Read the results of our review into the quality of care being provided to people in their own homes.
Home care is a range of care and support programmes that aim to help people live in their own homes and maintain their independence.
The number of people being cared for in their own homes is increasing. This trend is mirrored by the increased percentage of home care services that have registered with us. Sixteen per cent more home care services registered with us in 2011/12 compared to the previous year, and this increased again by six per cent in the first six months of 2012/13.
How did we carry out the review?
This review began in April 2012 and ran alongside our regular programme of inspections.
It looked at whether people receiving care at home are treated with dignity and respect, are supported by skilled staff, have choice about their care and benefit from processes that are meant to keep them safe.
During the review we inspected 250 services providing care to 26,419 people.
We wanted to gather as many experiences as possible and gathered the views of more than 4,600 people. This included:
- visiting 738 people in their own homes.
- discussing the experiences of 2,742 people, including 274 relatives and friends of people receiving care.
- analysing the responses of over 1,000 submitted questionnaires and 130 webforms.
Our inspection teams also included Experts by experience (people who have received home care or who have experience of caring for somebody who has). You can read Helen's story to find out more about Experts by experience and their work.
What works well?
Throughout the review we found many services that were delivering good care. Overall, 74 per cent of the 250 services inspected were meeting all five of the National standards we checked.
The services that performed well in our review displayed many similar ways of providing good care.
Services encouraged and supported people to express their views through things like satisfaction surveys. This meant that many people felt they could influence the way care was provided to them.
I always know what's going on, because they say what they are doing.
Services often encouraged people to comment directly into their care plans and involved relatives and carers in this process as well.
In addition, services that provided good care kept detailed records of people’s preferences and choices. They also carried out risk assessments when they updated the records to ensure that changing needs were met as safely as possible.
Written information about the choices available to people, which were explained face-to-face, was also evident.
Eighty-two per cent of services had provided people with written information about the signs and types of abuse that could occur and who to contact at the service if they had any concerns.
Ninety-seven per cent of services that had provided this information were meeting standards on safeguarding, compared to 90 per cent of services that hadn’t.
They encourage me to be independent. That is important to me.
Another aspect of good care came from care staff who had gained knowledge of people’s own routines and limitations. This allowed them to give people their independence to get on with their daily tasks without interfering until necessary.
Although I am not well I still feel I am in control as they ask me what I would like them to do."
Submitted questionnaires contained positive comments about safeguarding and preventing abuse. Eighty-six per cent of people receiving care said they always felt safe around care workers, and a higher percentage (95 per cent) of their friends, relatives and carers thought their relative felt safe.
This is because many providers had processes in place for staff and managers to follow if they suspected any abuse. Most staff had also received training and understood how to identify and report abuse and wore their identification badges to confirm their identity.
What needs to improve?
Many people feel that they lacked choice with regard to the number of new or unfamiliar care workers who arrived at their home.
There is a lack of continuity and we have had 25-30 different [care workers] since they started coming.
On many occasions, people received no advance notice that they would be visited by a care worker that they didn’t know. We found one instance where a person had 13 different care workers for 35 calls.
A number of people told us that new care workers were often not aware of their needs and they found it frustrating when they had to explain how they liked things to be done.
Systems and processes that monitor care
Some care managers did not have clear systems in place to monitor the quality and information in care plans. This meant that there was no clear way of determining whether the care was appropriate, if it was being delivered in the right way or if it was effective.
We are also concerned that some staff are not aware of their own whistleblowing policy or safeguarding procedures. This could mean that signs of abuse are not identified early and that concerns are not reported.
I feel like I am just a number to them.
Late and missed calls
At times, care was not being delivered as planned because of late or missed calls. Care workers put this down to being rushed or not staying for the allocated length of time because they had to travel to the next visit.
Weekends are a particular cause for concern with regards to missed or late calls.
Some staff felt they were not supported enough by their managers. Appraisals of staff’s performance did not always take place even when they were scheduled in.
Without formal appraisal of staff performance, it is difficult to identify what development, support or training staff need.
Capturing feedback and taking action
At times, there was no evidence to show what action services had taken after they had captured feedback from people who use their service. The findings were not used to identify themes or trends, and results were often not fed back to people.
It's very awkward, the supervisor comes round every three months and asks me questions. It's difficult to answer because she does it with the carers there.
There is pressure on services due to the arrangements for commissioning home care, strains on social care budgets and the rise in the number of people with complex needs.
Services should try to learn from our findings and incorporate them into the way they provide care. This is especially important as the need for good home care is only going to increase.
- continue to work with commissioners to understand the challenges around late or missed calls and find solutions.
- investigate incidents to identify problems so that the right action can take place to stop it from happening again.
- ensure that new care workers are introduced to the people they care for.
- give new staff a full induction according to national standards before they start work.
- train staff to support people in the best way possible, and give them the relevant information about local safeguarding procedures including how to raise concerns.
- gather the views of family and carers more proactively.