Domiciliary care policies

The rule: systems in the Regulations, documents in CQC's registration list

No statute lists the policies a home care provider must hold. The fundamental standards in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 are written as outcomes and systems: Regulation 13(2), for example, says “systems and processes must be established and operated effectively to prevent abuse of service users”. A policy is how a provider shows that the system exists, and CQC's guidance on Regulation 17 counts “governance arrangements such as policies and procedures” among the records of managing the service.

What brings a home care agency into that framework is the regulated activity of personal care. Regulation 2 defines personal care as physical assistance with “eating or drinking”, “toileting”, “washing or bathing”, “dressing”, “oral care” or “the care of skin, hair and nails”, or “the prompting, together with supervision” of those activities for someone unable to decide to do them without it. CQC's scope guidance on personal care says it “must be provided in the place where those people who need it are living at the time when the care is provided”, and “includes personal care provided through domiciliary or homecare services, and housing with care or supported living services”. For supported living, it adds, “there must be a real separation between the provision of personal care and the accommodation agreements”. That separation shapes the policy set: the care provider writes policies for the care, not for the tenancy.

Two documents are required by name. The statement of purpose, under regulation 12 of the Care Quality Commission (Registration) Regulations 2009, which the provider “must keep under review” and must send CQC details of any revision “within 28 days”. And, for an employer with five or more employees, a written health and safety policy: the HSE's guidance on writing a health and safety policy says “if you have five or more employees, you must write your policy down”.

The policies CQC asks home care and supported living providers for

CQC's supporting documents for new provider registration are the nearest thing to an official list. Every provider applicant must send: a complaints policy; a consent policy and procedure; an equality, diversity and human rights policy; governance and quality assurance policies; an infection prevention and control policy; a medicines management and prescribing policy “(including transportation of patient medication)”; public and employer liability insurance; a recruitment policy; a safeguarding policy and procedure; and a statement of purpose.

CQC's page of extra documents for home care agencies adds a business plan and financial forecast, evidence of legal occupancy, service user guides and a staff training plan. A service for autistic people and people with a learning disability must also send a positive behaviour support policy and a restraint policy. The supported living page asks for the same. Both then list documents to keep ready “in case we request them”: a duty of candour policy; a freedom to speak up, whistleblowing or confidential reporting policy; a list of risk assessments; a person-centred care planning policy; a reportable incidents policy; a risk management policy; a sample care contract; a sample care plan; and the staffing structure and rotas.

The list is written for applicants. For an agency that is already registered it is still the right baseline, because each document describes a system the fundamental standards require, and the documents should describe how the service actually runs.

The list, regulation by regulation, for care in people's homes

Grouped by the fundamental standard each policy serves, with what changes when the care is delivered in someone's own home. Regulation 9A on visiting applies only to care homes, hospitals and hospices, so it has no home care policy.

