Domiciliary Care Experts

On this page

• Overview
• Kindness, compassion and dignity
• Treating people as individuals
• Independence, choice and control
• Responding to people’s immediate needs
• Workforce wellbeing and enablement

Caring – this means we looked for evidence that the provider involved people and treated them with compassion, kindness, dignity and respect.

At our last assessment of this key question, we rated this key question good. At this assessment the rating has changed to requires improvement. This meant people did not always feel well-supported, cared for or treated with dignity and respect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always treat people with kindness, empathy and compassion, or respect their privacy and dignity. The provider had consistently failed to make improvements to the service to improve people’s lives.

We received mixed feedback from people and relatives about how they were treated. Comments included, “The company keep trying to send female carers and I keep telling them that my relative prefers male carers for their personal care. I have had to call the office and get them to send a male carer on numerous occasions , thankfully that has now stopped happening but my relative’s wishes should have been foremost and they were not and I believe that this company has not got my relative’s best interest at heart which is very upsetting and sad for both of us”, “The care staff are amazing and very kind and caring”, “I have all female carers and most of them are kind and caring”, “All the carers are kind to me”, “The staff are all kind and caring towards her and treat her with the utmost respect”, “Some of the carers are lovely and very kind and caring but some of them seem to have an attitude problem and can be rude and have no communication with me at all” and “Very few of the carers make an effort to get to know my relative.”

Some care plans provided details about people’s religious and cultural needs and how people preferred to be supported. Some care plans did not provide this information.

The provider did not always treat people as individuals or make sure people’s care, support and treatment met people’s needs and preferences. They did not always take account of people’s strengths, abilities, aspirations and protected characteristics.

We received mixed feedback from people and relatives about whether their care and treatment met their needs and preferences. A relative said,

“My relative has 2 carers a day, the morning carer is really good her name is [staff name] and we cannot praise or thank her enough for the care she gives our relation. The afternoon carers tend to rush in and straight out almost, to the extent that they are not prompting our relative to go to the toilet or to change their incontinent pad. The afternoon carers do not tend to wash our relative, or change them when they have had an accident, or change their bed linen if needed. This has been leading our relative to get infections which is unacceptable and unnecessary.”

Other comments included, “There is one lovely carer that I would like all the time. I have no special religious or cultural issues they need to know about. My religion is love and I incorporate all the lovely teachings together”; “My relative has complex needs and these carers do not know how to care for someone with these needs. I live in the same house, and I am regularly disturbed when the carers are here because my relative wants a drink or something to eat which is something they should be capable of doing. The carers tend to sit in a chair and do nothing” and “My relative certainly feels safe with them as they all get cuddles when they leave which reassures me that my relative feels very comfortable with them and is being looked after well.”

The provider’s electronic call monitoring data showed that a person had received care from 20 different members of care staff over 54 visits. That equated to a different staff member nearly every third visit. The call monitoring data showed there were 25 other people who had also received visits from 20 or more care staff on visits over the same period. This meant that people did not receive care form a consistent staff team. People’s feedback and provider’s records in the office also showed people and relatives had requested more consistent staff.

Some care plans provided details about people’s likes and dislikes and how they liked to be supported. Some care plans did not provide this information.

The provider did not always promote people’s independence, so people knew their rights and had choice and control over their own care, treatment and wellbeing. People lived independently in their own homes. Some people lived with relatives. They were supported to do things that were important to them such as going shopping or going to medical appointment by their relatives. Some people were supported by staff to access the community. Some care plans provided details about what people could do for themselves and how they liked to be supported. Some care plans did not provide this information. We received mixed views from people and their relatives about choice and control over care and whether staff made time to chat with them as part of their care and support. Comments included, “They literally just want to be in and out. The better ones do wash and shower me properly” and “I have had numerous meetings with the bosses of this company, they have come to our house and viewed the images on the camera’s that show that their staff are not interacting with my relative. They do not talk to my relative, they make no attempt to talk with them, they do not want to talk to them.”

Staff told us they supported people to do things for themselves to encourage independence. A staff member said, “I motivate people with their independence, trying to get them out for walks and get outside more. I make sure she eats and prompt her.”

The provider did not always listen to and understand people’s needs, views and wishes. Staff did not always respond to people’s needs in the moment or act to minimise any discomfort, concern or distress. We received mixed feedback from people and relatives as to whether their immediate needs were met. A relative said,

“I have never seen any evidence to show that any of these carers have ever washed my relative. The carers never wash or dress my relative, they expect me to, and in the end I must. These carers are here to help my relative and to give me some respite care during the day and once a fortnight there is an overnight carer so that I can go and stay somewhere for a complete break but it is now getting to the point where I cannot get away as they phone me sometimes at 0200 and I have had to come home. Plus, I do not feel that my relative is safe if I am not here.”

Other comments included, “We did have an issue with the carers not speaking to our relative when they first came into the room which we could not accept, we contacted the company and now all the carers say “Good Morning” to our relative. We are happy that this has been resolved and they recognise our relative”, “I am bedridden and they give me a strip wash every day and wash my bed linen if needed, which is good” and “They wash and shower me as often as I want and always ensure that I am warm enough.”

We observed that the manager stepped in on the second day of our visit to the office to provide support to a person who had been having a mental health crisis. This enabled the person to have support from someone they knew to stay with them until medical help arrived.

The provider did not always care about or promote the wellbeing of their staff. They did not support or enable staff to deliver person-centred care. Staff did not feel well supported they were unaware of any support for them in relation to their mental health, a number of staff reported not getting properly paid for areas such as travel, mileage and annual leave. This did not make them feel valued by the provider. Staff told us they were not always paid correctly for annual leave, mileage and travel. Some staff felt unable to challenge this in fear that their sponsorship to work would be revoked. Staff had reported concerns to the office, but they had not been resolved. We provided advice to staff about UK employment law and their rights. The provider told us they were investigating these issues and advised us they would be making contact with all staff to get an understanding of who had been affected.

Communication within the team was not always effective, staff told us extra care visits were added or removed from their rotas without them being notified or asked. This included on their scheduled days off. A staff member said, “Sometimes it is difficult, if I get sick and I am not able to work I will call the office and they tell me to find the cover, even to go for a dentist appointment. Sometimes I get messages from my colleagues asking for cover as they are sick and they’ve been told the same. Sometimes the office will find cover. Sometimes they add things to the rota without telling you. We complain about this, carers say I can’t check the rota in the middle of the night when I am sleeping.” Staff meetings had not taken place where staff could have opportunities to discuss this with the provider.

Staff gave us mixed feedback. They told us, “I am not sure about staff wellbeing packages or support to meet religious needs. I have alternate weekends off and some weekdays. They are not flexible around childcare at all”, “I have never heard of any staff wellbeing packages”; “After their last rating [the nominated individual] started to show some kind of care. We are told in training to report things, but it is not supported in practice, which means staff leave” and “They give every other weekend off so we can still go to church. They are flexible with childcare. I have not heard of an employee assistance programme.”