Home care

CQC compliance for home care and domiciliary care

In domiciliary care the service is delivered where no manager is watching, so CQC assesses the systems that give you visibility: call monitoring, records from people's homes, supervision and spot checks, and what people themselves say about timing and continuity.

Registration and scope

Register for personal care, and state clearly in your statement of purpose which areas you cover and which needs you can meet.
Be careful about clinical tasks. If you intend to support tracheostomy care, PEG feeding, catheter care or insulin, you need delegated clinical competency sign-off and named clinical oversight.
Keep the geography honest. Rounds that cannot be travelled in the time allowed become late and missed calls, which is a safe-domain finding.

Calls, travel time and continuity

Schedule realistic travel time between calls and pay for it. Rotas that assume zero travel do not survive scrutiny.
Use electronic call monitoring or an equivalent record so you can evidence start and end times, and run exception reports for late, short and missed calls.
Have an escalation process for a missed call: who is alerted, within what time, and how the person and family are contacted.
Show continuity — the number of different workers a person sees over a month is a question people are asked directly.

Care planning in someone else's home

Assess before the package starts, involve the person and any family or advocate, and record what matters to them as well as what they need.
Risk assessments should cover the home environment, moving and handling with the equipment actually present, pets, keys and entry, and fire safety.
Keep an accessible copy of the plan in the home, and make sure the electronic record and the home copy say the same thing.
Review after any change, hospital admission or incident, and record the review even when nothing changes.

Medicines support in the community

Define clearly the level of support for each person: prompting, assisting or administering, and record the level in the plan.
Use a MAR that workers complete at the point of support, with gaps followed up by the office rather than noticed at month end.
Written protocols for 'when required' medicines, time-critical medicines, and creams with body maps.
Competency assessment for every worker who administers, and a medicines audit that samples records regularly.

Staffing, recruitment and lone working

Regulation 19 evidence in every file: application, full employment history, references covering the last care role, enhanced DBS with the adult barred list, right to work, and identity.
Induction and Care Certificate progress, mandatory training with refreshers, and shadowing before working alone.
Supervision at planned intervals plus unannounced spot checks in people's homes, recorded with actions.
A lone worker policy that works in practice: check-in arrangements, out of hours contact, and what a worker does if they cannot gain access or finds someone unwell.

Safeguarding and consent

Workers who can describe, in their own words, what they would do if they suspected abuse and who they would tell.
Referrals to the local authority safeguarding team, with CQC notified where required.
Capacity assessments that are decision-specific, and best interests decisions recorded — including where family are making decisions without lawful authority, which needs to be addressed rather than accommodated.
Clear handling of money, keys, gifts and property, with a recorded process.

Governance and feedback

Weekly review of missed, late and short calls, with trends by round rather than only by worker.
Complaints log with outcomes, timescales and learning.
Regular surveys and welfare calls to people and families, with a published 'you said, we did'.
Audit schedule covering care plans, MAR charts, personnel files, spot checks and training compliance, with actions closed and re-checked.

Common questions

Does a domiciliary care agency need to register with CQC?

Yes, if it provides personal care — help with washing, dressing, eating, toileting or medication — in the place where a person lives. An introductory agency that only introduces self-employed workers, and takes no responsibility for the care delivered, may fall outside registration, but the test is the degree of control over the care, so take advice before assuming you are exempt.

What does CQC look at in a home care service?

Whether calls happen on time and for the full length commissioned, whether the same workers see the same people, how medicines support is recorded, how lone workers are kept safe and supervised, and whether the office knows quickly when a call is missed. Much of the evidence comes from people and relatives rather than files.

Are home care inspections announced?

Community services are often given short notice, because assessors need to arrange calls or visits with people using the service and to see records at the office. Assessment can also be entirely off site, through information requests and surveys to people, relatives and staff.

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