A care plan may describe the right support, yet the person receiving care can still have concerns about how it feels in practice. Perhaps personal care seems rushed, preferences are repeatedly overlooked or relatives are having to chase information that should already have been shared.
A care quality review brings together what was agreed, what is actually happening and the person’s own experience. It is an opportunity to recognise good support, investigate concerns and agree what needs to improve.
This guide is for families reviewing an existing home-care arrangement in England. It describes a discussion with the care provider, not a CQC inspection or a clinical assessment.
You do not need to wait until several problems accumulate before requesting a conversation.
Reviewing Quality Is the Provider’s Responsibility Too
Families can offer useful observations, but they should not have to inspect every care task to make the service work.
Regulated providers must have systems for monitoring the quality and safety of their care, managing risks, keeping appropriate records and acting on feedback. These responsibilities continue after the initial assessment and introduction. CQC’s good-governance guidance explains what providers are expected to have in place.
Ask how the provider checks the experience of people receiving care—not simply whether paperwork has been completed.
A useful question is: “How do you establish that the support described in the care plan is working for the person at home?”
Begin With the Person’s Experience
Start by asking what feels helpful and what they would like done differently.
“Are you happy with everything?” may produce a polite answer without revealing much. More specific questions can make the conversation easier:
“What helps you feel comfortable when getting ready?”
“Is there anything you would prefer to do yourself?”
“Do you feel able to ask for a different approach?”
Offer an opportunity to speak privately. Someone may prefer a short conversation without several relatives or the carer present. Ask what would help them participate, including communication support or involvement from someone they trust.
CQC’s requirements include respectful communication, privacy and support for autonomy. These are part of appropriate care, not optional extras dependent on how well two people get along.
Where communication is difficult, take observations seriously without assuming that a facial expression or change in behaviour provides the whole explanation. Ask the care team how the person’s views can be understood and included.
For couples receiving care at home, seek each person’s perspective. One partner’s satisfaction should not be treated as an answer for both.
Compare the Agreed Support With Everyday Care
Use the current care plan as a reference, alongside the person’s wishes and relevant records. The purpose is not to enforce an outdated routine, but to understand whether agreed assistance is happening and remains appropriate.
The following questions can help structure the discussion.
| Area | Questions to explore |
|---|---|
| Personal care and privacy | Is assistance offered respectfully? Does the person have time to participate and explain preferences? |
| Meals and drinks | Is the agreed help being provided? Are difficulties or repeated refusals being noticed and followed up? |
| Medicines support | Is the assessed assistance being given and recorded? What happens when a dose is missed, declined or uncertain? |
| Movement and equipment | Is assistance consistent with the current professional guidance? Have new difficulties been raised? |
| Communication and continuity | Are agreed updates happening? Does relevant information follow the person when carers change? |
| Choice and everyday life | Is the person supported to continue meaningful activities, rather than having every decision made for them? |
These are discussion prompts, not a scoring system. Several positive answers do not cancel out a serious safety concern elsewhere.
For medicines, ask the provider to check the agreed support and appropriate records rather than reconstructing doses from memory. CQC expects the assistance needed for each medicine, responsibilities and review arrangements to be documented. Our medication support guide explains the practical distinctions.
Distinguish Changed Needs From Problems With Delivery
Not every difficult day has the same cause. Ask the review to establish what needs attention rather than assuming that either the carer or the person is responsible.
The person may need different support. If an activity has become harder, the original arrangement may no longer be sufficient. A care plan review should consider the change and any necessary professional input. CQC expects assessments to be reviewed when needs and circumstances change.
Agreed assistance may not be happening. If an essential task is repeatedly missed or concerns are not followed up, ask the provider to investigate the delivery of the service. Rewriting the plan is not enough if the problem is that it is not being followed.
The person may have made a different choice. Choosing to wash later is not the same as never being offered the agreed assistance. Explore what was offered, what the person wanted and whether concerns required further action. Care must take account of consent and individual preferences.
Physical support needs particular care. If a transfer has become difficult, do not improvise a different lift or ask a relative to act as an additional helper without appropriate assessment. The method, equipment and number of helpers should reflect the person’s current moving-and-handling needs.
Keep Factual Notes Without Delaying the Conversation
Record enough information to explain the concern: what happened, when, how you know and what effect it had.
