relating to culture, ethics and religion are not understood or catered for.
  • The service does not seek out or engage with dietary and nutritional specialists. This puts people at risk because of poor monitoring and management of food and fluid intake.

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