What makes a care home feel like home?

For many residents, their care home is not just a service but their permanent home. It’s vital that it feels that way. Staff need to understand their residents’ experiences of care, what’s working and what they could improve.

Local Healthwatch provide a valuable way to do this through their legal power to “enter and view” care homes and other NHS services. These visits – to collect people’s direct feedback and/or observe the environment or services from their point of view – are set to be abolished under proposed legislation. 

Local Healthwatch carried out more than 200 care home visits across England in the last year. This article explores a random sample of 30 of these visits, the changes care homes made as a result, and the principles that make visits like these successful.

How does Healthwatch make a difference?

Enter and View visits aren’t like formal inspections that focus on safety or legal obligations. Healthwatch talk to as many care home residents as possible, as well as families, carers, and staff. This feedback, combined with their own observations, offers a snapshot of care that focuses on how care homes provide residents with comfort, dignity, choice, and a sense of home. 

The recommendations local Healthwatch make following these visits are often minor changes that don’t require much time or resource to put in place. But their impact can be huge.

How can care homes create a comfortable care environment?

More than a quarter of the recommendations in the reports we looked at focused on improving the care home environment. Healthwatch consider whether the layout is practical for those with mobility issues, and whether it is safe, warm and comfortable. They look at whether décor supports people with dementia, such as by using a contrasting paint colour for grab rails, or encouraging reminiscing through, for example, posters of film and pop stars that residents will remember. Looking at these things can lead to care homes taking vital steps in making the space feel like home.

One care home planned to refurbish their garden after Healthwatch Bracknell Forest and Healthwatch Windsor, Ascot and Maidenhead highlighted potential access problems for wheelchair users or those with other mobility issues. 

The two local Healthwatch pointed out the lack of a path to an existing gazebo and a potential trip hazard when accessing the care home’s garden. They suggested raised beds that residents could see from their windows and a greater variety of plants to involve them with the garden. 

They also suggested local organisations that could get involved and signposted to a tool to ensure the new garden was dementia-friendly. By acting on these recommendations, the care home will create a more attractive and accessible space for residents.

After Healthwatch Central Bedfordshire highlighted the need for more pleasant outdoor space, another care home removed unused and unsafe items and introduced daily cleaning and weekly jet-washing, helping residents enjoy leisure time and fresh air. Yet another added signs reminding staff to close the door at the top of a flight of stairs after Healthwatch Liverpool noted it could be a safety hazard.

How can care homes offer a good dining experience?

Looking at the dining experience is a key part of Healthwatch’s visits, which often take place at lunchtime so Healthwatch staff can see this firsthand. Healthwatch might comment on menu format, meal presentation, whether people had help to eat if they needed it, whether the food looked appetising, and whether meals took into account people’s preferences and dietary requirements.

“If I ask for mashed potatoes and peas, that’s what I get. If food is too spicy for me a portion is removed before the spices are added.” — Reported to Healthwatch Kingston upon Thames

Healthwatch recommendations have supported care homes to provide better dining experiences, with some creating dementia-friendly menu cards and ensuring residents always have access to updated menu information. One care home hired a second chef after local Healthwatch urged them to prioritise this, reducing the need to use external catering options and helping ensure consistent, high-quality meals.

There were also changes to the setting and ambience of meals that made it easier to socialise, with one care home turning off the TV and changing the setup of the dining room to aid conversation.

How can care homes offer the right activities?

Varied activities help keep residents interested and stimulated. Healthwatch ask about the range of activities available, including for people who don’t want to or can’t leave their room. They look at whether residents can practice their religion, including attending services and events and eating appropriate food. 

Healthwatch recommendations have led care homes to start consulting with residents on activities and ensuring there is clear information about activities available. One care home shared their plan with Healthwatch East Riding of Yorkshire to use a picture-based activity calendar that would stand out to residents, rather than a written one.

A care home manager described going beyond Healthwatch recommendations, and how positive this was for both residents and staff.

“The recent community Summer Fun Day at our care home was a fantastic success. In preparation for this, staff and residents pulled together to give the garden and grounds a beautiful make over… The day itself was filled with fun, laughter and a real sense of community – I loved it. The staff are now talking about ‘what else we can do’ and reviewing the activities the residents are able to enjoy.” — Reported by Healthwatch Cornwall

How can care homes provide high-quality care?

Healthwatch visits provide a comprehensive look at care, with Healthwatch speaking to care home staff as well as residents and their relatives. It’s essential that staff feel well-trained and supported and that residents feel safe and comfortable in their care. 

Healthwatch look at how person-centred care is delivered, and whether it is kind, respectful, and involves residents and their carers in care planning. Many residents comment on the excellent quality of the care they receive, but Healthwatch can still recommend ways to improve care. One care home increased their staff training after Healthwatch reported on the feelings of residents. Healthwatch also helped secure additional support for this.

“A complete training audit has been conducted to ensure all staff are up to date with mandatory and refresher training. Our digital training tracker now provides automatic alerts to staff when courses are due.” — Reported to Healthwatch Central Bedfordshire

Once again, some changes don’t require much work to implement, such as a recommendation to one care home by Healthwatch Walsall that staff always wear name badges. But this can really matter in helping residents feel at home.

How can visits continue to make a difference?

Enter and View visits offer a vital window into everyday life in care homes and a practical route to meaningful improvements. Their recommendations lead to safer environments, more personalised care, a wider range of activities and better support for residents’ cultural and dietary needs. 

Responses from care home managers show many of them find Healthwatch recommendations invaluable when it comes to providing better care.

An independent review into the Healthwatch model also noted that these kinds of visits can reveal early evidence of care problems that the health and care regulator, the CQC, needs to investigate.

Future responsibility for collecting the experiences of care home residents and NHS patients is set to shift from local Healthwatch to the bodies that fund and plan those services – councils, or NHS integrated care boards. Our evidence review shows that for care homes, this responsibility could be supported by having systems that:

• Can observe residents, visitors and staff going about their day-to-day lives in the care home to offer a real snapshot of what care looks like – and not just focusing on whether the service has complied with regulations.
• Collect evidence of what works well and what could be improved to both make recommendations to individual care homes and share recommendations on best practice between services.
• Learn about residents’, families’ and carers’ experiences by ensuring a trained person speaks to them directly, rather than relying solely on completed surveys or staff views.