Why consent is rarely evidenced well
Consent to care and treatment is one of the four KLOEs under the Effective key question. Almost every adult social care service has a consent policy. Most have training records confirming that staff have completed a Mental Capacity Act module. Both of these things matter. Neither of them, on their own, is what a CQC inspector is looking for.
Consent is one of the areas where the gap between a service's intentions and its practice is most visible to an inspector. A policy describes what the service intends. An inspector watching how a care worker approaches a reluctant care home resident, or reading a care record that notes "consent obtained" with no further detail, is seeing what the service actually does. This is closely connected to person-centred care more broadly. Our post on what CQC inspectors mean by person-centred care covers how the two areas of evidence overlap.
A consent policy confirms your intentions. Evidence of how consent is sought in practice, recorded person by person, is what demonstrates your culture.
The CQC draft assessment framework for adult social care (2026) places the Consent to care and treatment KLOE within the Effective key question. It asks whether people are supported to understand and exercise their right to consent to care, support and treatment. The scope includes consent, advocacy and support, communicating rights, and the Mental Capacity Act 2005. Each of these requires its own evidence, and together they make consent one of the most evidence-intensive areas of the framework.
The legal framework behind the KLOE
Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 requires providers to obtain consent from service users. Where a person lacks capacity to consent, the provider must act in their best interests in accordance with the Mental Capacity Act 2005. This is not optional compliance. It is a fundamental legal requirement, and failure to meet it can result in a breach of Regulation 11 alongside a poor rating under the Effective key question.
The Mental Capacity Act 2005 sets out five principles that must underpin all practice. Every person is assumed to have capacity unless assessed otherwise. Every practicable step must be taken to help a person make their own decision before any conclusion is reached that they lack capacity. A person has the right to make unwise decisions. Any decision made on behalf of a person who lacks capacity must be made in their best interests. The least restrictive option must always be chosen.
These principles are not background context for a training module. They are the framework within which consent must be sought, assessed and recorded, every time and for every person, as a matter of daily practice.
What the CQC framework expects at Good and Outstanding level
At Good level under the Consent to care and treatment KLOE (CQC, 2026), the framework expects that people are supported to understand their rights to consent, including the right to withdraw consent at any time. Staff must know the importance of consent and the relevant legal requirements, and must ensure that people understand what they are consenting to before care is delivered. Where capacity is in doubt, capacity assessments must be completed, recorded, and made in line with the Mental Capacity Act 2005. Advocacy must be promoted where relevant.
At Outstanding level, the framework expects exceptional skill and creativity in obtaining consent, particularly where language, age, disability or other factors create barriers. Consent practices must be actively monitored and improved, informed by learning from practice and feedback from people. Creative approaches to supporting informed decision-making should be developed collaboratively with people who use the service and those close to them.
The distinction between Good and Outstanding in this area is not about having a better policy. It is about having a more responsive, more reflective, more person-specific approach to an inherently complex process.
How to assess the strength of your consent evidence
Is consent recorded in a way that reflects the process? "Consent obtained" is not an evidence record. It is a notation. A strong consent record describes how consent was sought, what information was provided, whether the person demonstrated understanding, and what they agreed to. Where there was any reason to doubt capacity, the record should reflect that a capacity assessment was conducted, the outcome, and the basis for that conclusion.
Are capacity assessments decision-specific and documented? A common misunderstanding is that mental capacity is a fixed characteristic: either a person has capacity or does not. The Mental Capacity Act 2005 is explicit that capacity is decision-specific and time-specific. A person may lack capacity to make a complex financial decision but retain full capacity to decide what they want for breakfast. Capacity assessments must reflect this. A single blanket assessment in a care plan, with no further records of decision-specific assessments, is a compliance risk.
Are best interest decisions recorded? Where a person lacks capacity to consent to a specific decision, a best interest decision must be made and recorded. The record should show who was involved, what the person's wishes and feelings were (as far as they could be ascertained), and why the decision made was in their best interest. A care plan that describes the care being delivered without any reference to the consent process that authorised it is incomplete.
Is advocacy promoted and evidenced? Where relevant, the service should be able to demonstrate that access to independent advocacy was promoted. For people subject to the Deprivation of Liberty Safeguards (DoLS), this includes access to a relevant person's representative. Is there a record showing that advocacy was offered and either accepted or declined? Is there evidence of the outcome?
Do staff demonstrate understanding in practice? The clearest test of whether consent culture is embedded in your service is whether care workers can describe, in their own words, how they seek consent before delivering care. If the answer is a reference to the policy, that is an indication that knowledge exists at policy level. If the answer describes a specific approach to a specific person: how they communicate with someone who has limited verbal communication, how they watch for signs of reluctance and respond to them. That is evidence of embedded practice.
How AlwaysReady supports consent and MCA evidence
Consent evidence is inherently dispersed: it lives in care records, capacity assessments, best interest decision records, DoLS authorisations, supervision notes and training matrices. AlwaysReady gives you a structure to bring those records together under the Consent to care and treatment KLOE, so the complete picture is visible in one place.
Upload capacity assessment records linked to the Consent KLOE. Store decision-specific capacity assessments in AlwaysReady, linked to the Consent to care and treatment KLOE under Effective. Where a person's capacity status changes, upload the updated assessment. A chronological record of capacity assessments, each decision-specific and dated, is strong compliance evidence.
Store best interest decision records alongside care plans. Upload best interest decisions made on behalf of people who lack capacity and link them to both the Consent KLOE and the relevant person's care records. This creates the connected evidence trail that demonstrates your service is not just delivering care, but delivering it in accordance with the legal framework.
Delegate the staff consent spot-check to a senior colleague. Using AlwaysReady's task delegation feature, assign a brief knowledge check to a senior staff member. Ask them to speak with two care workers about how they seek consent in practice, and to record what they said. The record is timestamped and stored against the Consent KLOE, creating ongoing evidence that the knowledge is live in the service, not confined to a training completion record.
Track DoLS authorisations and review dates. Upload current DoLS authorisations in AlwaysReady and note the review date. Linking these to individual care records also supports the evidence trail for safeguarding governance, where DoLS and capacity intersect. A service that can demonstrate that every active DoLS authorisation is current, reviewed on schedule, and linked to the relevant care record is meeting the standard CQC expects under the Consent KLOE and the Safeguarding KLOE within Safe.
Download AlwaysReady's free Annual Compliance Audit Calendar. August's focus is the Mental Capacity Act and Deprivation of Liberty Safeguards specifically, covering capacity assessments, best interest decisions, DoLS records and consent documentation. Working through the calendar each year builds a consistent, evidenced approach to one of the most legally significant areas of adult social care governance. Download it here.
References and regulatory sources
- Care Quality Commission (2026). Draft assessment framework for adult social care. Published 19 March 2026. Available at: cqc.org.uk
- Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 11: Need for consent.
- Mental Capacity Act 2005. Available at: legislation.gov.uk