Separate what you witnessed from what somebody told you. Include the person’s own words where possible and avoid guessing motives.
For example, you could say:
“Mum says her clothes were chosen for her on Monday and Wednesday without asking what she wanted. She would like to keep making that choice. Please can we discuss how this will be respected?”
That identifies a specific concern and a desired outcome without turning the conversation into an accusation about someone’s character.
You do not need a fortnight of evidence before contacting the provider. Report the concern and continue making relevant notes while it is addressed.
Keep personal information secure. Agree what care information can appropriately be shared with relatives rather than assuming everyone is entitled to every record. Providers must protect the confidentiality and security of care records while ensuring authorised people can access necessary information.
Include the Carer’s Account Without Making It a Confrontation
Ask the care team to hear from the people involved and consider relevant records.
The carer may have noticed a difficulty that relatives have not seen, or may explain that equipment, instructions or the agreed level of support no longer meet the situation. Their account deserves consideration alongside the person’s experience.
The review should not become an argument in front of the person receiving care. Separate conversations may be more appropriate, particularly if somebody feels uncomfortable speaking openly.
A minor preference can sometimes be discussed directly with the carer where the person is comfortable doing so. However, there is no need to make that the first step when you would rather contact the care team.
For concerns involving safety, repeated problems or the conduct of the person providing support, raise the matter directly with the responsible manager.
Agree Actions, Not Just Reassurance
Before the discussion ends, establish what the provider will do and how you will know whether it has helped.
Ask for written confirmation of the concern considered, any immediate precautions, the action agreed, who will arrange it and the date for an update.
“Discussed with the carer” may describe an action, but it does not establish that the person’s experience has improved. Ask how the effect will be checked.
For the clothing example, an agreed response might include confirming the person’s preference, making sure the relevant care information reflects it and asking them afterwards whether they are being offered the choices they want.
Where the care plan changes, the updated information must reach the people providing the relevant support. CQC expects plans to reflect agreed goals and carers to be kept informed of changes in needs and preferences.
Also identify what should remain unchanged. A familiar approach to communication or an activity the person enjoys may be worth preserving even while another part of the arrangement is improved.
Know When a Review Is Not the Right First Response
Do not wait for a scheduled meeting when someone needs urgent help.
If someone suddenly becomes confused, seek immediate medical assistance. The NHS guidance on sudden confusion advises going to A&E or calling 999 because some causes can be life-threatening. Do not assume the change is simply dementia or a care-quality issue.
If you suspect abuse or neglect, contact the person’s local council and ask for the adult safeguarding team. You do not need to resolve the matter informally with the carer first. Call 999 where immediate emergency assistance is required. The NHS safeguarding guidance explains who to contact.
A regulated provider must act without delay when abuse is suspected or reported, including making appropriate referrals. A routine quality review must not replace that response.
For other health concerns, obtain appropriate clinical advice and inform the care provider. The review can then consider what practical support needs to change.
What If the Provider’s Response Does Not Resolve the Concern?
Ask for the formal complaints procedure and explain which matters remain unresolved. Keep the correspondence and request confirmation of the next steps and expected response time.
You can complain to the organisation providing or paying for the care. You can also give information to CQC, although the regulator does not take forward individual complaints on your behalf. Its role is different from resolving your particular dispute.
The Local Government and Social Care Ombudsman can consider complaints about adult social care, including privately funded care. It will normally expect the provider or council to have had a fair opportunity to respond first. If the response is unsatisfactory or the complaint is not answered within a reasonable time, ask the Ombudsman whether it can consider the matter.
These complaints routes do not replace urgent healthcare or safeguarding action where someone is at risk.
How Live In Care Ltd Reviews Care Quality
Live In Care Ltd is a family-owned, CQC-regulated provider of fully managed live-in care across England.
Our ongoing support and review arrangements include electronic care information, communication with the people involved, regular reviews and quality-assurance checks. The care team can review recorded concerns and consider what response is needed.
If we provide your care, contact our care team when something needs attention. Explain what is working as well as what concerns you, and tell us what the person receiving care would like to be different.
A useful care quality review ends with more than an assurance that somebody has listened. It leaves the person and their family clear about what has been understood, what will happen next and how the result will be checked.