The CQC report ‘Better care in my hands’ emphasised the importance of residents’ relatives being able to help plan their care and support. The CQC’s more recent guidance ‘Information on visiting rights in care homes’ explains that such involvement is better enabled by family members being able to visit residents in their home, talk to the staff and pass on their feedback.
Care home staff should respect residents’ relationships and allow as much privacy for visits as possible. Where this is not facilitated, the provider may be breaching a number of regulations contained within the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which may result in the CQC exercising its enforcement powers.
The guidance states the following questions in relation visiting will be considered when services are inspected:
- How are people supported to maintain good health, have access to healthcare services and receive ongoing healthcare support?
- How is people’s privacy and dignity respected and promoted? Are people’s relatives and friends able to visit without being unnecessarily restricted?
- How do people receive personalised care that is responsive to their needs? How are people encouraged and supported to develop and maintain relationships with people that matter to them and avoid social isolation?
It is noted that inspectors will expect to see:
- Where individuals lack capacity to make decisions regarding their care, their friends and family are involved as appropriate
- Staff are proactive, and make sure that individuals are able to keep relationships that matter to them
- Concerns and complaints are always taken seriously, explored thoroughly and responded to in good time
Where the resident lacks capacity to make decisions in relation to who visits them
The guidance states that visitors should be allowed unless there are compelling reasons that permitting such visits would not be in the resident’s best interests. Decisions to restrict visits should be agreed through a Mental Capacity Act decision making process.
Where visitors have concerns regarding the provider
The CQC is keen to hear from people as to whether they feel comfortable sharing concerns and complaints with providers and this will be checked as part of any inspection.
Providers should note that the regulations state that people must be able to make complaints and complainants must not be discriminated against or victimised. A resident’s care and treatment must not be affected if a complaint is made by them or by any other person on their behalf.
Where difficulties arise with visits
Sadly, not all visits go smoothly. We find it is surprising how often concerns arise in relation to visitors abusing staff or residents.
Providers have a duty to prevent those who are using their service from suffering abuse, from staff and others they have contact with including visitors.
The guidance recommends providers should talk to the visitor in the first instance and if the behaviour giving rise to the concern continues, a provider should assess the level of risk and the impact upon the resident. There may of course sometimes be circumstances where the matter requires investigation and/or a referral to adult safeguarding becomes necessary.
It is open to providers to implement conditions which restrict a visitor’s entry to the premises, however these must be carefully considered to ensure that they are proportionate to the identified risk and kept under review. On occasion it may become appropriate to require an undertaking on the future conduct from a visitor, or even to suspend visits by that person.
If the visitor has a Lasting Power of Attorney consideration should also be given to contacting the Office of the Public Guardian who can take a view on whether an application should be made to the Court of Protection.
It is of the utmost importance that records are kept of all interactions and decisions reached, and that timely referrals are made if appropriate.