Duty of Candour in a Care Home: What Regulation 20 Requires and How to Comply

Duty of Candour in a Care Home: What Regulation 20 Requires and How to Comply

A plain-English guide to the duty of candour in adult social care: the general duty to be open, the formal steps for notifiable safety incidents, and how to evidence that you did it.

The duty of candour is a legal duty for registered providers to be open and transparent with people using their service, and their families, about care and treatment. CQC says it applies at all times and in all cases. Regulation 20 adds formal steps when a “notifiable safety incident” happens: tell the person in person as soon as reasonably practicable, apologise, share the facts and the enquiries you will make, follow up in writing and keep a record.

Duty of candour is one of the most misunderstood regulations. Many managers assume it only applies to serious incidents, or confuse it with the “duty of care”. This guide separates the general duty from the formal one, explains what triggers the formal steps and how to document them, and shows how inspectors are likely to test it.

The General Duty: Be Open and Honest

Regulation 20 says registered persons “must act in an open and transparent way with relevant persons in relation to care and treatment provided to service users”. CQC’s guidance describes it as an overarching duty that applies “at all times and in all cases”, so if something goes wrong you must let the person know what has happened (CQC: Reporting medicine related incidents). Openness is also a culture: staff need to feel safe to report mistakes so you can put them right.

Duty of candour is different from the duty of care. Duty of care is about the standard of care you provide. Duty of candour is about honesty when something goes wrong.

What Is a Notifiable Safety Incident?

For a provider that is not an NHS body, a notifiable safety incident is any unintended or unexpected incident that occurred during the provision of a regulated activity and that, in the reasonable opinion of a health care professional, appears to have resulted in one of the following (CQC: Regulation 20):

• the death of the person, where it relates directly to the incident rather than their illness or condition;
• an impairment of sensory, motor or intellectual function that has lasted, or is likely to last, at least 28 days;
• changes to the structure of the person’s body;
• the person experiencing prolonged pain or prolonged psychological harm (defined as at least 28 days);
• a shortening of the person’s life expectancy;
• the person requiring treatment by a health care professional to prevent death, or an injury that, if left untreated, would lead to one of the outcomes above.

The regulation defines the terms precisely, so read the full text and get the opinion of a health care professional where the threshold is unclear. CQC also published clarification of what “unexpected or unintended” means for applying the test. If in doubt, follow the formal steps.

The Steps You Must Take

The “relevant person” is the person who used the service, or someone acting on their behalf, for example if they have died or lack capacity. Regulation 20 also covers the case where a person cannot be reached: keep a written record of attempts to contact them.

A Practical Example (Illustrative)

A resident is given the wrong dose of a medicine and needs emergency treatment, with harm that a clinician expects to last for more than 28 days. The manager arranges care first. Once the resident is safe, the manager speaks to the resident’s family in person, explains what happened, apologises, says what the home will investigate and when they will hear back, and later sends a letter setting out the same. Every conversation, including a missed call to a family member, is recorded. The incident is also entered in the incident log, considered for CQC notification and safeguarding referral, and reviewed for root cause. See what to do after a medication error.

Duty of Candour vs Notifying CQC

These are separate obligations. Telling the person under Regulation 20 does not replace notifying CQC where a notification threshold is met, and notifying CQC does not satisfy the duty of candour. Your incident record should show what you told the person, what you told CQC and safeguarding, and when. See notifiable events.

What Inspectors Look For

• Whether staff understand that being open applies to every incident, not only serious ones.
• Records of notifications, apologies and written follow-ups for notifiable safety incidents.
• A culture where mistakes and near misses are reported and learned from, not hidden.
• Whether complaints and incidents show openness in how the provider responds. See how to handle a complaint.
• A duty of candour policy that staff can describe.

Keeping the Records

The strongest evidence is an incident record that shows what you told the person and when. CQCLogic’s incident management log records incidents with flags for RIDDOR, CQC and safeguarding notifications, alongside complaints, medication error and CQC notification logs, so the trail sits together. Recording who was told and when is still something your team must do, so add it to your incident procedure.

Sources: CQC: Regulation 20, Duty of candour · CQC: Reporting medicine related incidents