What Is a Nursing Home? Care Homes With Nursing, CQC Registration and How They Differ From Residential Homes
For providers and managers: what makes a care home a nursing home, how CQC registers it, and what changes for staffing, medicines and governance.
A nursing home, properly called a care home with nursing, provides accommodation and personal care together with nursing care, and always has one or more qualified nurses on duty. In CQC terms it is registered for “Accommodation for persons who require nursing or personal care” and, where it employs registered nurses who carry out treatment, is likely to need to register for “Treatment of disease, disorder or injury” too. Nursing homes usually cost more than residential homes because they provide nursing care.
The difference between a residential home and a nursing home is mostly explained to families as a price and care-level difference. For a provider it is also a regulatory one, with consequences for registration, staffing, medicines and clinical governance.
This guide uses CQC’s scope of registration guidance (accommodation for persons who require nursing or personal care), the NHS description of care homes (NHS: care homes) and CQC’s controlled drugs guidance.
Key takeaways
- A nursing home is a care home with nursing: personal care plus nursing care, with a qualified nurse always on duty.
- CQC registers it for Accommodation for persons who require nursing or personal care, and likely also for Treatment of disease, disorder or injury if its nurses carry out treatment.
- Care homes with nursing can hold stocks of controlled drugs in Schedules 3, 4 and 5 without a Home Office licence. Care homes without nursing cannot hold stock.
- Nursing care brings clinical governance duties: nurse supervision, clinical audits and professional accountability sit alongside the fundamental standards.
- If a person’s needs outgrow a residential home, you need a documented plan, not an informal transfer.
In this guide
What Is a Nursing Home?
The NHS says nursing homes provide personal care too, but there will always be one or more qualified nurses on duty to provide nursing care. They are sometimes called care homes with nursing, and some care homes offer both residential and nursing places. Some nursing homes support people with, for example, severe learning or physical disabilities, a complex medical condition needing a qualified nurse (such as a colostomy or tube feeding), or a recent serious illness or surgery requiring rehabilitation.
How Is a Care Home With Nursing Registered With CQC?
A care home with nursing is registered for the regulated activity Accommodation for persons who require nursing or personal care, the same activity as a residential care home. CQC’s guidance adds that providers of care homes with nursing are likely to also need to register for Treatment of disease, disorder or injury if they employ registered nurses or other listed professionals who carry on that activity. CQC notes possible exceptions where registered nurses are not employed in their professional capacity and do not carry out treatment.
Where nursing care is needed in a care home, CQC says tasks may be delegated to care staff by a listed healthcare professional employed by a provider registered for Treatment of disease, disorder or injury, for example a district nursing service. See who needs to register with CQC and how to change a registration if you want to add nursing.
Nursing Home vs Residential Home: What Is the Difference?
| Residential care home | Care home with nursing (nursing home) | |
|---|---|---|
| Personal care | Yes | Yes |
| Nursing care | No | Yes, with a qualified nurse always on duty |
| Typical needs | Support with daily living | Complex medical needs, clinical monitoring, rehabilitation |
| CQC registration | Accommodation for persons who require nursing or personal care | The same, and likely Treatment of disease, disorder or injury |
| Controlled drugs stock | Cannot hold stock; only drugs prescribed for an individual | Can hold stock of Schedules 3, 4, 5 without a Home Office licence; may need a licence for Schedule 2 stock |
| Cost to the person | Usually lower | Usually higher because nursing care is provided |
See what is a residential care home and controlled drugs in care homes.
What Extra Governance Does Nursing Care Bring?
The same fundamental standards apply, but nursing homes carry additional risks that inspectors test, especially under Regulation 12 and Regulation 18:
- Clinical competence: registered nurses’ revalidation and supervision, and competency checks for delegated tasks.
- Clinical audits: medicines, infection control, wounds and pressure care, nutrition and falls, with findings and re-audits.
- Medicines: stock controlled drugs registers, fridge temperature records and stock balances.
- Escalation: clear criteria for when to call a GP, 111 or 999, and records of the response.
- Staffing: enough nurses and care staff on every shift, and a plan for gaps. See safe staffing levels.
How Can CQC Logic Help a Care Home With Nursing?
CQC Logic helps you evidence the governance side: a schedule of audits with ratings, findings, actions and re-audit dates (you can add clinical audits as custom audits), incident, complaint, safeguarding and medicines error logs, a training tracker and supervision log, a notification tracker and an inspector evidence pack. It does not provide clinical records, nurse rostering or an eMAR. See plans.
Sources: CQC: Accommodation for persons who require nursing or personal care · NHS: Care homes · CQC: Controlled drugs in care homes
Evidence clinical and care governance together
CQC Logic tracks your clinical and care audits, incidents, notifications and actions in one place so inspectors can see how your home is governed. See a sample improvement plan, view pricing or get started free.
Frequently Asked Questions
What is a nursing home?
A nursing home, properly a care home with nursing, provides accommodation, personal care and nursing care, with at least one qualified nurse on duty at all times.
What is the difference between a care home and a nursing home?
A residential care home provides accommodation and personal care. A nursing home provides the same plus nursing care from qualified nurses. Some care homes provide both types of place.
How does CQC register a nursing home?
For Accommodation for persons who require nursing or personal care and, where employed registered nurses carry out treatment, likely also Treatment of disease, disorder or injury.
Can a nursing home hold controlled drugs?
Yes. CQC says care homes with nursing can hold stocks of controlled drugs in Schedules 3, 4 and 5 without a Home Office licence and may need a licence to hold Schedule 2 stock.
Does a nursing home have to employ nurses?
To be a care home with nursing it needs to provide nursing care, which the NHS says means a qualified nurse is always on duty. CQC also says in some cases nursing tasks can be delegated by a listed healthcare professional from another registered provider.
Is a nursing home the same as a hospital?
No. A nursing home is a place where people live and receive nursing and personal care. Hospitals provide acute treatment and are registered for different regulated activities.