First reported 30 Dec 2016•Latest report 22 Jul 2024
Definition
What this concern includes
Includes failures of domiciliary-care provision where scheduled or commissioned home-care visits omit, inadequately deliver or inappropriately redirect essential cleaning, personal care or meal support, including the anchor's care hours being used for social attendance and the supporting failure to provide personal care during twice-daily visits.
Not included
Excludes failures limited to community-care assessment, commissioning, care-package arrangement or review where delivery of domiciliary care is not itself deficient.
Excludes generic staffing, training, documentation or safeguarding deficiencies unless they directly result in failure to provide essential domiciliary care.
Excludes failures concerning hospital, residential-care or nursing-home care unless the assertion specifically concerns domiciliary care delivered in the person's home.
Excludes refusal of care by the person where the domiciliary-care service appropriately provides, escalates or reviews the response and no failure of care provision is identified.
Reports
5
Distinct published reports
Individual concerns
5
A report can raise multiple concerns
Date range
2016–2024
First to latest report issue date
Stated actions
19
Described in published responses
Reports over time
Reports over time
Reports about this concern issued each year.
* 2026 is projected from reports observed to 7 Sep 2026.
Most frequent recipients
Most frequent recipients
Reports about this concern sent to each recipient.
Department of Health and Social Care2
Central London Community Healthcare NHS Trust1
Comfort Call Limited1
East London NHS Foundation Trust1
Kapital Care (UK) Limited1
London Borough of Newham1
London Borough of Redbridge1
North East London NHS Foundation Trust1
Sunlight Care Group1
The Human Support Group Limited1
Trafford Borough Council1
University College London Hospitals NHS Foundation Trust1
Westminster City Council1
London borough council3
NHS trust3
Domiciliary care provider2
Ministerial department2
English metropolitan district council1
Private limited company1
Social-care provider1
Concerns and responses across reports
Only concerns grouped under this recurring concern are included. Select any concern, action or position to view the source wording.
East London
Concerns raised1
Failure of domiciliary care to provide essential cleaning, personal care and meal support
This report raised 5 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.11
Action
Meet with Sunlight Care to address and mitigate risks to residents receiving its care and support.
Stated by London Borough of NewhamStated completedThe respondent said that this action was complete when they made their response on 31 July 2024.
Action
Implement and continue the quality improvement plan for Sunlight Care.
Stated by London Borough of NewhamStated in progressThe respondent said that this action was in progress when they made their response on 31 July 2024.
Action
Provide enhanced monitoring of all residents receiving care and support from Sunlight Care.
Stated by London Borough of NewhamStated completedThe respondent said that this action was complete when they made their response on 31 July 2024.
Action
Conduct welfare checks for Sunlight Care residents who live alone.
Stated by London Borough of NewhamStated completedThe respondent said that this action was complete when they made their response on 31 July 2024.
Action
Develop an escalation procedure for partners to flag high unmitigated risk or differing risk assessments, including reviews of no-reply and refusal-of-care protocols.
Stated by London Borough of NewhamStated plannedThe respondent said that this action was planned when they made their response on 31 July 2024.
Action
Update safeguarding, notification, response and monitoring policies, including 24-hour reporting, 48-hour response expectations and proactive follow-up.
Stated by Sunlight CareStated completedThe respondent said that this action was complete when they made their response on 31 July 2024.
Action
Implement an eight-week programme of revised-policy communication and staff training covering self-neglect, safety, nutrition, risk, capacity, safeguarding and multidisciplinary collaboration.
Stated by Sunlight CareStated in progressThe respondent said that this action was in progress when they made their response on 31 July 2024.
Action
Implement new inter-agency communication and escalation strategies for timely safeguarding escalation across teams.
Stated by Sunlight CareStated plannedThe respondent said that this action was planned when they made their response on 31 July 2024.
Action
Introduce regular multidisciplinary reviews for cases involving self-neglect, incorporating physical, mental and social wellbeing in decision-making.
Stated by Sunlight CareStated in progressThe respondent said that this action was in progress when they made their response on 31 July 2024.
Action
Publish the first part of the Care Workforce Pathway for adult social care.
Stated by Department of Health and Social CareStated completedThe respondent said that this action was complete when they made their response on 31 July 2024.
