Safeguarding and quality in commissioning care homes


Key points for commissioners


  • utilise the governance framework to promote good quality care and to gather intelligence from monitoring partners (e.g. Care Quality Commission (CQC)) to assess risk
  • use information gathered during investigations and serious case reviews to inform future commissioning
  • provide information to the local Safeguarding Board to assist the Board in its governance role
  • identify services that are at risk of isolation from the wider community and address this - isolation presents a greater risk of abuse and institutionalised care as there are fewer people to notice and report it
  • utilise feedback and complaints information from care homes
  • give care home staff opportunities to give their views about the service to feed into the service monitoring process.

Commissioners ensure that care homes:

  • incorporate safeguarding principles into recruitment, induction and supervision
  • provide a safe environment and can demonstrate good practice on health and safety
  • provide (or access) good quality training on quality standards and safeguarding for all care and support staff
  • demonstrate good leadership and a culture of dignity and respect
  • encourage staff to question poor practice, to develop learning and avoid a blame culture
  • encourage connections with the wider community and access support (e.g. befriending) for people who are at risk of social isolation
  • actively promote empowerment, providing education about risks and enabling residents to protect themselves
  • properly support and monitor residents who may present a risk to others
  • can demonstrate how they learn from mistakes
  • can demonstrate good practice in administration of medication, falls prevention, pressure sore care, nutritional care and financial safeguarding.


There are many approaches to the prevention of abuse, neglect and harm in care homes. These include the empowerment of residents, promotion of quality services, good leadership, training and support for staff. SCIE has explored these issues in SCIE Adult Safeguarding: Prevention

The local authority has lead responsibility for safeguarding in its area. Safeguarding issues are more likely to arise in services that offer poor quality care. Commissioners should therefore take an active interest in the quality of all care service provision in their area, including the integration of health and social care, whether or not it is commissioned by them and whatever the method of funding.

The Association of Directors of Adult Services (ADASS) assert that ‘it is important not to rely only on single means of quality assurance but to be able to triangulate information from different sources to be able to evaluate effectiveness, both of partner organisations as well as the partnerships’ (ADASS, 2011).

Providers should not be overburdened by additional requirements to those relating to registration and regulation. It is therefore important that commissioners work to ensure that all monitoring activity is aligned as much as possible. Commissioners should gather information from all the stages of the commissioning process and all the activities carried out by stakeholders to inform their work.

What others are doing - ideas you could use

Set up a team of Safeguarding Adults Practice Officers

Durham County Council and County Durham Primary Care Trust have set up a team of Safeguarding Adults Practice Officers, consisting of two nurses and two social workers. The team works with residential and nursing homes to respond to safeguarding incidents that have occurred in care homes and to work proactively with providers to reduce the number of safeguarding incidents. The team works collaboratively with providers to share best practice, promote Dignity in Care principles, and to ensure care practices within care homes in County Durham are of the highest quality (The National Mental Heath Development Unit).


The governance framework

The mechanisms in place for defining services, setting standards and quality assurance should all consider safeguarding as core business. Commissioners should effectively utilise and coordinate the many strands of monitoring and quality assurance activity in order to assure quality of service and good safeguarding practice.

Resources on prevention