• Person-centred care (Regulation 9): assessment before the first visit; care and support planning and review; end of life care at home; involving family carers. NICE's home care guideline NG21 says visits shorter than half an hour should be made only if the worker is known to the person, the visit is part of a wider package, and it allows enough time for specific, time-limited tasks or to check the person is safe and well; the visit-length policy should say how the agency applies that.
• Dignity and respect (Regulation 10): privacy and dignity in the person's own home, including what workers may and may not do with the person's belongings and space; equality and human rights.
• Need for consent (Regulation 11): consent to care and to entering the home; the Mental Capacity Act 2005; best-interests decisions; who may consent for someone who lacks capacity.
• Safe care and treatment (Regulation 12): risk assessment, including the home environment; moving and handling with the person's own equipment; falls; pressure care; infection prevention and control, having regard to the code of practice on the prevention and control of infections, which applies to “providers of independent healthcare and adult social care in England”; and medicines. CQC's Regulation 12 guidance says medicines policies “should be in line with current legislation and guidance” and address supply and ordering, storage, dispensing and preparation, administration, disposal and recording.
• Safeguarding (Regulation 13): safeguarding adults, aligned with the local authority's procedures under the Care Act 2014; restraint and restrictive practice, because Regulation 13(4)(b) prohibits control or restraint that is not necessary or proportionate; deprivation of liberty, because Regulation 13(5) says a person “must not be deprived of their liberty for the purpose of receiving care or treatment without lawful authority”; and handling people's money, because Regulation 13(6) defines abuse to include “theft, misuse or misappropriation of money or property belonging to a service user”.
• Nutrition and hydration (Regulation 14): meal preparation and prompting to eat and drink, including recording concerns about weight or fluid intake.
• Premises and equipment (Regulation 15): the office, and equipment “used by the service provider” in the home, such as hoists and slings the agency supplies or checks.
• Complaints (Regulation 16): how a person or family can complain, how it is recorded to its outcome, and how a complaint made to a care worker on a visit reaches the office.
• Good governance (Regulation 17): quality assurance and audit; seeking feedback, because Regulation 17(2)(e) requires the provider to “seek and act on feedback from relevant persons and other persons on the services provided”; records and data protection; electronic call monitoring and visit verification where used; business continuity for staff shortage, severe weather and IT failure.
• Staffing (Regulation 18): training, induction, supervision and spot checks in the home, which are how a manager sees work nobody else watches.
• Fit and proper persons employed (Regulation 19): recruitment and DBS checks, with references and the full employment history Schedule 3 requires.
• Duty of candour (Regulation 20): what is said, by whom and when, after a notifiable safety incident, and the written record that follows.

The policies home care needs that a care home does not

The standard set assumes staff who work in sight of each other. Home care does not, and the gaps show up in the same places in most agencies:

1. Lone working. The HSE's guidance on protecting lone workers says “as an employer, you must manage any health and safety risks before people can work alone”. The policy covers the check-in and check-out arrangement, what happens when a worker does not check in, late evening visits, aggression from a person or a relative, travel between visits and the out-of-hours on-call manager.
2. Missed and late visits. NG21 says providers should “closely monitor risks associated with missed or late visits and take prompt remedial action”, “ensure plans are in place for missed visits”, and make sure workers contact the person “if they will be late or unable to visit”. The policy should set the escalation times, who calls the person and the family, and what is recorded.
3. No reply and access. What a worker does when nobody answers the door: who is phoned and in what order, when the police or ambulance service are called, and how long the worker waits. The same policy covers key safes and key holding, codes, and consent to enter.
4. Money and property. Shopping, collecting pensions, cash kept for bills, gifts and bequests, and the receipts and countersignatures that let the agency show nothing went missing.
5. Medicines support in the person's home. NICE's guideline NG67, managing medicines for adults receiving social care in the community, says that “when social care providers have responsibilities for medicines support, they should have a documented medicines policy”, likely to include assessing support needs, “when required” and time-sensitive medicines, sharing information, accurate records, medicines-related safeguarding, giving medicines without the person's knowledge, ordering, storage, disposal and staff competency. The care plan then records, for each person, exactly what support the agency gives with their medicines.
6. Supported living. Where the person holds a tenancy, the care policies cannot borrow the landlord's rules. Restrictive practices, positive behaviour support, shared-house arrangements and people's right to choose who supports them need policies written for the care service, kept separate from the housing agreement as CQC's scope guidance requires.

Making the policies work: ownership, review and inspection

Policy templates and subscription packs bought from a vendor are a reasonable start for a new agency. The regulatory risk is a policy that describes a different service: a care home's visiting arrangements, a nursing procedure the agency does not provide, a local authority it has never worked with. Adapt each one to the service in the statement of purpose, and remove what does not apply. CQC's Regulation 12 guidance puts the test plainly when it describes the policies for raising concerns: they “must be in line with current legislation and guidance, and staff must follow them”.

Give each policy a named owner, a review date and a place in the audit programme; review on a set cycle, usually yearly, and whenever the law, national guidance or the service changes. For home care, three practical tests matter more than the wording. Does a care worker on a 7am visit know what the policy says without opening a folder at the office? Does the on-call manager at 10pm have the same procedure the office uses? And do the records – visit notes, call monitoring, incident logs, complaints – show the policy being followed? CQC assesses the service against its five key questions, whether it is safe, effective, caring, responsive and well-led, using the quality statements in its assessment framework; a policy is one piece of evidence, and practice that matches it is the rest.

