Home care services are generally good but late or missed calls, inadequate support for staff and a lack of care worker continuity for clients are leading to poor care from a minority of providers.
That was the Care Quality Commission’s verdict on the sector in a thematic report today that drew on the findings of 250 inspections and feedback from over 4,600 service users or carers.
The CQC’s probe follows a series of reports that have raised concerns about the quality and safety of home care services, notably the Equality and Human Rights Commission’s 2011 report into human rights breaches in the sector.
Good services overall
However, the CQC found that 74% of the services inspected met all five of the standards CQC inspected them against: meeting care and welfare needs, respecting and involving service users, safeguarding them from abuse, monitoring service quality and supporting staff. On safeguarding and involving service users, 96% and 97% of services, respectively, were meeting standards.
Practice was good where service users had continuity of care worker, staff were trained in understanding clients’ medical conditions, care plans were regularly updated through staff accurately completing daily logs, and service users and their families were involved in decisions about care.
However, the CQC raised concerns about poor practice in a minority of services and highlighted late or missed calls by staff as the most significant problem, as it left clients feeling “vulnerable and undervalued”.
Lack of travel time
A key cause was a lack of travel time between visits for staff; inspectors found “numerous examples of rotas that did not allow time for staff to travel between visits”, and were told by staff that it wasn’t unusual for them to have to cover an additional visit during a day, meaning other visits were cut short. Late or missed calls were a particular problem at weekends.
Though it said this was an issue for commissioners and providers alike to address, it criticised some providers for failing to investigate late or missed calls and take action to reduce their occurrence, and for not informing service users where rotas were changed unexpectedly.
Service users interviewed by the CQC also expressed concerns about a lack of continuity of care workers. It said providers needed to ensure that there was a small team of staff working with each service user and ensure new staff were personally introduced to clients before their first appointment.
Lack of support for staff
While 88% of providers met the standard for supporting staff, “many staff” told inspectors that they could be better supported, while service users and carers interviewed said new staff often did not appear to be adequately trained.
The CQC found that appraisal and supervision were not being delivered in line with company policies in some agencies while others did not have a documented policy on supervision; many staff files were incomplete and did not include records of supervision.
The United Kingdom Homecare Association welcomed the report for highlighting “the positive impact that high-quality services have on the lives of older people in England”.
Regarding the issues raised about late or missed visits, it said: “Home care providers have a duty to constantly monitor this essential requirement and act without delay. It is vital that people who use services are kept informed about delays to their expected service and know if the care worker they expect has been unavoidably replaced.”
However, the association stressed the role of councils commissioning care in slots of 30 minutes or less in causing late or missed calls.
“This inevitably creates a system lacking in flexibility, where the need to respond to urgent and unexpected events may delay a care worker’s subsequent visits during the day and threatens providers’ ability to fund training and supervision of the workforce,” it added.
The CQC made the following recommendations:
- Commissioners and providers of home care services must work together to address the issues of timings and length of visits and the travel times required
for staff between visits, to ensure that people have the appropriate length of time needed for their care;
- Providers should try to ensure that there is a small team of care workers for each person receiving care, to reduce the risk of them having a visit from someone they don’t know;
- Staff caring for people with dementia should have access to relevant training and be able to develop their knowledge and expertise in this area;
- Staff must be able to regularly see other care workers and meet with managers to discuss the needs and progress of the people they provide care for;
- Providers must give staff enough information to allow them to identify and record people’s preferences and choices about how they would like to receive
care in their own home.