The key principles of the Commission in regulating care services were threefold; keeping people safe; promoting dignity and choice, and supporting independence.

The regulation was carried out by means of RICE, which is an acronym for Registration, Inspection, Complaints investigation, and Enforcement.

Registration ensured that the service, before opening, could demonstrate that it would be provided in line with legal and good practice requirements, and in conformity with the Health and Social Care Standards.

Complaint investigations were initiated by communication from service users, their relatives, or members of the public.

It usually consists of additional conditions on further operation: where these are not met, the enforcement can ultimately lead to the closure of the service.

The aim of the grading system was to provide a clearer indicator of quality and of where improvements were needed.

[9] In September 2011, under plans to toughen up the system, it was revealed that Scottish care homes will get at least one unannounced inspection a year.

[11] The affected organisations including the Care Commission worked closely together to ensure a smooth changeover to the new structures.

Issues with the Care Inspectorate's performance and the effectiveness of the Scottish Parliament's oversight of it have long been raised at the highest level in Scotland.

In 2011, the Health Secretary, Nicola Sturgeon announced that the Care Inspectorate was failing to fulfil its obligations.

In August 2023, BetterCareScotland reported that the Scottish Public Services Ombudsman is investigating claims that the Care Inspectorate's inspection processes routinely fail to identify and, therefore, address risk-taking by care providers or recognise the indicators of "closed cultures" in the sector and stonewalls serious complaints about its operations.

In April 2024, BetterCareScotland called on the Scottish Parliament to address the need for independent oversight of social care regulation in Scotland by a professional body with risk management, regulatory, compliance, analytical & lay expertise to eradicate poor practices that expose women to the risk of abuse in care homes for older people in Scotland & loopholes that enable its cover-up.