Action
Develop the Care Workforce Pathway to work alongside existing standards and competency frameworks.
Stated by Department of Health and Social CareStated in progressThe respondent said that this action was in progress when they made their response on 31 July 2024.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.5
Position
Formal interventions for capacitous clients depend on statutory agencies rather than the care provider.
Stated by Sunlight CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Existing DoLS safeguards do not apply to people living at home, and the proposed LPS framework will not be implemented.
Stated by Sunlight CareUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The Trust cannot comment on behalf of the local authority or domiciliary care company regarding their communication and care arrangements.
Stated by East London NHS Foundation TrustUnable to actThe respondent said that a constraint prevented them from taking the relevant action.
Position
The commissioner and General Practitioner are expected to manage concerns about domiciliary care and the service user’s poor decision-making.
Stated by East London NHS Foundation TrustRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
Position
Employers have ultimate responsibility for ensuring health and care staff possess the necessary skills and competence.
Stated by Department of Health and Social CareRedirects responsibilityThe respondent said that another organisation was responsible for deciding or taking action.
East London
Concerns raised1
Domiciliary care visits failing to provide personal care
This report raised 4 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
No linked response statements
No respondent-stated action or position is linked to these concerns in the published data.
Inner North London
Concerns raised1
Failure to provide required personal hygiene and catheter care during home visits
This report raised 8 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.7
Action
Update home-held care-plan templates with clear carer instructions, escalation criteria and community nurse contact details.
Stated by Central London Community Healthcare NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2022.
Action
Update home-held care-plan templates with clear carer instructions, escalation criteria and community-nurse contact details.
Stated by Central London Community Healthcare NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2022.
Action
Review and improve information shared with carers before vulnerable adults are discharged, including holistic-care instructions and pressure-damage prevention equipment.
Stated by Central London Community Healthcare NHS TrustStated completedThe respondent said that this action was complete when they made their response on 8 December 2022.
Action
Complete manual-handling, mobility-equipment and environmental assessments before or during the initial visit.
Stated by Kapital Care (UK) LimitedStated plannedThe respondent said that this action was planned when they made their response on 8 December 2022.
Action
Escalate equipment-related barriers to essential personal care and resolve them before staff leave the property.
Stated by Kapital Care (UK) LimitedStated plannedThe respondent said that this action was planned when they made their response on 8 December 2022.
Action
Complete manual-handling, mobility-equipment and environmental assessments during initial visits.
Stated by Kapital Care (UK) LimitedStated plannedThe respondent said that this action was planned when they made their response on 8 December 2022.
Action
Escalate equipment-related barriers to care coordinators and resolve them before staff leave the property.
Stated by Kapital Care (UK) LimitedStated plannedThe respondent said that this action was planned when they made their response on 8 December 2022.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
Improved local processes, staff education and monthly partnership reviews are considered sufficient to address discharge and post-discharge safety concerns.
Stated by University College London Hospitals NHS Foundation TrustExisting arrangements considered sufficientThe respondent said that existing arrangements were sufficient, so no further action was needed.
Manchester South
Concerns raised1
Failure to provide the assessed duration of care
This report raised 2 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Actions described in response An action is something a respondent says it has done, is doing, or plans to do in response to the concern raised.1
Action
Include travel time between care assignments as a separate element in staff rotas.
Stated by James ThorburnStated completedThe respondent said that this action was complete when they made their response on 15 February 2018.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
A care call being shortened by a few minutes does not inherently mean that adequate care was not delivered.
Stated by James ThorburnDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
Manchester City
Concerns raised1
Failure to undertake both daily care visits
This report raised 6 other concerns. They are not shown here because they do not form part of this recurring concern.
Responses linked to these concerns
Each statement is shown once, even when linked to more than one concern.
Respondent positions A position is what a respondent says about the concern when they do not describe a specific action.1
Position
The alleged missed visits did not all occur: some were unscheduled, discontinued under the care plan, or cancelled by the individual.
Stated by Human Support GroupDisputes the concernThe respondent disagreed with part of the concern or the basis for it.
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Includes failures of domiciliary-care provision where scheduled or commissioned home-care visits omit, inadequately deliver or inappropriately redirect essential cleaning, personal care or meal support, including the anchor's care hours being used for social attendance and the supporting failure to provide personal care during twice-daily visits.
