Surprise home care inspections underway

The Care Quality Commission (CCQ) has embarked on a special programme of 250 unannounced inspections of home care services. Over the next three months the CQC will be carrying out inspections to test ways of getting better information about how services are performing and what people think about their services.

The inspections will run alongside CQC’s programme of planned inspections, under which it will inspect all of the 6,000 or so registered home care locations each year. The 250 inspections build on what the regulator learned from a pilot programme of 30 inspections last autumn. CQC inspectors were joined by ‘Experts by experience’ – people who have a personal experience of using home care services. Experts by experience and professional experts will also be involved in this inspection programme.

Philip King, Director of Regulatory Development, Care Quality Commission, said: ‘Home care is an area where it has been difficult for regulators to carry out unannounced inspections. We clearly can’t turn up on someone’s doorstep hot on the heels of a carer without notice. And with a large number of small providers, inspectors need to be sure that there are sufficient staff available at the agency’s premises to assist with their questions without compromising care.

‘Another problem is that people may feel that it is an intrusion if you observe them receiving care in such an intimate setting; people’s privacy and dignity are included in the standards that we assess so we have to be mindful of our presence and it’s impact on people.  This makes it all the more important to hear directly from the people using home care services.

‘The difficulties inherent in regulating this sector have not deterred us in our task, but have deepened our resolve in directing our efforts into more effective regulation.

‘This special programme of inspections will be based on unannounced inspections and will use a range of ways of getting the views of people who use services and their families.

‘But we also want to use the programme to encourage providers to make sure their services comply with regulations and essential standards before their annual inspection takes place. Providers have been used to getting short notice of home care inspections: our message to all of them today is that we could be knocking on their door tomorrow.’

For the inspections, CQC will use a combination of methods to examine services. It has asked some local authorities to let it have contact details for people whose home care they fund, and when inspectors visit the provider’s office they will ask for details of a random sample of people including those who fund their own care.

They will use these details in a number of ways: they will send questionnaires to some service users and their families; others will be telephoned by experts by experience; and inspectors will make appointments to visit some people to speak with them in their own homes.

As well as interviewing the staff and managers of services, inspectors will accompany some care workers to people’s homes or may go with managers on some of the spot checks they carry out on their services. This will allow CQC to see how the agency delivers care and how the manager assesses their service. Before the visit, inspectors will ask the people using the service if they are happy for us to come to their home.

These methods, coupled with checking records, care plans, staff training and the providers’ processes and other aspects of the business, should give CQC a more rounded and reliable picture of care than regulators have been able to get before. We will ask LINks and other local groups to tell us about the care provided in their area.

The programme is supported by an advisory group, with members drawn from a range of organisations including the Equality and Human Rights Commission, Age UK, the United Kingdom Homecare Association, Mencap, Ceretas, the National Care Forum and the Association of Directors of Adult Social Services.

CQC will also take learning from this approach to regulation when considering how to improve regulation in other areas of health and social care which take place behind closed doors in people’s homes, such as community mental health, health visiting and district nursing.

Bridget Warr, Chief Executive of the United Kingdom Homecare Association, said: ‘We are extremely encouraged by the development of CQC’s new inspection process. Really listening to the experiences of people who use homecare services is essential to effective and balanced regulation.  It enables both homecare providers and the regulator to genuinely focus on what will make the greatest contribution to the lives of elderly and disabled people at home.’

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