What is unsatisfactory care?

Standards to expect

You might think that a care home, care agency or NHS hospital isn’t providing the level of service that they should; there might be a specific incident that you’re unhappy with; or your loved one might seem unhappy, but you’re not sure of the exact reason. In extremely rare cases, you might have concerns about neglect or abuse.

If you’re concerned about unsatisfactory care of your relative or friend, knowing your rights is a good starting point. Care homes, home care agencies and NHS hospitals must all be registered with their national regulatory body and meet the minimum standards that they set. The national watchdog in each country is:

In England: the Care Quality Commission (CQC).

In Northern Ireland: the Regulation and Quality Improvement Authority (RQIA).

In Scotland: the Care Inspectorate.

In Wales: the Care Inspectorate Wales (CSSIW).

They are responsible for:

• setting national minimum standards for care homes, home care agencies and NHS services (hospitals and GPs)
• monitoring and inspecting care homes to make sure that the services they provide come up to the required standard.

National standards for care homes in England

If your loved one is receiving care services, they have five basic rights:

1. To be respected, involved in their care and support and told what’s happening at every stage
2. To expect care, treatment and support that meets their needs
3. To be safe
4. To be cared for by staff with the right skills to do their jobs properly
5. To expect the care provider to routinely check the quality of their services.

National standards for care homes in Scotland

In Scotland, new Health and Social Care Standards were introduced in April 2018. They aim to ensure that individuals receiving care are treated with respect and dignity, and say that they should:

For more information, read our information about the quality and regulation of providers.

Identifying problems

Your loved one might tell you about problems themselves. If not and you think they are unhappy, or you suspect a problem, try to talk to them about it.

In addition to their views, use your own observations to judge how the care is going. If you’re unable to visit while the carer is present, is there someone else (a neighbour or friend) who could?

If your loved one is not able to communicate problems to you, or you have further worries, there are some common problems that you can look out for: see our common problems to look out for article.

Abuse in care homes or at home

Cases of abuse in care homes or by an agency carer at home are rare, but if you suspect that anyone is being abused by their carer, or you witness an incident, it can help to know what action to take. Abuse can be psychological, financial or physical.

If you suspect abuse

If your loved one seems frightened, upset or unhappy, talk to them in private and get as much detail as possible. Be patient with them, as it may take them some time to give you the full story. Suggest that you report the matter to the care manager together and ask for an explanation or an investigation. 

If you’re not satisfied with the answer, then contact the social care registration authority in your country. 

If you’re still unsatisfied, you can contact the local council (regardless of whether they fund the care). All councils have procedures in place to deal with the protection of vulnerable adults and have the authority to intervene. 

If you witness abuse

If you see your friend, relative or another person being abused by a carer, challenge the abuser immediately and tell them to stop. Write down exactly what happened and speak to the care manager in private to report what you’ve seen. In serious cases, report the incident to the registration authority and/or local council immediately.

If you want independent advice or support, contact the Relatives & Residents Association (R&RA), a charity that supports older people in residential care and their families.