Finally, keep the statement of purpose, the policies and the actual service in agreement. If the agency starts supporting people with a learning disability, adds a supported living scheme, or begins administering rather than prompting medicines, the statement of purpose changes, CQC must have the revision within 28 days, and the policies that the new service needs must exist before the first visit.

The policy route and the message route

Almost every policy in a home care agency describes a route to the office. Phone the coordinator if nobody answers the door. Report a safeguarding concern to the manager the same day. Tell the office before taking money from a client's purse for shopping. Escalate a refused medicine. In practice the first step on most of those routes is a message from a lone worker's own phone: “no answer at Mr H's, curtains still shut”, “she's refused her evening tablets again”, “his son asked me to get £50 out for him, is that OK?”, sent to a coordinator's personal number or to a carers' group chat at the end of a run.

Those messages are the first record of exactly the events the policies govern – a missed-visit escalation, a medicines refusal, a money transaction, a possible safeguarding concern – and they sit on phones the agency does not own. The coordinator who replied “yes that's fine” may have left; the group chat includes former staff; the visit note written later says something shorter. When a family complains, a safeguarding enquiry asks what the agency knew, or CQC asks how the no-reply procedure worked last Tuesday, the agency's answer depends on messages it cannot produce.

The fix is not another policy telling staff not to message, because a lone worker who cannot reach the office is the bigger risk. It is to write the actual route into the policy: an approved channel the agency controls, where everyone is told it is on the record, where bank and agency staff can be included, and where anything that belongs in the care record is still copied into it. The question for the next management meeting: for your no-reply procedure, where does the first message go, and could you produce it?

Questions people ask

What are the CQC policies and procedures for domiciliary care providers?

CQC asks every new provider, including home care agencies, to send a complaints policy, a consent policy and procedure, an equality, diversity and human rights policy, governance and quality assurance policies, an infection prevention and control policy, a medicines management policy, a recruitment policy, a safeguarding policy and procedure, and a statement of purpose. Home care agencies also send service user guides and a staff training plan, and should keep a duty of candour policy, a whistleblowing policy, a reportable incidents policy and a risk management policy ready for CQC to request.

What are the 5 main care standards?

The five things CQC checks in every service, including home care, are its five key questions: is the service safe, effective, caring, responsive to people's needs and well-led? Under each one CQC's assessment framework sets quality statements, and the fundamental standards in Regulations 9 to 20A of the 2014 Regulations are the legal requirements behind them.

Does supported living require CQC?

A supported living service must register with CQC if it provides the regulated activity of personal care, which CQC's scope guidance says includes “housing with care or supported living services”. For the service to be correctly registered for personal care, CQC adds that “there must be a real separation between the provision of personal care and the accommodation agreements”. Support that involves no personal care as defined in Regulation 2 is not that regulated activity.

What are some examples of domiciliary care services?

Domiciliary care services provide personal care in a person's own home: help with washing or bathing, dressing, toileting, eating and drinking, oral care and the care of skin, hair and nails, or prompting and supervising someone to do those things, as Regulation 2 defines personal care. Home care agencies, supported living services, extra care housing schemes and Shared Lives schemes can all provide it.

What are the policies and procedures in care?

Policies and procedures in care are a provider's written rules for how it meets the law – safeguarding, medicines, infection control, consent, complaints, recruitment and governance among them – and the steps staff follow to put each one into practice. CQC treats them as records of how the service is managed under Regulation 17 and expects them to match what staff actually do.

Official guidance and your next step

The primary sources are the 2014 Regulations and CQC's guidance on each regulation in regulations for service providers and managers; CQC's registration document lists for home care and supported living; NICE's guidelines NG21 on home care and NG67 on medicines support in the community; and the HSE's lone working guidance. Wales, Scotland and Northern Ireland have their own regulators and standards; this guide covers England.

It is a summary, not legal advice, and not a substitute for policies written for your own service.

Then do one thing, whether you are a small homecare provider or a large one: put CQC's list in section two beside your own policy index, and mark each policy with the regulation it serves and its last review date. Then add the six home care policies in section four. Any line without an owner is the next job.