Putting people at the centre of visiting decisions

Being able to see loved ones is incredibly important to wellbeing. The pandemic has made this challenging for many people, but for some people in care settings this has meant being separated and deprived of physical contact with loved ones for over a year. We also know that safe visiting during the COVID-19 pandemic feels different to residents, relatives and loved ones from what they are used to.

We have always been clear in our engagement with care providers - at every level of communication and at every stage of the pandemic - that the individual must be at the centre of any decisions made and all decisions need to stay under review as circumstances change. Every concern we have heard related to a potential blanket ban to visiting has led to action from our inspectors. This includes following up with providers, inspecting, raising safeguarding alerts where appropriate and engaging with local authorities.

Kate Terroni, Chief Inspector of Adult Social Care, said:

“The pandemic has had an unprecedented impact on many people and we know it has been particularly difficult for those who are living in care homes and their families and loved ones. We have taken decisive action throughout the pandemic to help keep people safe in care settings including undertaking over 7,000 inspections, and making absolutely clear to providers that blanket approaches to visiting are unacceptable and may trigger an inspection. We have been clear throughout the pandemic that the individual must be at the centre of decisions around visiting.

We continue to seek assurances from care home providers about how they are supporting visiting to happen and we are verifying this information when we go out and inspect. We have a mandatory question on each of our care home inspections which looks at how visiting is being supported to happen in a safe way and since 8 March of this year we’ve undertaken 1,282 inspections. We have found that 95% were enabling visiting to happen, and action was taken with those 5% of providers where we had outstanding concerns.

“Concerns have been raised with us about 37 potential blanket bans and we have taken action in every case, including following up with providers, inspecting, raising safeguarding alerts where appropriate and following up with local authorities. We expect providers to follow government guidance on visiting where people are entitled to have designated visitors, and where we are made aware that this is not happening we will follow up with the provider and inspect if we consider that there is risk.

“Where we have any evidence that this is not happening we will continue to take action and are grateful to all those who continue to share their concerns with us.”

We know that there is a need to balance safety, through good infection prevention and control (IPC), with the human rights of individuals to see their loved ones - affording people their rights, including the right to life and the right to family life. That is why person centred, high quality care has never been more important and recognising that part of people’s identity and wellbeing comes from their relationships is critical. Meeting people’s holistic needs requires an individualised approach.

As restrictions on care homes are relaxed, we will continue to monitor the situation and support providers to implement the new guidance and investigate concerns when we hear about potential blanket bans. We know the majority of providers are making every effort to follow the latest guidance and we have made clear to them that if something changes, and they are no longer able to do this then they should speak with their CQC inspector as soon as possible.

Our regulatory role and core purpose to keep people safe and ensure that they have high quality, person centred care remains front and centre of our approach. We monitor, inspect and regulate services to make sure they meet fundamental standards of quality and safety. These fundamental standards are grounded in human rights principles. We assess care home visitation policies against these standards on a case-by-case basis and our assessment will include local factors too e.g. vaccination rates, number of positive cases, IPC findings.

Anonymity

Through our engagement with organisations that represent people who use services we have heard that some people who use services, and their loved ones are, worried that if they raise concerns, whether to the care home, or to CQC, they will face negative consequences. Throughout our monitoring and inspection activities all information that is shared with us by members of the public remains anonymous. Our inspectors are trained to plan and complete engagement and regulatory activities, including inspections, in such a way that their investigations of anonymous information do not reveal the source of that information.

Kate Terroni, Chief Inspector of Adult Social Care, added:

“Care homes are people’s homes and no-one should live in fear of being penalised for raising concerns. Sadly, we’re aware that this is not always the case. It is not acceptable for people to be treated unfairly if they raise concerns and I am clear that appropriate action will be taken if we find providers failing in their responsibilities.

“We already review how providers handle complaints when looking at how responsive and ‘well led’ a care home is, as well as checking with residents and relatives whether they know how to raise concerns and if they feel listened to. We have also launched our joint Because We All Care campaign with Health Watch England to support people in care and their loved ones by encouraging people to share feedback on individual experience”

We have been working with Healthwatch England to deliver an awareness raising campaign, ‘Because we all care’, to encourage people to share feedback on individual experiences of care with us. The aim of the campaign is to support individuals to raise concerns and to help services identify and address quality issues. It has a special focus on improving awareness and encouraging feedback from people from seldom heard groups