Duty of Candour in Domiciliary Care: What Regulation 20 Requires

The duty of candour is a legal requirement for all CQC registered providers. It requires you to be open and transparent with service users and their families when things go wrong. Specifically, when a "notifiable safety incident" occurs, you must tell the person affected (or their representative) what happened, apologise, and offer appropriate support. This is not optional. It is a condition of your CQC registration under Regulation 20 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

For domiciliary care agencies, understanding when the duty is triggered, what it requires, and how to document compliance is essential.

What Triggers the Duty of Candour

The duty is triggered by a "notifiable safety incident." In the context of domiciliary care, this means any unintended or unexpected incident that occurred during the provision of a regulated activity that, in the reasonable opinion of a healthcare professional, appears to have resulted in the death of the service user (where the death relates directly to the incident), severe harm, moderate harm, or prolonged psychological harm.

The threshold is important. The duty of candour does not apply to every incident. It applies when the incident has caused or could have caused significant harm. A missed visit where the service user was unharmed may not trigger the duty. A medication error that resulted in the person being hospitalised would.

The question of whether an incident meets the threshold requires professional judgement. Your policy should state who makes that determination. In most domiciliary care agencies, this will be the registered manager, potentially in consultation with the service user's GP or other healthcare professional.

What You Must Do

When a notifiable safety incident occurs, Regulation 20 requires you to:

1. Notify the relevant person: tell the service user (or their representative if the service user lacks capacity to be informed) as soon as reasonably practicable after the incident is identified. This initial notification should be verbal, face to face where possible.
2. Provide a reasonable account of what happened: explain what the incident was, why it happened (if known at that stage), and what you are doing about it.
3. Apologise: offer a sincere and meaningful apology. The legislation is clear that an apology is not an admission of liability.
4. Follow up in writing: after the verbal notification, provide a written notification containing the same information. The written notification must include the apology.
5. Provide reasonable support: consider what support the person needs as a result of the incident. This might include arranging alternative care, facilitating access to medical treatment, or providing emotional support.
6. Keep a record: document everything. The verbal notification, the written notification, who was told, when, what was said, and what support was offered.

Common Mistakes

The most frequent failure is simply not applying the duty of candour when it should be applied. Many agencies do not recognise when an incident crosses the threshold, particularly for moderate harm. If a service user sustains an injury during a moving and handling task and needs medical treatment, that is likely to be moderate harm, and the duty is triggered.

Another common mistake is treating the duty as a box-ticking exercise. Sending a standard letter without a genuine apology or explanation does not meet the requirement. The duty requires openness and transparency, not a form letter.

A third mistake is failing to follow up. The initial verbal notification is only the first step. The written follow-up must also be provided. Many agencies do the verbal notification but forget or delay the written one.

How CQC Inspects Compliance

CQC inspects the duty of candour primarily under the Well-Led key question, although it also features under Safe. Inspectors will check that your duty of candour policy exists and reflects Regulation 20 accurately, that staff understand what the duty of candour is and when it applies, that you have records demonstrating compliance when notifiable safety incidents have occurred, and that your incident reporting system identifies when the duty of candour threshold is met.

If an inspector reviews your incident records and finds notifiable safety incidents with no evidence that the duty of candour was applied, this is a regulatory breach. For a broader understanding of what CQC inspects in your governance documentation, see our guide on registered manager documents.

Writing Your Duty of Candour Policy

Your policy should include the legal basis (Regulation 20), a definition of notifiable safety incident with practical examples relevant to domiciliary care, who is responsible for identifying when the duty is triggered (typically the registered manager), the process for verbal notification including who delivers it, the process for written notification including templates and timescales, how support is determined and provided, how records are maintained, and how staff are trained on the duty.

The policy should also reference your other related policies, particularly your safeguarding policy, your incident reporting procedure, and your complaints procedure. The duty of candour overlaps with all of these, and your staff need to understand how they work together.