Home care providers in the UK are inspected by care regulators to uphold national minimum standards for domiciliary care. These ensure people living at home in need of care receive the quality of care they have the right to expect.
To ensure that everyone receives the level of care they require, the regulators of home care providers in each UK country have developed a set of standards. Care inspectors carry out inspections and check home care agencies are following these standards.
Who regulates domiciliary care providers in the UK?
- England: Care Quality Commission (CQC)
- Scotland: The Care Inspectorate (CI)
- Wales: Care Inspectorate (CIW)
- Northern Ireland: Regulation and Quality Improvement Authority (RQIA)
The regulatory bodies are responsible for domiciliary care quality assurance, by monitoring and inspecting the quality of home care providers and other health and social services. Following inspections, the regulators publish reports which are publicly available.
If a care provider is found to operate below national minimum standards, the regulators take action to force improvement. In some cases they force closure.
England
The Care Quality Commission (CQC) regulates all health and adult social care services in England, including home care agencies. It is responsible for making sure home care services give people safe, effective and high-quality care.
What does a CQC inspection involve?
A CQC inspection involves CQC inspectors reviewing a home care provider’s policies, procedures, and care records. Inspectors speak to home care staff, people receiving home care and their relatives.. They may also observe care at home being delivered.
When the CQC inspects a home care agency, inspectors assess whether the service meets its standards by assessing:
- Is it safe? – Are people protected from abuse and avoidable harm?
- Is it effective? – Does the care, treatment, and support achieve good outcomes and promote a good quality of life?
- Is it caring? – Do staff treat people with compassion, kindness, dignity, and respect?
- Is it responsive? – Is care tailored to meet people’s individual needs?
- Is it well-led? – Is the leadership effective and are staff supported and engaged?
The CQC’s fundamental standards of care outlines the standards that no domiciliary care provider must fall below, and what people have the right to expect.
What are the fundamental standards of care in England?
- Person-centred care Care is tailored to each individual
- Dignity and respect: Service users are treated with dignity and respect
- Consent: Consent must be given before any care or treatment is provided
- Safety: Risks to health and safety are assessed and staff have the competence, qualifications, skills and experience to keep service users safe
- Safeguarding from abuse
- Food and drink: service users have enough to eat and drink to maintain good health
- Premises and equipment: Equipment is clean, suitable, used and looked after properly
- Complaints: Providers must have a complaints system in place and investigate thoroughly
- Good governance: Providers must have plans in place to meet these standards
- Staffing: Staff must be qualified and competent enough to meet these standards
- Fit and proper staff: Staff must be able to provide care and treatment appropriate to their role. As well as this, providers must carry out relevant checks e.g. DBS checks
- Duty of Candour: Providers must be open and transparent
- Display of ratings: Providers must display their CQC rating and make reports available to service users
How does the CQC rate a home care service?
After an inspection, the CQC publishes a report and gives the home care agency a rating:
- Outstanding
- Good
- Requires Improvement
- Inadequate
CQC ratings for home care providers are published on the CQC website. In addition to this, ratings must be prominently displayed by the care provider, including on its website and in the home care provider’s offices.
What happens after a CQC inspection?
If the CQC finds that the home care provider is inadequate or fails to meet CQC standards, the CQC has the power to force to make improvements. In serious cases, the home care provider may no longer be allowed to operate.
The CQC has the power to:
- Issue warning notices.
- Impose conditions on a home care provider’s registration.
- Issue fines.
- Suspend or cancel registration.
Scotland
The Care Inspectorate (CI) is Scotland’s main independent regulator for social care. It registers, oversees, monitors, inspects and regulates care services, including home care providers.
The Healthcare Improvement Scotland (HIS) is focused on health services and independent hospitals but can conduct joint inspections with the Care Inspectorate for integrated health and social care settings.
The Scottish Social Services Council (SSSC) monitors individual home care workers providing personal care in home settings.
The Mental Welfare Commission (MWC) is not a regulator but visits home care settings as part of investigations to protect the rights of people with mental illness, learning disabilities, or incapacity.
How is home care inspected in Scotland?
The Care Inspectorate registers home care providers, conducts home care inspections, publishes graded reports, issues improvement requirements and can enforce sanctions. It can also deregister a home care service if standards aren’t met.
Inspectors assess home care services based on Scotland’s Health and Social Care Standards.
What are Scotland’s Health and Social Care Standards?
The Standards outline what people should expect when receiving care and support from health, social care or social work services in Scotland, including home care.
The Standards seek to provide better outcomes, ensure that individuals are treated with respect and dignity, and that the basic human rights everyone is entitled to are upheld.
The five standards have been developed from the care seeker’s perspective:
- I experience high quality care and support that is right for me.
- I am fully involved in all decisions about my care and support.
- I have confidence in the people who support and care for me.
- I have confidence in the organisation providing my care and support.
- I experience a high quality environment if the organisation provides the premises.
