25% of home care services failing to meet standards

A report launched today by the Care Quality Commission (CQC) has found that a quarter of home care services provided to older people in England are failing to meet quality and safety standards.

While the CQC found that most providers were doing a good job, in 1 in 4 cases home care providers were found to be delivering a poor service in which vulnerable older people had to endure late or missed calls, and a lack of continuity of care workers. In these instances, providers also failed to listen to the views of older people using their services and their families.

In such examples of poor home care, there was also a lack of planning, with care staff failing to receive adequate support, the report found.

David Behan, Chief Executive of the CQC said: 'People have a right to expect to be treated as an individual, to be able to exercise choice, and to make sure their carers are aware of their specific care needs. We found evidence of this, however we also found elements of poor care, which happen too often.'

The report captures the findings from inspections of 250 home care agencies providing support and care at home to around 26,500 of people aged 65 and over across England.

Many older people are reluctant to complain

The report revealed that many older people who receive poor care at home are reluctant to complain about the service. Some are worried about getting their regular care workers into trouble, and others may be worried about reprisals if they complain, the report found.

Michelle Mitchell, Charity Director-General at Age UK, commented: 'As the report shows there are many providers committed to offering the best care possible, which is very welcome news. Excellent, compassionate, dignified care must be the bedrock on which everything rests. All training, commissioning and day-to-day decisions around an individual's care should always come back to providing that person with the same standard of care that we would want to see given to our loved ones.

'However, funding pressures are resulting in many committed care workers becoming over stretched, with staff forced to choose between rushed visits or leaving early without being able to finish tasks, which can have a devastating effect on older people who rely on these services. There must be a zero tolerance attitude to poor, neglectful care.

'The problem cannot be tackled with window dressing and tick box exercises, we need to work hard at every level to get to the heart of these issues and drive real change. The social care system must provide a sustainable and fair source of funding to ensure that older people are given the care that they desperately need, both now and in the future.'

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Key findings

The report looked at how providers of home care had performed against 5 of CQC's national standards:

Older people did not feel valued when visits were delayed or cancelled

• The overwhelming majority of providers were respecting and involving people (97% or 241 providers).
• Where providers were failing to meet an element of the standard, CQC found older people did not feel valued because their visits were often delayed or sometimes cancelled.
• This was made worse if people were not kept informed if their care worker was going to be late.
• It sometimes appeared that the older people using the service were resigned to accepting a level of unreliability.

38 providers were not promoting the care and welfare of the older people who used their services

• The majority of providers were promoting the care and welfare of people using this service (85% or 212 providers).
• 38 providers were not meeting this standard, with just under a third of these located in London.
• CQC found a number of occasions when risks associated with a person's care or medical conditions, such as diabetes or catheter care, had not been assessed, and care plans had not been updated for several years.

The overwhelming majority of providers were safeguarding older people who used their services from abuse

• The overwhelming majority of providers were safeguarding older people from abuse (96% or 240 providers).
• Many providers had processes that detailed the action that staff and managers had to take if they suspected any abuse and all agencies had a whistleblowing procedure.
• Of the 10 who failed to meet this standard 5 were found to have a moderate impact and CQC took enforcement action against one provider.

Most providers support their staff

• The majority of providers were supporting their staff (88% or 221 providers).
• People who receive care in their own home, and their relatives, value care workers who are knowledgeable and understand their or their relative's condition.
• 29 providers were failing to meet this CQC national standard, of these, 3 were judged to be of moderate impact on patients and one service was judged to be major.

Most providers could assess and monitor the quality of the services they delivered

• The majority of providers demonstrated an ability to monitor and assess their services (85% or 212 providers).
• CQC inspectors saw a range of effective methods of monitoring quality including: agencies that made weekly phone calls to people using services to check that the care was meeting their needs; and annual quality audits.
• Of the 38 agencies who failed to meet this standard 15 agencies were judged to have a moderate impact and two had a major impact on people.

'People need to know what good home care looks like' - CQC

Overall the report makes 15 recommendations aimed at driving improvement across the sector, including:

• Providers need to work more closely with local authority commissioners to improve care and find solutions to these common problems, and put systems in place to monitor the impact of missed or late visits on people receiving care.
• Where providers are failing to meet CQC national standards they must learn from the good practice that exists across the sector.

The CQC wants to use this report to inform people of what good home care and poor home care look like.