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A guide to launching a domiciliary care agency

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Welcome

Setting up a new business is often a daunting task. There are many things to consider and pitfalls to avoid. Launching a domiciliary care agency has the added burden of ensuring that you are successfully registered with the Care Quality Commission. Turning your dream into reality requires many things; you need to know where to begin, an organised approach and a thorough understanding of the marketplace in which you will be operating.

Statistics from the King’s Fund show that in 2019/20 838,530 adults received funded long-term social care, primarily in care/nursing homes or their own homes. These are substantial figures and are indicative of how important the domiciliary care market is in the delivery of care. There are now in excess of 8,800 providers of homecare in England registered with the CQC.

To get started it is essential to have the right policies and procedures in place to ensure that you successfully register with the regulator and are able to pass future inspections. This applies just as much as to registration with the Care Inspectorate in Scotland and Care Inspectorate Wales, as it does with the CQC in England. Quality Compliance Systems is here to help you with this essential element of launching your domiciliary care business. The following pages provide advice and guidance on the other start-up elements you need to consider.

Registration

First things first, before you offer any care services in England, you need to register with the Care Quality Commission (CQC). It is a legal requirement under the Health and Social Care Act 2008 to register your organisation and the individual who will be your Registered Manager. This may be you if you have the relevant qualifications and are not employing or entering into partnership with someone who is to fulfil those requirements.

QCS provides advice and guidance about successfully registering in England, as well as providing accompanying policies and procedures that are required. To begin your registration in England, visit the following CQC webpage:

https://www.cqc.org.uk/guidance-providers/registration/register-new-provider

Before registering you need to consider whether you have the relevant qualifications and experience to provide homecare, whether you have experience and understanding of relevant legislation including

  • Health and Social Care Act 2008 and its associated regulations
  • Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards

And, whether you truly are committed to the vocation of providing excellent standards of care that respect and enrich the lives of those to whom you provide services. It’s an important consideration and one which the CQC will ascertain through your registration and delivery of services. Here are the key elements of registration on which you need to concentrate.

  1. You need to apply for a CQC-countersigned DBS (Disclosure Barring Service) check. Formerly known as a CRB check, the DBS ensures that you can lawfully work with vulnerable adults. This is the very first action which you must undertake and can take up to eight weeks to receive back. The DBS check needs to be carried out for the following
  • Individuals registering to provide a care service
  • All partners (if there are any)
  • Registered Manager

Click the following link to apply for your DBS check: https://cqc.disclosures.co.uk/

Further information can also be found here: https://www.cqc.org.uk/guidance-providers/registration/dbs-checks-cqc-registration

  1. References - You will need to provide the following information:
  • Details of employment history
  • GP name and contact details
  • Last employer’s name and contact details
  • Declaration of medical fitness

Where it is a partnership, the same information should be supplied for all partners.

  1. Financial Viability - You will need to have the financial resources to provide the services you are applying for and need to provide assurance of your financial position to CQC. A statement letter from a financial specialist, such as a registered accountant, should be submitted with the application.
  2. Fill in the right registration form. The forms vary according to whether you intend to supply services as an organisation, a partnership or as an
  3. Fill in the Registered Manager
  4. You must have a Statement of Purpose in place. This is quite information-rich so to ensure nothing is omitted, QCS provides you with a template which you can adapt to your Much information needs to be included within the Statement of Purpose, including but not limited to:
  • Details of the services  provided
  • Contact details
  • The provider’s aims and objectives
  1. Once you have received your CQC-countersigned DBS and fulfilled the above, you are ready to submit your It should be sent by email, alongside all the supporting documentation.

The CQC provide a useful webpage which highlights the most common errors found in applications. Read this list and ensure that you do not make these mistakes, as it will only delay your application and the start of your business:

https://www.cqc.org.uk/guidance-providers/registration/registered-manager-application/final-checks-common-errors

Qualifications & Training

All care professionals must satisfy the CQC’s requirement that “care providers show that they are complying with the relevant regulations covering staff competence and training”. This means that all care staff must have completed the Care Certificate which is applicable to the adult social care sector. These standards must also be completed within 12 weeks of commencing employment.

Registered Manager

Beyond the Care Certificate, certain roles require that specific qualifications be in place before care is provided, and in one case, before a service is provided. This position is that of the Registered Manager, perhaps the single most important position recruited into any care business. When sourcing a Registered Manager, you must make absolutely certain that they have the relevant skills and experience before a care service is provided. This is a critical role within your establishment and one which will be scrutinised by the CQC from the registration stage.

