How to Set Up a Care Home in England: A Step-by-Step Guide

Starting a care home is a rewarding but complex endeavour. You need to balance business acumen, legal compliance, and high standards of care. Here’s what you need to think about—and do—if you want to set up a care home in England.

1. Do Your Research & Planning

Define Your Care Home Model

• Type of service: Will it be a residential care home (personal care), a nursing home (with nursing care), or a specialist home (e.g., dementia, learning disabilities)?

• Target market: Who will your residents be? Elderly, people with disabilities, long-term or short-term stays?

• Size and location: Consider how many beds you will have, and where (urban or rural). The right premises are vital.

Market & Financial Feasibility

• Business plan: Estimate your startup costs (property, staff, training, equipment), running costs, and revenue.

• Funding: Will you fund this privately, take a loan, or find investors?

• Local demand: Research local authority social care commissioning, the competitive landscape, and demand for care services in your area.

2. Legal Structure & Governance

Choose Your Legal Entity

You need to decide whether the care home will be set up as:

• An individual (sole trader)

• A partnership

• A limited company / organisation

Your choice affects your liability, tax structure, and regulatory responsibilities. Care Quality Commission+1

Appoint a Registered Manager

If you are not managing daily operations yourself (or don’t have the right experience), you must appoint a registered manager. This person will be legally responsible for the care service. Care Quality Commission

3. Register with the CQC

Why You Must Register

To provide personal care or nursing care (“regulated activities”) in England, you must register with the Care Quality Commission (CQC). Operating without registration is a criminal offence. Care Quality Commission+1

How to Register

• Use the CQC’s provider registration form. Care Quality Commission+1

• Prepare and submit a Statement of Purpose, describing what services you'll offer, who they’re for, and your aims. Care Quality Commission

• Provide details of the location(s), legal entity, and the registered manager. Care Quality Commission

• Undergo a site visit by CQC inspectors. Care Quality Commission

• Complete DBS (Disclosure and Barring Service) checks for key personnel. Care Quality Commission

• Understand conditions: e.g., if you're running a care home without nursing, you may need to accept a “no nursing” condition. Care Quality Commission

Fees

• There is no application fee, but after registration you must pay an annual fee. GOV.UK+1

• The fee depends on the size and type of your service. Care Quality Commission

4. Premises, Safety & Policies

Find and Prepare Your Premises

• Ensure the building is suitable for residential care: accessibility, safety, fire risk, adequate rooms, communal areas.

• Comply with planning permission and building regulations.

• Have proper insurance: employer’s liability, public liability, contents, professional indemnity, etc. CPD Online College+1

Health & Safety

• Fire safety: alarms, escape routes, risk assessments.

• Infection control: cleaning schedules, PPE, protocols.

• Food safety: if you serve meals, staff handling food need food hygiene certification. CPD Online College+1

Policies, Procedures & Documentation

• Develop care policies: admissions, safeguarding, medication, complaints, safeguarding.

• Risk assessments for residents.

• Record-keeping systems for care plans, staff records, training, incidents.

5. Staffing & Training

Hiring

• Recruit qualified care staff, nurses (if needed), support staff, admin, and management.

• Carry out DBS checks for all staff. CPD Online College

• Consider staff contracts, pay, benefits, and shift patterns.

Training

• Mandatory training: first aid, moving & handling, safeguarding, medication, health & safety.

• Food hygiene training for kitchen staff. CPD Online College+1

• Leadership training for the registered manager.

6. Financial Management & Systems

• Set up accounting / bookkeeping: track income, payroll, expenses.

• Pricing: decide on fees for residents, how you’ll charge (self-paying vs local authority-funded).

• Financial sustainability: build in contingency for unexpected costs (repairs, regulatory issues, staffing).

7. Quality Assurance & Governance

• Develop a Quality Assurance Framework: audits, resident satisfaction surveys, incident reviews.

• Establish a governance structure: who is responsible for oversight, regular management meetings, reporting.

• Use risk management: plan how to mitigate risks (financial, operational, regulatory).

8. Launch & Operations

Pre-Opening

• Final CQC checks / inspection (as part of registration)

• Recruitment finalised

• Staff induction and training completed

• Marketing: reach out to local authorities, healthcare professionals, families

• Set up IT systems for records, rostering, billing

Opening Day

• Welcome your first residents

• Ensure care plans are in place

• Embed routines for medication, meals, activities, cleaning

Ongoing Operations

• Monitor and review performance: care quality, staffing, finances

• Prepare for CQC inspections: stay compliant, maintain policies, and keep records up to date

• Continuous improvement: use feedback, audits, and staff training to improve

9. Marketing & Building Referrals

• Build relationships with local authorities and social services teams — they often commission care.

• Use local networking: GPs, hospitals, community organisations.

• Develop your online presence: website, social media, care home directories.

• Advertise your care home’s unique selling points: specialist care, small home, excellent staff.

10. Sustainability & Growth

• Consider future growth: adding more beds, offering different types of care.

• Explore partnerships: health providers, local government, charities.

• Stay up to date with regulatory changes and best practice.

• Foster a positive culture: staff retention, high morale, good leadership.

Key Challenges to Be Aware Of

• Regulatory burden: CQC requirements are strict.

• High costs: property, staffing, training, insurance.

• Recruitment and retention: it's hard to hire and keep good care staff.

• Quality risk: poor care or inspections can damage your reputation.

• Cash flow: especially early on, when you have many fixed costs but fewer residents.

Conclusion

Setting up a care home in England is a serious undertaking—but also a deeply meaningful one. It requires careful planning, strong governance, and a commitment to quality care. By following the right steps—from researching and planning, to registration, staffing, and quality management—you can build a care home that’s both sustainable and compassionate.