Evidence of Competency Should NOT Be a Tick Box Exercise
What Does Competence Really Mean in Community Complex Care? What Do the CQC Regulations Say?
Heather Smith. Registered Nurse.
20th March 2026.
What Are the CQC Competency Requirements for Staff?
It took me almost a year of working in an intensive care department to be signed off as competent in all the required fundamental skills and subject areas, and that was completely acceptable. No one would expect that after attending training in the hospital, that means you are automatically competent in what you were taught. So why does it feel like there is that added pressure for providers within community complex care? Competence comes with practice, experience, troubleshooting, learning on the job, discussions, problem solving, more practice, more exposure, more experience. It takes time to learn, remember and then relay the information.
Yes, CQC require competency assessment evidence. Yes, regulated providers must have evidence of them. But what is most important, is that the staff in the care teams actually demonstrate competence, and feel confident, capable and supported in their roles.
Competent. Definition: having the necessary ability, knowledge, or skill to do something successfully. How does that relate to healthcare? Having the necessary understanding, being able to demonstrate safe technique and having the knowledge of what is abnormal and when to escalate, ultimately to keep a client safe in their environment.
Practical training is great; it is the focus of my business. Allowing teams to practice complex care techniques in a controlled environment, where questions can be asked, mistakes can be made, techniques can be developed, and there’s no pressure. And as much as training in simulation is valuable, it cannot directly simulate real life. I’m aware of that, and I’m okay with that. And that is why I don’t sign off complex care skills in training environments.
Let’s have an example:……………………………………………………………………………………………………………………………………………………………………………………………………………………………..
If Carer A had training in oral deep suctioning, and they were signed off in training after practicing once or twice on the simulation manikin. Great, CQC will be happy about that, right? A tick in the box.
Fast forward 3 weeks. Carer A is looking after Client D on a 1:1 basis. Client D’s oxygen levels are dropping, they’re becoming distressed, both Carer A and Client D start to panic, and Carer A knows they really need to get them secretions up, but they’re on their own, and the last time they practiced this was on a plastic face that didn’t move or alarm for low oxygen levels? This could lead to an acute deterioration and a very unwell client, a traumatised care worker and an incident report. But it’s okay, as the staff member is signed off? Is that a safe environment? Absolutely not. That poor care worker has no one to turn to, feeling a huge load of responsibility and pressure as they were rushed into competency sign off when they were not ready. This puts clients at risk of health deterioration, and staff at risk of feeling unsupported.
Now, think in a different environment, Carer A is working with competent Carer B, who has done this all before, they’re prepared, skilled and ready to tackle this acute episode head on. Carer B can guide and advise, support and assist Carer A into managing this situation. Carer A will feel more at ease, less under pressure, and can use the opportunity to develop skills in a controlled environment, with someone there to help if things do deteriorate. Carer A feels supported, Client D feels reassured, Client D receives the care they need to stabilise the situation and the CQC is still happy.
Support With Competency Assessments in Community Complex Care
Initial competency assessments and re-assessments, are different. Initial competency assessments require a period of supervised practice and evidence of clinical experience; re-assessments are evidence of continued safe practice. Re-assessments are often simply confirming knowledge, ensuring the staff are up to date with latest policies, and being reassured they know when, why and how to escalate care. I am more comfortable performing annual competency re-assessments within the training environment through a range of assessment techniques.
I can provide competency assessments, and I am happy to do so in the right circumstance, though my assessments are thorough and backed by evidence. I will look at most recent policies and legislations and match the competency headings against these. I will only sign someone off as competent when they can confidently explain what, why, when and how in a particular skill, and can evidence that they know where their scope limitations lie, and when it is appropriate to escalate for review. I’d be wary of any training provider or even in house clinical lead, that doesn’t have the same processes in place. For competency assessments, I am utilising my nursing registration, and although the responsibility for supervision and ongoing competence monitoring remains with the provider, I am very protective of my NMC Pin! Therefore, I am even more focused on ensuring that the staff I ‘sign off’, can comprehensively demonstrate safe practice in complex care areas.
What Do the Regulations Say?
