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Care homes briefing 174 – CQC report: The state of adult social care service 2014-2017

The CQC’s recently published report ‘The State of Adult Social Care Services 2014 to 2017’ presents findings from adult social care inspections between October 2014 and February 2017. During that time the CQC completed over 33,000 inspections of around 24,000 adult social care homes.

The inspectors considered whether services were safe, effective, caring, responsive and well-led.

The outcome was that 77% of adult social care services in England were rated as Good with 2% assessed as Outstanding. Nearly 20% were rated as Requiring Improvement with 2% rated as Inadequate.

Key elements of good care

The most successful services had three common key elements that made their care Good or Outstanding: good leaders, a positive culture and person-centred care.

Good leaders

Good leaders have an important role in helping to shape a positive culture in a care home. This involves creating a supportive environment for staff, other professionals, people using the services and their families, listening to and communicating well with them.

Strong leadership is not restricted to managers. They were supported by directors in communicating a strong vision and values to staff and by robust quality assurance systems and processes. This encourages a culture of openness and transparency.


A culture of improvement based on good practice and feedback, coupled with staff who were well-trained, caring, skilled, dedicated, enthusiastic and focused on positive outcomes. Examples of positive culture include:

  1. Staff not wearing uniforms in recognition that they were in a home and viewing themselves as ‘guests’
  2. Involving people who use the services in training
  3. Staff designated as ‘champions’ in particular areas

Person-centred care

Staff getting to know people and creating relationships with residents. Working together with families and seeking their input in order to create meaningful goals.

Common factors in poor care

Two factors were common in the service of providers rated as Inadequate or Requiring Improvement:


Insufficient staffing levels particularly at peak times and staff without the necessary skills.

Medicines management

Medicines not being administered properly, staff lacking knowledge of medicines and their side effects, issues with record keeping, a lack of medicines audit and medicines being out of date or incorrectly stored.

What can providers do?

In light of the CQC’s civil and criminal enforcement powers, providers should give careful consideration to appropriate staffing levels, rotas and training, medicines management, record keeping and how staff interact with residents and their families.

The report published by the CQC shows that high quality care is the responsibility of everyone in the social care sector and there are many providers offering high quality services. However, there are still a large number of people experiencing care which is not of an acceptable quality and in this respect there is still much to do.

If you have any questions, please contact:

Marianne Frall
T. 020 7227 7260

Ilja Balkus
Trainee Solicitor
T. 020 7227 6748


This briefing is for guidance purposes only. RadcliffesLeBrasseur LLP accepts no responsibility or liability whatsoever for any action taken or not taken in relation to this note and recommends that appropriate legal advice be taken having regard to a client's own particular circumstances.

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