When the Care Quality Commission assesses a service under Well-led, it is not simply asking whether care plans exist or audits are completed. It is asking a more fundamental question: How do leaders know that staff are practising safely and appropriately when the Registered Manager is not present? For most services, this is the majority of the time. A 24/7 service operates for 168 hours each week. Even a Registered Manager working 60 hours a week is present for only around on