The care home sector is going through a transformational change and is ill prepared for the pressures of increased regulation, limited finances, more complex workloads and the need for a larger skilled workforce. The Putting People First agenda calls for more personalised care where the person maintains independence, choice and dignity in all decisions throughout their care pathway. Coupled with the integration of health and social care regulation, care homes must deliver on government targets while operating in an increasingly risk adverse and regulated environment.