Domiciliary Care Compliance: What CQC Expects From Homecare Providers

Why domiciliary care compliance is harder than a care home

In a residential setting an inspector can observe. They can walk a corridor, watch a mealtime, look at how medicines are stored, and speak to several people in an afternoon. Observation carries a lot of the weight.

In domiciliary care that route is mostly closed. Nobody can observe forty visits spread across a city. So the weight shifts onto the evidence categories you can actually produce: processes, outcomes, and feedback from the people you support, from your staff, and from partners such as commissioners, district nurses and hospital discharge teams.

The practical consequence is uncomfortable. In homecare your records are not a supporting exhibit, they are the primary evidence. A care home with thin paperwork and strong practice can often demonstrate the practice directly. A domiciliary service with thin paperwork has very little left to show, however good the care actually is.

Lone working: the evidence CQC asks for

Every one of your care workers delivers care unsupervised, in a private home, often with no other professional present. Inspectors will want to understand how you keep both the person and the worker safe.

Have ready:

• Lone working risk assessments, per person and per environment, not one generic document (including pets, access, parking, lighting, and anyone else in the household)
• Your escalation route when a worker cannot get an answer at the door, with recorded examples of it being used
• Check-in and check-out records, and what happens when a worker does not check out
• Evidence that staff know what to do in a medical emergency alone in someone's home, and that this has been tested rather than assumed
• Records of any incident where a worker felt unsafe, and what changed for the next visit

The strongest position here is not “we have a lone working policy”. It is being able to name a specific visit where something went wrong, show the report, and show what you altered as a result.

Call logging, missed calls and late calls

Missed and late calls are the single most common source of complaints and safeguarding referrals in domiciliary care, and inspectors know it.

Have ready:

• Actual visit times against scheduled times, over a period long enough to show a pattern rather than a good week
• Your definition of a late call and a missed call, applied consistently
• Every missed call, with the reason, who was informed, what the consequence was for the person, and what was done
• Travel time built into rotas, and evidence it is realistic rather than nominal
• How you handle back-to-back calls at opposite ends of a round

Two things get providers into trouble here. The first is a rota that only works if nobody hits traffic. The second is recording a missed call without recording the impact. A missed lunch call for someone diabetic is not an administrative event.

Medication in someone else's home

Community medication support carries risks that a care home does not have: no clinical room, no second checker, no pharmacy on site, and family members who may also be administering.

Have ready:

• MAR charts from the home, with your process for retrieving, auditing and querying gaps
• A clear record of what level of support each person receives (prompting, assisting, or administering) and who agreed it
• Medication competency assessments for every worker who supports medicines, with observed reassessment
• Medication errors and near misses, with root cause and action
• How you handle changes to a prescription communicated by a family member or a GP surgery rather than in writing
• Controlled drugs and covert administration, where they apply, with the mental capacity documentation to support them

A gap on a MAR chart is not automatically a failure. Not being able to explain a gap is.

Spot checks and supervision without a shared office

You cannot supervise by walking past someone. Supervision in homecare has to be deliberate and recorded.

Have ready:

• Community spot checks at the frequency your own policy states, including unannounced ones and some outside office hours
• What the spot check actually examined, not just that it happened
• Supervision and appraisal records, with the gap between policy frequency and actual frequency visible and explained
• Competency observations for specific tasks: moving and handling, catheter care, PEG feeding, whatever your service delivers
• How you supervise staff you rarely see in person

If your policy says six-weekly and your records show quarterly, fix the records or fix the policy. An inspector will find the discrepancy, and the discrepancy is worse than the longer interval.

Care plans that travel

In homecare the care plan lives in the person's home, which means the copy in the office and the copy at the point of delivery can drift apart.

Have ready:

• Evidence that the plan in the home matches the plan in your system
• Review records showing the plan changing as needs change, with the person's own words in it
• How a worker on their first visit to someone learns what matters to that person before they knock
• Risk assessments reviewed after any change, not on a calendar alone

Recruitment, induction and staff continuity

Homecare staffing carries checks a building-based service does not, and inspectors ask about them.

Have ready:

• Full pre-employment checks, with a written rationale wherever a DBS return was not clear
• Driving licence, business use insurance and vehicle checks where staff drive between calls, kept current rather than checked once at hire
• Induction records showing what a new worker did before their first unsupervised visit, and who signed it off
• Care Certificate progress, where it applies
• Shadowing records, including who was shadowed and for how long
• Continuity data: how many different workers visit each person over the course of a month

That last item is the one most services cannot produce, and the one that most affects how people describe your service. Continuity is not only a Caring consideration. Someone supported by fourteen different workers in a month has fourteen chances of something being missed, and their family will say so when asked.

If your turnover is high, do not hide it. Show the figure, show what you have understood about why, and show what you changed. An inspector who finds turnover you have not acknowledged reaches a different conclusion from one who finds turnover you are actively managing.

Which evidence categories CQC prioritises for homecare

CQC publishes separate evidence priorities by sector, and homecare and shared lives services are treated differently from care homes and supported living. Read the section for your own sector rather than the generic framework.

The pattern worth planning around is that observation gives you less and feedback gives you more. Feedback from people using the service, from your own staff, and from partners will carry proportionally more weight than it does in a building-based service, and feedback from partners is the one nobody prepares. Your commissioners, district nurses and discharge teams already hold a view of your reliability. That view is evidence whether or not you have ever asked them for it.

Our guide sets out the six evidence categories and what each one asks of a homecare service.

Running a domiciliary care mock inspection

A useful mock inspection is not a document review. It is a rehearsal of being asked for things you cannot prepare in advance.

Pick three people you support at random and try to produce, in under twenty minutes: their current care plan, their last risk assessment review, their MAR chart for last month, the last spot check on a worker who visits them, and any incident involving them in the past year. Then pick three care workers and try to produce their training record, last supervision, and medication competency.

If any of those takes longer than twenty minutes to find, that is your finding. Inspectors do not usually discover that a service is bad. They discover that it cannot show it is good.

For a wider structure to rehearse against, work through the CQC inspection checklist.