Domiciliary Care Experts

On this page

• Overview
• Person-centred Care
• Care provision, Integration and continuity
• Providing Information
• Listening to and involving people
• Equity in access
• Equity in experiences and outcomes
• Planning for the future

Responsive – this means we looked for evidence that the provider met people’s needs.

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’s needs were not always met.

The service was in breach of legal regulation in relation to person centred care and managing complaints.

This service scored 43 (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 make sure people were at the centre of their care and treatment choices and they did not work in partnership with people, to decide how to respond to any relevant changes in people’s needs. The provider did not have systems and processes in place to ensure that care plans were reviewed and updated in a timely manner to ensure staff had clear information in order to meet people’s needs. A person told us they did not have a care plan that detailed their care and support needs. A staff member who worked with them confirmed this. A staff member responsible for creating and amending care plans confirmed this. The provider told us they had been trying to engage with the person to resolve this.

We found care plans were out of date and did not reflect people’s needs. For example, a person’s care records identified they had suffered a stroke which had impacted on their ability to communicate and had left them with right side weakness. Their care plan provided information which showed they were unable to form words and could only make noises. The care plan provided no guidance to staff about how to effectively communicate with them. The care plan also stated that the person was prescribed medicines to manage stress and distress in Alzheimer’s Disease or delirium. There was no guidance for staff within the care plan to show how to support the person when they were anxious, distressed or confused.

Care plans provided limited guidance for staff on how to meet people’s catheter care needs. For example, they did not always provide guidance for staff on how to identify if the catheter was working correctly and what action they should take. Care plans for some people who lived with diabetes contained guidance to staff which was irrelevant in the UK. For example, telling staff about blood sugar monitoring data which is not used in the UK. The care plans provided staff with generic information and did not detail how diabetes affects individuals, such as what was the normal blood sugar level for the person was.

We found care plans had not been personalised. They appeared to contain generic information. For example, on how much fluids a person should drink in a day.

Staff told us that they did not have access to people’s care plans on their mobile phones, these had not been uploaded by the provider. This meant they had to reply on paper copies of care plans in service user homes. This led to delays at care calls and there was a danger that staff did not have the most up to date copy of the care plan to give staff clear information about each person’s care and support needs. A staff member said, “There is no care plan just a date of birth and the address. When we get there, we can read the care plan in the person’s home. If it is someone new, they get angry and frustrated because staff have to spend 5 to 10 minutes reading and we do not know what to do.”

The nominated individual emailed us 11 days after the last day of visits to the service to say, ‘We have uploaded 36 care plans and risk assessments (including routines) on to the carefree GO portal, this means care staff are able to view these on their carefree app. We will be uploading further care plans and risk assessments / care routines on Monday.’

There were some shortfalls in how the provider understood the diverse health and care needs of people and their local communities, so care was not always joined-up, flexible or supportive of choice and continuity. Care records evidenced a lack of continuity for people. We found emails and logs of contact from people asking to have a regular small group of staff visiting to meet their needs.

People and relatives gave us mixed views. Some experienced consistency and some did not. They told us, “I have asked for regular carers and the company have said that they will try and arrange that for me”, “Lots of times carers have not turned up especially when we were having 2 carers come in, we would be given maybe 10 minutes notice or it happened that no one turned up and we hadn’t been made aware”, “I have the same carer every day, so I know who is coming in on a Monday for example. It took some getting used to, having carers coming in but 2 years along and we are comfortable with the rota now.”

The provider did not supply appropriate, accurate and up-to-date information in formats that were tailored to individual needs. The provider had an accessible information policy in place. Care records evidenced that people had communication needs. It was not always evident how these were met. For example, a person used Makaton sign language and staff had not been trained in Makaton sign. Another person did not speak English as a first language, staff told us there was a communication issue and that they at times had to involve relatives to translate. Another person was recorded as using non-verbal communication methods, these were not recorded, and the staff did not know what these were. Communication plans were basic and did not provide the guidance for staff to effectively communicate with people.

Some relatives feedback that their loved ones were not communicated with by staff effectively, they gave examples of being ignored and not spoken with as part of their care.

The provider did not always make it easy for people to share feedback and ideas, or raise complaints about their care, treatment and support. The provider had not established and operated effective systems to manage complaints. Complaints had not been effectively recorded, responded to and investigated in a timely manner. We found several complaints from September and October 2025 that had not been properly dealt with. A complaint made on 1 September 2025 had no record of any response or investigation. Another complaint on 7 October 2025 about missed lunchtime medicines involved email exchanges, but there was no clear investigation outcome or apology. A further complaint on 20 October 2025 about late care calls showed that a staff member had already raised concerns about not getting enough rest between shifts, a response/outcome letter had been sent to the complainant. Effective measures had not been put in place to learn from complaints because the issue of staff being rostered to work back to back day and night shifts was still occurring (we have reported about this in safe).

The provider had not carried out any surveys with people and their relatives to gain feedback about their experiences in the last year. The nominated individual told us surveys were being planned for 2026.

We received mixed feedback from people and relatives about how well they were listened to. Comments included, “I keep complaining, they come out to our house but don’t do anything to improve their service. Because there are so few care companies in this area we are stuck”, “There has been a good response to our complaint” and “If there are any issues then I go straight to the company to get it sorted.”

The provider did not always make sure that people could access the care, support and treatment they needed when they needed it.

People lived independently in their own homes in the community and mostly managed their own daily activities and community engagement. People and their relatives told us they were always able to make contact with the service when they needed to. The service had moved to electronic records which meant staff completed daily notes on an application on their phones.

Relatives raised with us that they did not have access to these call records and therefore, they were unable to keep up to date, informed and involved with their loved one’s care and support. They told us they had raised this with the provider, but nothing had changed. Comments included, “They used to leave us little written notes about any problems, but they have now gone over to doing it all electronically which has made it much more difficult for us to monitor what is going on. I have mentioned it to the care manager and the agency, but they just say that is the way that this agency is doing things now. It was so much easier for us to monitor things before and I wish it could go back to the pre electronic ways” and “All the notes are now digitized, I have not been given access to this system and so I cannot see what the carers have been saying they have done or their comments on how my relative is on any day. I believe that I should be able to access these notes.”

Staff and leaders did not always actively listen to information about people who are most likely to experience inequality in experience or outcomes. This meant people’s care was not always tailored in response to this. It was clear from some care records people had time to chat with staff as part of care visits, showing that the visits were not task focused. However, some people experienced shortened care visits, which evidenced that not everyone had the same experience. Spot checks had not always taken place to enable people to discuss these concerns with the management team. During the assessment some spot checks had started to happen.

We received mixed views from people and their relatives in relation to their experiences. Comments included, “They don’t all know my needs and some just want to rush in and rush out”, “We like this service as they always keep us well informed and they are just so good at what they do” and “They always talk to me in a nice way and explain things to me.”

People were supported to plan for important life changes, so they could have enough time to make informed decisions about their future, including at the end of their life. Some people had a DNACPR (Do not attempt cardiopulmonary resuscitation) form in place. This is an advanced decision not to attempt CPR. It is not about other treatments or care. Some staff told us they had received training to support them to provide end of life care when needed. The provider’s records confirmed this. At the time of the assessment, no one was at the end of their life.