A nurse calls in sick at six in the morning, the agency sends someone for the long day, and by half past seven she is standing at the medicines trolley with residents she has never met. If a CQC inspector asks that afternoon how you know she was safe to be there, “the agency checked” is not an answer that holds. Booking agency nurses for care homes is routine for most nursing home managers. The paperwork that sits behind each booking is where homes get caught out.
This guide is for the registered manager of a nursing home in England who books agency nurses and wants to know what to hold on file and what to check on the day.
Why agency nurses count as your staff for CQC
Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 covers fit and proper persons employed. CQC’s guidance is clear that “person employed” includes agency and bank staff who work in your service. The information listed in Schedule 3 of those regulations, such as proof of identity, criminal record information, employment history and evidence of qualifications, has to be available for each of them.
An agency can do the checks. The responsibility stays with you. CQC’s wording is that providers must assure themselves that all checks are complete and satisfactory. In practice that means you need something on file, before the shift, that tells you what the agency checked and when.
What the agency should send before the first shift
Ask every agency for a profile of each nurse it sends. A good profile names the nurse, carries a photo, and confirms the NMC PIN, the enhanced DBS with adult barred list check and its date, right to work, references, recent mandatory training, and any competencies relevant to your residents, such as PEG feeding, catheter care or syringe drivers. It should be dated and signed off by someone at the agency you could ring.
Agencies have their own legal duties here. The Conduct of Employment Agencies and Employment Businesses Regulations 2003 require an agency supplying someone to work with vulnerable adults to obtain copies of relevant qualifications, take two references and confirm it knows of nothing that makes the person unsuitable. If an agency cannot send you that confirmation in writing, that tells you something about the agency.
How to check the NMC register yourself
This is the check most often skipped on a short notice shift, and it takes two minutes. Search the NMC register online using the nurse’s PIN. Confirm three things. The name matches the person in front of you. The registration is current and in the right part of the register, which for most nursing homes is adult nursing or, for some units, mental health or learning disabilities. There are no conditions of practice, cautions or interim orders that would affect the work you are asking them to do.
Nurses revalidate every three years, and a registration can lapse if the annual fee or revalidation is missed. A PIN that was fine on a profile in March may not be fine in October. Check on each new booking, and at least monthly for a nurse who works with you regularly. Our guide to NMC register checks walks through what each entry on the register means.
Right to work after the October 2026 changes
From 1 October 2026, section 48 of the Border Security, Asylum and Immigration Act 2025 extended the illegal working rules beyond employees to workers, agency staff and people engaged through contracting chains. The person who employs the nurse, usually the agency or its payroll, is still the one who carries out the check. What has changed is how closely the rest of the chain is now looked at.
The civil penalty is up to 45,000 pounds per illegal worker for a first breach and up to 60,000 pounds for a repeat breach within three years. Your contract or terms with each agency should say in writing that it carries out right to work checks under the Home Office code of practice before every placement, and your profile should record that the check was done. We covered the detail in our piece on right to work checks for care staff.
On the day: identity, induction and medicines
When the nurse arrives, check photo ID against the profile. Homes have been sent the wrong person before.
Regulation 18 requires staff to have the competence and support to do the job, and CQC inspectors look for evidence that agency staff were inducted. A one page local induction covers most of it. Fire procedure and exits, the emergency grab sheet, who the on call manager is, residents at risk of falls or choking, residents with DNACPR decisions, and how your medicines system works, especially if you use an electronic MAR the nurse has not seen before. Keep the signed sheet with the profile.
If a nurse cannot log on to your eMAR or does not know your controlled drugs procedure, that is a medicines safety risk under Regulation 12. Book the first shift for a new agency nurse with your own nurse on, where you can.
The twelve week rule and what you tell the agency
Under the Agency Workers Regulations 2010, a nurse who works the same role for you for twelve calendar weeks becomes entitled to the same basic pay and conditions as a nurse you employ directly. The agency has to apply it, but it can only do so if you tell it what your own staff nurses are paid and what their basic conditions are. Our explainer on the 12 weeks rule covers how the weeks are counted and when the clock resets.
If you want to take on an agency nurse permanently, read your agency terms first. The 2003 Conduct Regulations allow a transfer fee only in limited circumstances and give you the option of a longer hire instead of paying one.
A short file that answers the inspector
For each agency nurse, aim to hold the profile, the date you checked the NMC register, the signed induction, and the shifts they worked. That is four things, and they answer most of what an inspector will ask about agency use.
Flamingo Workforce supplies registered nurses to care and nursing homes with the profile and compliance file sent before the first shift. If you would like to talk about cover for your home, send us your details through our enquiry form and we will come back to you.