Safe · KLOE 1

Safety culture

Is there a positive and equitable safety culture where risks are proactively managed, concerns are listened to, incidents are thoroughly investigated, and lessons are learned to improve care?

In brief

Safety culture is key line of enquiry 1 under the Safe key question in the Care Quality Commission (CQC) draft adult social care assessment framework (v9, 19 March 2026), currently published for consultation. It covers safe culture, raising safety concerns, closed cultures, duty of candour. 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: Safe
Line of enquiry: KLOE 1 of 7 under Safe
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. 3–5 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:

Safe culture
Raising safety concerns
Closed cultures
Duty of candour

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.

A positive safety culture is firmly embedded in the service. Safety concerns are recognised as essential to continuous learning and improvement.
The service continually and actively seeks opportunities to learn from risk and safety incidents, good practice, and national safety alerts. Learning is regularly revisited and shared with partners to strengthen safety across the wider system.
When an incident has occurred, the people affected are partners in helping to understand what has gone wrong. People are supported to be involved in this process where required.
Staff and people using the service are encouraged and supported to raise concerns and suggest ideas to improve, without fear of negative repercussions. All concerns are taken seriously, acted on promptly and used to drive improvement. People more likely to face safety risks are encouraged and enabled to participate.
People are involved with agreeing actions following safety incidents, and the service works collaboratively with them and relevant partners to implement improvements and prevent recurrence. The effectiveness of the controls is monitored and measured. This includes solutions to risks more likely to affect particular groups of people, which would otherwise lead to safety inequalities.
Leaders demonstrate visible commitment to safety. They are open, responsive and able to show clear, sustained improvements in safety outcomes for people.
Staff and leaders actively invite challenge, using it to strengthen safety practice and enhance organisational learning.

Good

In plain terms: The service meets the expected standard.

Safety is a shared priority for everyone, including staff and people using the service.
There is a strong learning culture in which incidents that have caused harm, or could cause harm, are treated as opportunities to improve.
Safety risks are consistently monitored, proactively identified and managed.
Any safety risks that result from inequalities, or that affect particular groups of people, are identified and acted on.
Complaints, concerns and other feedback about safety are welcomed and prioritised as key sources used to identify and manage safety risks before safety incidents happen.
When an incident has happened, staff are open and transparent with people and those close to them. All incidents are recorded, investigated and outcomes are communicated to those involved. If harm has occurred, people are given full details of what happened, why, and what has been learned.
There is a good understanding of the duty of candour.
The service looks for safety-related themes and trends. Patient safety alerts are consistently reviewed and acted on, and learning from external safety incidents is embedded in the delivery of care.
Staff and leaders understand what constitutes a closed culture and the risks to people, including organisational abuse. There are systems and processes in place to identify concerns and prevent closed cultures from developing, and appropriate action is taken when needed.

Requires improvement

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

Good safety practice is not consistently maintained.
Staff do not consistently understand their role in proactively identifying and contributing to managing risk within the service or how they can do this.
Safety concerns are not consistently identified or addressed quickly enough to keep people safe.
There is limited analysis or understanding of safety risks that affect particular groups of people.
Incidents are not consistently recorded or investigated appropriately, and the right people are not routinely involved.
The service isn’t consistently open and transparent about incidents that have occurred or how it will improve.
Reporting processes for safety concerns are unclear or not reliably followed.
Staff sometimes hesitate to raise concerns and lack confidence that these will be welcomed or lead to improvement.
The service does not routinely look for safety-related themes and trends or does not do so reliably and rigorously. Monitoring of safety is inconsistent. Opportunities to identify and address risks before harm occurs are missed.
The service doesn’t routinely review or act on patient safety alerts or learn from external safety events.
Staff and leaders do not consistently monitor, recognise or act on the risks of a closed culture at the service.

Inadequate

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

Safety is not a sufficient priority for the service, and the service has a track record of failing to provide good standards of safety.
The service does not recognise concerns, incidents or near misses that place people or staff at risk of harm, or that have caused harm.
Investigations into concerns or complaints are insufficient, delayed or not completed.
Actions taken to address identified risks are unclear or poorly co-ordinated.
There is no analysis or understanding of safety risks that affect particular groups of people, leading to higher risks of harm for some groups.
There is little or no evidence of learning from events or of action taken to improve safety.
Serious incidents or significant and preventable safety incidents occur at unacceptable levels. Safety performance is not measured or monitored effectively.
People are not routinely informed when something goes wrong or do not receive an apology where appropriate.
Systems for recording or reporting safety concerns, incidents and near misses are absent or not used consistently. Learning is not identified from concerns or adverse events.
Staff are afraid or discouraged from raising concerns and there is a culture of blame.
The service does not review or comply with patient safety alerts.
Staff and leaders have limited or no understanding of the risks of a closed culture at the service, and these are not monitored, recognised or acted on when needed.

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