The current qualification which the Registered Manager should possess is the QCF Level 5 Diploma in Leadership for Health and Social Care, choosing one of the following pathways:

  • Management of Adult Services
  • Management of Adult Residential Services

If the Registered Manager does not have the Level 5 Diploma, then he/she ought to register on to the programme within 3 months of appointment and expect to complete it within 18 months to 2 years. This advice has been provided by Skills for Care and is utilised by the CQC in making a proportionate judgment about any Registered Manager that does not possess either the Level 5 Diploma or an equivalent older qualification.   When making a decision the CQC takes into consideration such factors as the impact this could have on service users; whether the individual has registered on to the programme; previous experience and relevant qualifications.

Qualifications which are no longer offered, but are still valid in satisfying the CQC’s requirements are:

  • Registered Manager’s Award (RMA)
  • NVQ Level 4 in Leadership and Management for Care Services

It’s important to remember that the two general qualifications above need to be supplemented with a further qualification which demonstrates that the Registered Manager has the right skills and knowledge for the specific care setting. An NVQ Level 4 in Health and Social Care or a relevant nursing qualification are two examples.

Ensure that proof of all qualifications upon preparing your official registration with the CQC is supplied.

Responsible Individual

The Responsible Individual is a key management position, whereby the post holder must demonstrate that they have all the key skills and experience for overseeing the running of a care business. This is not necessarily a position where the post holder provides care. However, it is reasonably common for the Registered Manager and the Responsible Individual to be the same person in a start-up business. In this case, all of the above requirements for the Registered Manager apply.

For further guidance please visit the Skills for Care website. You can view relevant material and resources to help you ensure that you have the right qualifications and skills in place for all your employees, not just the Registered Manager:

http://www.skillsforcare.org.uk/

Funding

Establishing an adequate cash-flow is one of the most significant challenges for start-up businesses.  Winning tenders is likely to be a significant element in securing the income you need and understanding the essentials of the process is one of the keys to success.

Once a tender has been advertised, say by a Local Authority, you need to register your expression of interest with the tendering body. Following this a Pre-Qualification Questionnaire (PQQ) is sent out to you with a deadline for completion and return. The shortlist of providers is drawn from the submitted PQQs. Having successfully made the shortlist you are then able to officially tender to provide the service(s).

The structure of the PQQ may vary from one tendering body to another and may include, but is not limited to:

  • Evidence of financial viability of the applicant organisation
  • Evidence of registration with the CQC
  • Evidence of relevant experience in the provision of similar services
  • Evidence of previous businesses including director prosecutions, insolvency,
  • Evidence of suitably qualified and trained staff
  • Contact details for suitable referees
  • Personnel information about both the provider and any staff
  • Certificate of incorporation
  • Health and safety information
  • Company financial information
  • Business Continuity Plans

It may take time to establish that you have enough history to successfully win a tender contract for the provision of care services, so finding income from independent paying clients is often crucial. Effective marketing can help enormously, but so does having a prudent cash-flow policy and start-up fund.

Employing Staff

Running a domiciliary care agency is a very challenging undertaking. The logistics of providing care in multiple locations requires the recruitment of suitably qualified, trustworthy staff. When sourcing suitable candidates, you need to be certain about the qualifications and experience that are required. We have a qualifications page which gives you essential guidance on this. You also need to think about background checks via the DBS where appropriate, where to advertise, which agency to use and how an interview must be conducted.

Helpful advice about employing staff can be found at the following websites:

  • Department of Business, Innovation and Skills: bis.gov.uk
  • Chartered Institute of Personnel and Development: cipd.co.uk

The QCS Management System contains a comprehensive Human Resources section and includes an accompanying folder. This provides you with policies and procedures covering everything from absence, sickness, contracts, employee handbooks, equality and disability and job descriptions, through to performance and discipline, recruitment, training, and induction. Our aim here is to provide you with solid support, enhanced by our HR partners and expert contributors, Napthens Solicitors.

Checklist

  • Registration with the CQC, Care Inspectorate or CIW: Both your agency and the Registered Manager
  • Setting up your business: Sole trader; Limited Company; Partnerships
  • Insurance
  • Tendering
  • Recruitment, induction, and training
  • Marketing
  • Pay and VAT
  • Disclosure Barring Service
  • Company registration
  • Funding – tendering, direct payments, cashflow

About QCS

Quality Compliance Systems (QCS) offers a unique approach to CQC Compliance with an online based service specifically tailored to the individual needs of your organisation.

Whether you are an established Care Provider or a start-up organisation, our service is provided with the aim of ensuring that all aspects of compliance are being attended to.

Our industry experts continually update existing policies and procedures, whilst introducing new ones in response to the latest changes issued by the Care Quality Commission (England) and the Care Inspectorate (Scotland).

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