Who inspects care homes in the UK?

Moving into a care home or helping a loved one find a care home place can be daunting for many reasons. One reason is that you want your loved one to live in a good care home, receive the best care possible and be reassured that the level of care provided is of a certain standard.

Care homes across the UK must follow the national minimum standards for care homes in their country, set out by their regulatory body. Based on these standards, care homes should develop quality assurance systems to ensure they adhere to regulations and provide care in accordance with best practice.

These organisations regulate and inspect care homes in the UK to ensure standards and best practices are upheld according to their quality assurance frameworks.

Who are the care regulators?

• England – Care Quality Commission (CQC)
• Wales – Care Inspectorate (CIW)
• Scotland – The Care Inspectorate (CI)
• Northern Ireland – Regulation and Quality Improvement Authority (RQIA)

Each regulatory body has a set of national minimum standards for care homes, that should also be upheld across all other health and social care services.

Who inspects care homes in England, Wales, Scotland and Northern Ireland?

Each care watchdog regularly visits care homes to check whether they comply with fundamental standards and produces inspection reports available to the public to ensure transparency. 

England

Care homes in England are required to maintain fundamental standards that everyone has the right to expect from their care. The CQC inspects care homes to ensure that they do not fall below these standards, and if they do, they take action to improve.

The fundamental standards state that care homes must:

• Provide person-centred care
• Make it possible for residents to have visitors and go out on visits.
• Treat residents with dignity and respect
• Acquire consent before giving any care or treatment
• Ensure they do not give unsafe care or treatment, and that staff have the qualifications and skills to keep residents safe
• Safeguard residents from any form of abuse or improper treatment
• Provide food and drink which keep residents in good health
• Keep premises and equipment clean, suitable and looked after
• Offer a complaints system, investigate incidents thoroughly and take action
• Have plans in place to ensure they can meet above standards and systems to check quality and safety of care
• Have enough suitably qualified, competent and experienced staff to meet standards
• Only employ staff who can provide care and treatment appropriate to their role
• Be open and transparent about care and treatment
• Display their CQC rating clearly and make their latest report available to you

When the CQC inspects care homes, they ask whether the service is safe, effective, caring, responsive, and well-led.

The CQC then gives care homes ratings to help care seekers compare services and make informed choices about their care:

• Inadequate
• Requires improvement 
• Good
• Outstanding

Wales

Care homes 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 care homes that do not adhere to the requirements.

The requirements and standards are outlined in the Guidance for providers of care home and domiciliary support services, issued by Welsh ministers and Inspection of Social Care. They have been put in place to ensure that care home residents are provided with the quality of care and support they need to achieve the best possible well-being outcomes.

National Minimum Standards

Requirements on standards of care and support include:

• Ensuring the care and support provided enables residents to meet the personal outcomes
• Provision of staff that have the knowledge, skills and competency to meet residents’ needs
• Ensuring staff have the appropriate language and communication skills
• Ensuring residents are provided with a continuity of care
• Care homes should seek support from relevant agencies and specialists where required
• Care homes must ensure that care and support is provided in a way that protects, promotes and maintains the safe and well-being of individuals
• Care homes must ensure that care and support is provided to individuals in accordance with their individual care plans

The CIW inspects care homes and looks at resident well-being, the care and support provided, the environment as well as leadership and management. They then produce a report which is freely available to care seekers on their website.

Scotland

In Scotland, care homes follow the Health and Social Care Standards (the Standards), which came into effect on 1 April 2018, replacing the National Care Standards, and serves as a quality framework for care homes for adults. The CI is required by law to consider these standards when inspecting care homes.

The Standards outline what people should expect when receiving care and support from health, social care or social work services in Scotland, including care homes.

Health and Social Care Standards

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:

1. I experience high quality care and support that is right for me.
2. I am fully involved in all decisions about my care and support.
3. I have confidence in the people who support and care for me.
4. I have confidence in the organisation providing my care and support.
5. I experience a high quality environment if the organisation provides the premises.

Five principles underpin these standards:

1. Dignity and respect
2. Compassion
3. Be included
4. Responsive care
5. Support and wellbeing

At their inspections, the CI looks at key areas and gives care homes quality grades in each area: Care and Support; Environment; Staffing; and Management and Leadership.

Each area is given a score from 1 to 6, where 1 is unsatisfactory and 6 is excellent. The reports are published to show their findings to enable care seekers to make informed decisions.

Northern Ireland

The quality standards for health and social care in Northern Ireland are underpinned by five key quality themes:

1. Corporate leadership and accountability of organisations
2. Safe and effective care
3. Accessible, flexible and responsive services
4. Promoting, protecting and improving health and social well being
5. Effective communication and information

When the RQIA inspects care homes, they look at four key areas and ask whether the service is safe, that care is effective, the service is well-led and the care is compassionate.

Northern Ireland has specific care standards for nursing homes and residential care homes, which aim to improve the quality and consistency of care for residents. These quality standards serve as a benchmark for care homes and the RQIA in registering and inspecting the homes.

Minimum standards in Northern Ireland

The minimum standards for residential care homes specify the arrangements, facilities and procedures that need to be in place to ensure quality care, and no provider is expected to operate below these standards.

There are 35 minimum standards for residential care homes covering quality care and management of the home, including:

• Residents’ views and comments shape the quality of services and facilities provided by the home
• Each resident has an individual and up-to-date comprehensive care plan
• Residents receive a nutritious and varied diet in appropriate surroundings at time convenient to them
• There are policies and procedures in place that direct the quality of care and services

There are 48 care standards for nursing homes, each with their own criteria, covering admission, quality of life, quality of care, quality of management and quality of the physical environment. They include:

• Every resident has an individual written agreement setting out the term and conditions with the home
• The culture of the home is based on quality relationship-centred care that nurtures the wellbeing of the residents, enables them to feel valued, and promotes and supports their engagement and participation in the running of the home and decisions about their daily lives
• The number and ratio of staff on duty at all times meet the care needs of residents
• The internal and external environment for the home is arranged so as to be suited to the needs of residents

Always check inspection reports

When looking for care homes, it is vital to check their inspection reports to ensure they comply with national regulations and standards of care. 

The reports tell you whether the residential care home or nursing home you are considering has quality assurance systems in place and whether they provide the level of service and standard they advertise.

Every care home listed on carehome.co.uk includes details of inspection reports. Visit the website to start your search.