Yes, this next part is very ‘wordy’ and very ‘formal’, but it is regulations after all….
Regulation 18: Staffing:…………………………………………………..…………………………………………………………………………………………………………………………………………………………………………
18(2)(a) Persons employed by the service provider in the provision of a regulated activity must receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform
Training, learning and development needs of individual staff members must be carried out at the start of employment and reviewed at appropriate intervals during the course of employment. Staff must be supported to undertake training, learning and development to enable them to fulfil the requirements of their role.
Where appropriate, staff must be supervised until they can demonstrate required/acceptable levels of competence to carry out their role unsupervised.
Regulation 19: Fit and proper persons employed:……………………………………………………………………………………………………….……………………………………………………………….
19(1)(b) Persons employed for the purposes of carrying on a regulated activity must have the qualifications, competence, skills and experience which are necessary for the work to be performed by them, and
· Providers must have appropriate processes for assessing and checking that people have the competence, skills and experience required to undertake the role. These processes must be followed in all cases and relevant records kept.
· Providers should have systems in place to assess the competence of employees before they work unsupervised in a role. They must provide appropriate direct or indirect supervision until the person is assessed as competent to carry out the role.
Regulation12: Safe care and treatment:………………………………………………………………………………………….……………………………………………………………………………………..
12(2)(c) Care and treatment must be provided in a safe way for service users, ensuring that persons providing care or treatment to service users have the qualifications, competence, skills and experience to do so safely;
Staff must only work within the scope of their qualifications, competence, skills and experience and should be encouraged to seek help when they feel they are being asked to do something that they are not prepared or trained for.
Staff should be appropriately supervised when they are learning new skills, but are not yet competent.
So really, what does it mean?
I want regulated providers to recognise that there is more to competence than a signature on a document, it’s evidence of a supported team, a confident carer and a compliant organisation.
CQC regulations do not state that competence must be achieved immediately after training. The regulations require providers to ensure staff are appropriately trained, supervised and supported until they can demonstrate safe and effective practice. For community complex care providers, this means having clear systems for supervision, peer support and structured competency assessment before staff work independently.
However, on numerous occasions lately, have I been asked by providers to perform competency assessments in various complex care skills for brand new staff, as part of initial training. I then must politely explain the above and reassure them that the CQC also recognise this. The CQC understand that a staff member can practice and develop under the supervision of another worker, until their competence is achieved. This not only is allowed within CQC regulations but gives the staff the opportunity to learn from peers, discuss in confidence, develop in a clinical environment and become ready themselves, to work independently.
Let us together ensure that Client D receives high quality, safe care from their team, and that Carer A, feels confident in their role to do this.
I am always happy to discuss CQC compliance and competency support, whether it be a local authority care provider, a case manager, or someone just beginning their CQC registration journey, as ultimately, I want staff to feel supported, organisations to do things properly, and clients to be safe.
Frequently Asked Questions About CQC Competency Requirements:
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Click to view on CQC Website:
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Providers should be able to demonstrate clear processes for assessing, supervising and reviewing staff competence. This may include documented supervision, observed practice, structured competency assessments, policy awareness and escalation knowledge. A signature alone is unlikely to demonstrate robust governance.
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No. CQC regulations require providers to ensure staff are appropriately trained, supervised and supported until they can demonstrate safe and effective practice. Competence may take time to develop, particularly in complex care settings, and should be evidenced through structured supervision and assessment rather than assumed following a single training session.
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An initial competency assessment confirms that a staff member can safely perform a skill following a period of supervised practice if they are new to the skill or care need. A reassessment reviews ongoing competence, ensuring knowledge remains current and safe practice continues.
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Reassessments may be completed in a structured training environment using questioning, discussion and scenario-based assessment, depending on the complexity of the skill. Initial competency assessments for complex skills typically require evidence of supervised practice within a real clinical setting.
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Yes. I provide structured, evidence-based competency assessments in complex care skills such as tracheostomy care, PEG feeding, medications management, suctioning, ventilation, and others. My assessments align with CQC regulations and focus on ensuring staff can safely demonstrate knowledge, technique and appropriate escalation.
