Residential homes are inspected by the Care Quality Commission, established in 2009 to regulate health and social care services in England.
The CQC regulates private and local authority-run homes, along with GP surgeries and hospitals, and has a team of inspectors who carry out both pre-announced and surprise visits.
Care providers must be registered with the CQC to operate and are required to meet a set of safety and quality standards to do so.
There are four ratings issued by the CQC: outstanding, good, requires improvement and inadequate. Care homes are given an overall rating, and one for each of the inspection areas of being safe, effective, caring, responsive and well-led.
During an inspection, the CQC may speak to staff and residents at a home, check that the building meets safety standards, that medications are kept safely, records are updated and that there are adequate numbers of staff.
By law, care providers have to display their CQC ratings.
Care providers must take action in response to areas of concern raised by the CQC, and face follow-up visits to make sure improvements have been made.
An inadequate rating and failure to improve can see the CQC effectively close a home down by cancelling its registration.
The CQC can issue enforcement notices and draw up action plans to raise standards.
Warning notices can also be issued under the Health and Social Care Act 2008 if regulations have been breached.
Homes rated as inadequate can be placed in special measures, where the CQC closely supervises people’s care and helps the home improve within a set timescale.
Providers can be fined and prosecuted by the CQC in serious cases where people have been harmed or put in danger.
The CQC strengthened its inspection regime to better respond to whistleblowers and protect vulnerable people after a TV documentary exposed mistreatment of residents at Winterbourne View Hospital near Bristol in 2011.
It was described as a "watershed moment" for the regulator. Before Winterbourne View, the CQC was receiving around 50 whistleblowing contacts a month. That rose to more than 500 after the scandal emerged.
Local authority safeguarding teams also work with the CQC and respond to concerns raised over the welfare of care home residents.