This overview outlines the Care Quality Commission's (CQC's) approach to monitoring compliance with essential standards of quality and safety. CQC is the independent regulator of health and adult social care in England. From April 2010, CQC introduced a new registration system across the care sector. Registration is a licence to operate. To be registered, all health and adult social care providers must comply with essential standards. This document lists the 16 essential standards directly related to the quality and safety of care that CQC use in their judgement framework. It goes on to outline the registration model and the tools and methods CQC use to monitor compliance, reach judgements on risk and decide on a regulatory response. The document includes two case studies to illustrate these processes.