Adult social care
Care Worker Appraisal & Supervision (CQC)
Supervision and annual appraisal for care home and home care staff, covering safe, person-centred practice and learning.
19 questions ~15 min to complete Self + manager
Downloadable template
Editable Word + printable PDF
Coming soon
Not available to buy yet. Use the interactive template today.
Designed to support staff supervision and appraisal processes relevant to CQC Regulation 18 (Staffing).
Written for England
Not a substitute for your organisation's regulatory obligations or legal advice. Buying or completing this template does not by itself demonstrate compliance.
What's included
- Safeguarding, consent, medicines and records in one review
- Works for regular supervision and the annual appraisal
- Care Certificate and qualification progress captured
Areas rated
- Person-centred care
- Dignity and respect
- Safeguarding
- Consent and capacity
- Medicines
- Safe practice
- Records
- Communication
- Teamwork
- Learning
- Intended for
- Adult social care · Self and manager appraisal
- Written for
- England
- Version
- Version 1
- Content reviewed
- 18 October 2026
Includes future updates to this pack. Updates are added as a new template version; your past reviews never change.
What respondents see
Required
How well is care delivered around each person's needs, preferences and routines?
All 19 questions
Every question in version 1, in order. Rating questions use a 1–5 scale; written questions leave room for the employee and manager to respond.
Person-centred care
- 1How well is care delivered around each person's needs, preferences and routines?Rating: Rarely to Consistently
- 2How well are people supported to stay as independent as they want to be?Rating: Rarely to Consistently
Dignity and respect
- 3How consistently are privacy, dignity and respect shown in everyday care?Rating: Rarely to Consistently
Safeguarding
- 4How confidently are signs of abuse or neglect recognised and reported through the right route?Rating: Rarely to Consistently
Consent and capacity
- 5How well is consent sought, and are people supported to make their own decisions?Think about the Mental Capacity Act and the person's care plan.Rating: Rarely to Consistently
Medicines
- 6Where medicines support is part of the role, how safely and accurately is it given and recorded?Leave unanswered if medicines are not part of this role.Rating: Rarely to Consistently · optional
Safe practice
- 7How consistently are infection prevention and control practices followed?Rating: Rarely to Consistently
- 8How safely are moving and handling plans and risk assessments followed?Rating: Rarely to Consistently
Records
- 9How accurate, timely and respectful are care notes and handovers?Rating: Rarely to Consistently
Communication
- 10How well does communication with people, families and other professionals work?Rating: Rarely to Consistently
Teamwork
- 11How reliably are shifts, cover and support for colleagues handled?Rating: Rarely to Consistently
Learning
- 12How actively has training been completed and put into practice?Rating: Rarely to Consistently
Reflection and next steps
- 13For home care: how is lone working going, and is anything making visits unsafe or rushed?Written · optional
- 14Describe a recent time you made a real difference to someone's day.Use initials, not full names.Written
- 15What has been difficult or worrying in your work since the last review?Supervision is a confidential space to raise this. Avoid other people's personal details.Written · optional
- 16Training completed since the last review, and how it has been used.Include Care Certificate standards, the Level 2 Adult Social Care Certificate or other qualifications in progress.Written
- 17Is there anything about safeguarding, practice or safety you want to raise?Report urgent concerns straight away through your safeguarding procedure. Don't wait for a review.Written · optional
- 18Learning and development goals for the next period.Written
- 19Agreed actions, who owns them, and the date of the next supervision.Written
Word and printable PDF versions
We're preparing a downloadable version of this pack: an editable Word template and a printable PDF form with the same 19 questions and rating scales, space for employee and manager responses, agreed actions, a development plan and sign-off. It isn't available to buy yet.
Today, the pack is available as an interactive template in Appraisal Software, where responses, ratings and results are collected for you.