How to choose a domiciliary care agency or carer

If you are still getting to grips with the term, what domiciliary care is and how to arrange it explains it first. This page assumes you know you want visits at home and are now choosing who will make them.

The searches are here: the Care Quality Commission's find care services for England, the Care Inspectorate's find care for Scotland, the Care Inspectorate Wales directory, and RQIA inspection reports for Northern Ireland. If the search returns more agencies than you can ring, start with the ones whose office is close to your relative, because carers based nearby spend less of their day travelling between visits.

The council is the other place to ask. Under the Care Act 2014, every council in England must run an information and advice service that covers, among other things, the choice of care providers available in its area. Ring adult social care and ask which home care agencies cover your relative's address. If your relative may need help paying, ask for a care needs assessment on the same call, because the council's own arrangements and a direct payment both start there.

Registration tells you the agency is allowed to provide personal care and is inspected. It does not tell you whether it has carers free in your relative's area on the days you need. Ask that early, before you spend time on anything else. How home care is regulated explains what registration covers in each of the four nations, and why a self-employed carer you engage directly, and an introductory service such as PrimeCarers, are not registered in the same way.

In England the Care Quality Commission gives an overall rating of outstanding, good, requires improvement or inadequate. It also rates each of the five key questions it asks of every service: whether it is safe, effective, caring, responsive to people's needs and well-led. An agency can be good overall and still require improvement on one of the five, so look at all of them.

1. 1

   Check the date of the last inspection

   Top of the report

   A rating from several years ago tells you how the agency was run then. If the manager or owner has changed since, ask the agency what is different now.
2. 2

   Look at the rating for safe

   The first of the five

   This covers how the agency protects people from harm, including how it handles medicines, how it vets staff and whether there are enough carers for the visits it has taken on.
3. 3

   Read what the inspectors found

   The findings, not the summary

   Look for comments about late or missed visits, rushed calls, carers changing often and how complaints were handled. These are the things your relative will notice first.
4. 4

   Note any actions the agency was told to take

   Requires improvement or inadequate

   The report says what must change. Ask the agency what it has done about each point and when the inspectors are due back.

In Scotland, Wales and Northern Ireland the reports are set out differently, but the same approach works: check the date, read what was found about safety and staffing, and look for anything the service was told to improve. An agency with a good report that cannot answer your questions clearly on the phone is still worth crossing off the list. A report shows the agency on the days of the inspection, and your phone call shows you how it treats a family that is asking for help now.

Two of these deserve more time than the others. The first is who will come. National guidance from NICE tells home care services to prioritise continuity of care, so that the person is supported by the same care workers and can get to know them. An agency that says it cannot tell you in advance who will visit, or how many different people to expect, is telling you something important. Why the same carer every visit matters explains what changes when your relative sees one familiar face.

The second is how long each visit lasts. NICE says visits shorter than half an hour should be made only when the care worker already knows the person, the visit is part of a wider package of support, and there is enough time for a specific, time-limited task or a check that the person is safe and well. The Care Act statutory guidance says visits of 15 minutes or less are not appropriate for people who need help with intimate care. If your relative needs help to wash, dress or use the toilet, ask for at least 30 minutes. Why 15 and 30 minute calls fail sets out what fits into each length of visit, and what domiciliary care costs shows how the length changes the weekly bill.

This is the route PrimeCarers is part of, so it is worth being clear about where we sit. PrimeCarers is an introductory service, not a care agency or a care provider, and it holds no CQC registration. The carer you choose is self-employed and works for you. Before a carer's profile appears, we check their identity and right to work, check that they hold an enhanced DBS certificate (or a PVG in Scotland, or Access NI in Northern Ireland) issued within the last 2 years, and interview them online. For visits booked through PrimeCarers, we arrange insurance cover where the carer does not have their own, subject to the policy terms. We do not check qualifications, training or references. How carers are checked sets out each step.

On the DBS check, gov.uk says that if you are engaging a self-employed person to care for a member of your family, you cannot request a DBS check for them. They apply for their own, and you check their certificate. Do private carers need a DBS? explains the levels of check, and private carer insurance covers the kinds of cover worth asking about.

Cover for illness and holidays is the main thing an agency does for you that a self-employed carer does not. Some families meet two carers at the start so they have someone familiar to call on. When your carer is ill or on holiday goes through the options, and PrimeCarers' paid managed service includes help with scheduling and holiday cover for families who would like it. In return you choose who comes, you can keep the same person, and you pay a lower hourly rate. Questions to ask at interview has more to ask once you have a shortlist.

When you have worked through the checklist and are ready to look at people, you can search for carers near your relative and compare their rates, reviews and availability. Each profile shows the carer's hourly rate with our fee included.

With an agency, the Local Government and Social Care Ombudsman asks you to go through the agency's own complaints process first. If you are still unhappy at the end of it, or have had no reply within a reasonable time, you can take it to the Ombudsman. It is free, and it looks at adult social care complaints including care that is paid for privately. The Care Quality Commission does not take individual complaints forward, but it asks people to tell it about poor care, because that information guides its inspections.

If you think your relative is being harmed or neglected, by anyone, that is a safeguarding concern rather than a complaint. Contact the council's adult social care team, or the police if somebody is in immediate danger. Safeguarding adults and how to report it explains what happens next. Whichever route you chose, keep a short written note of dates and what happened, because it makes every later conversation easier.