Five principles underpin these standards:
- Dignity and respect
- Compassion
- Be included
- Responsive care
- Support and wellbeing
During inspections, the CI looks at four areas and gives quality grades, scoring each area from 1 to 6.
The four areas are:
- Care and Support
- Staffing
- Management
- Leadership.
All registered care providers in Scotland undergo a full inspection within their first year and then have regular annual inspections after this.
What happens after a CI inspection?
A report by CI is compiled following the inspection and is shared with the home care service first.
The home care provider is given the chance to say if they feel the report is factual, or if they feel there are any errors with this. The final report is then published online.
Wales
Domiciliary care agencies in Wales must maintain the National Minimum Standards outlined in the Guidance for providers of care home and domiciliary support services.
The guidance was put in place by ministers and Inspection of Social care to ensure care providers in Wales uphold the standards of care that people have the right to expect.
Care Inspectorate Wales (CIW) is the lead agency in Wales, conducting regular inspections and ensuring that home care providers comply with national standards.
How is home care inspected in Wales?
In Wales, home care providers are monitored, inspected and regulated to ensure high-quality care is delivered.
CIW is an independent regulator working under the Welsh Government to oversee the quality of services provided in the health and social care sector.
Home care services in Wales must uphold the National Minimum Standards to be allowed to provide their services. Registered providers are regulated by CIW, which can take action against home care providers that do not adhere to the requirements.
CIW conducts scheduled and unannounced inspections, with inspectors observing the home care service in action, reviewing policies and procedures, and speaking to home care staff, home care clients and their families.
National Minimum Standards for home care in Wales
- Providers must establish clear arrangements for an ongoing cycle of quality assurance and review to make sure they operate in line with legal requirements and are supporting individuals appropriately
- Providers must ensure that their service is provided with sufficient care, competence and skill
- Providers must ensure there are effective arrangements in place for monitoring, reviewing and improving the quality of care and support
- The time allocated for each visit must be sufficient to enable care and support to be provided to the individual in accordance with their personal plan
- Care and support must enable an individual to meet their personal outcomes
- Provision of staff with the knowledge, skills and competency to meet well-being needs of individuals
- Providers must ensure their services are delivered in a dignified and respectful manner in which staff have meaningful interactions and positive and caring attitudes towards individuals
What happens after a CIW inspection?
Following an inspection, CIW issues a report that details the findings, and highlights areas where a provider is meeting or failing to meet regulatory standards.
If a home care provider is found to be non-compliant with regulations, CIW may take enforcement action. Enforcement action can include issuing a warning, requiring improvements, or in extreme cases, cancelling the provider’s registration.
You can find look at a CIW report about a home care service by visiting Care Inspectorate Wales.
Northern Ireland
In Northern Ireland, the primary body responsible for inspecting and regulating home care providers is the Regulation and Quality Improvement Authority (RQIA).
The RQIA publishes detailed inspection reports, outlining the strengths and areas for improvement in each provider’s services.
If home care providers fail to meet required standards, the RQIA has the authority to take enforcement action. This can range from issuing warnings to imposing sanctions, including closures.
Northern Ireland’s quality standards for home care services
Home care services in Northern Ireland must adhere to Quality Standards for Health and Social Care as established by the Department of Health (DoH).
The RQIA uses these standards to assess whether home care providers are delivering the highest quality services.
The Health and Social Care standards are made up of 5 themes:
- Corporate leadership and accountability of organisations
- Safe and effective care
- Accessible, flexible and responsive services
- Promoting, protecting and improving health and social well being
- Effective communication and information
RQIA inspectors ask whether the service is safe, that care is effective, the service is well-led and the care is compassionate.
What does a RQIA inspection involve?
An RQIA inspection involves:
A preliminary assessment of the care provider’s services, focusing on policies, procedures, and documentation.
RQIA inspectors visit the location where care is provided, including conducting interviews with home care users, families and home care staff.
Inspectors observe the quality of care being delivered. This includes hygiene, comfort, communication, and how well the care meets the individual’s needs.
Inspectors collect feedback about the quality of the care service from the people receiving care, family members, and staff.
What happens after a RQIA inspection?
The RQIA publish a report about the home care service which includes inspection findings and any recommendations for improvement.
RQIA inspection reports are published on its website.
The RQIA inspection process not only identifies failings but also encourages continuous improvement in care services. Home care providers are expected to act on the recommendations outlined in RQIA reports and demonstrate that they are making the necessary changes to improve care quality.
In some cases, RQIA will conduct follow-up inspections to assess whether providers have addressed issues raised in previous reports. If improvements are not made, further enforcement action can be taken to ensure the safety of home care users.
Always check inspection reports
When choosing a home care provider, it is essential to read their reports to make sure you feel confident that they uphold the standards you expect.
Read our guide to finding domiciliary care that is right for you, including what to look for and questions to ask providers.
If you’re looking for a home care service, you can also read reviews about home care services on homecare.co.uk
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