Such investigations can be extremely challenging for any care provider and have the knock on effect of reputational damage and pressure on staff. Demands for improvements and the threat of enforcement can also add significant stress and concern to businesses.

The CQC when undertaking their inspections and monitoring of service seek to ensure that five key questions are addressed: Is the service safe, effective, caring, responsive and well led?

Previous enforcement and prosecution usually arise due to failures to provide safe care and treatment and where breaches of regulations result in avoidable harm and/or significant risk of harm.

There have been a significant increase in both enforcement action and the level of fines over recent years with recent examples of CQC prosecutions against care facilities including:

• when a resident fell out of her wheelchair,

• the failure to share details in a timely manner of what happened following the death of a resident,

• a failure to keep a resident safe when a door that had been removed by builders was left in an unsafe position causing it to fall onto a resident,

• a failure to provide safe care and treatment and failure to protect a resident from avoidable harm when a resident was subject to a sexual assault by another resident

• a substantial fine of £1.5m for a care provider that failed to provide safe care and treatment when a resident choked on food when the care provider knew or ought to have known that he was at an increased risk of choking.