CQC Quality Statements

Theme 3 – How the local authority ensures safety in the system: Safe systems, pathways and transitions

We statement

We work with people and our partners to establish and maintain safe systems of care, in which safety is managed, monitored and assured. We ensure continuity of care, including when people move between services.

What people expect

When I move between services, settings or areas, there is a plan for what happens next and who will do what, and all the practical arrangements are in place.

I feel safe and supported to understand and manage any risks.

1. Introduction

A ‘no reply’ is when a practitioner has tried to visit an adult who is receiving care and support services at home, at a prearranged time, and the person has not answered the door / is not at home / is not replying for some reason (possibly because they are ill or have had an accident).

It is important that practitioners know how to respond to a no reply incident. Making sure that the adult is safe should be a priority, and other work / appointments may need to be rearranged while steps are taken to ensure the adult has not come to any harm. Managers should be contacted for advice.

This chapter is for Adult Social Care (ASC) staff who visit an adult who does not reply and also covers actions to take when a no reply is reported by another organisation and ASC staff have to investigate the incident.

2. Definitions

There are different ways in which a home visit can be considered not to have taken place. These are:

  • a no reply is when a practitioner has visited, but the person’s whereabouts are unknown, they cannot be found or they may be at home and not answering, and there is reasonable concern about their safety.
  • a failed visit is when a visit has been refused, but the person is safe because either:
    • the worker has seen or spoken with the adult; or
    • the worker has not seen the person, but a family member / carer has explained where the person is or why they do not want a visit. A failed visit is different to a no reply and other organisations do not need to report these to ASC.
  • a missed visit is when a practitioner has not been able to make the visit; this may be due to the practitioner being off sick or pressure of other work. This must be resolved as soon as possible by their service. A missed visit is different to a no reply. The service should report the missed visit to the adult’s social worker or the relevant team in ASC as soon as possible, informing them why it was not possible, when the next planned visit is to take place and what alternative intervention, if any, they have put in place to visit the adult;
  • a cancelled visit is when the adult has cancelled a visit and has informed the service / relevant team that they will not be at home for the planned visit. If this visit was to provide care and support services to the adult, it is important to check that they have the mental capacity to make such a decision (see Mental Capacity chapter). If they do not have mental capacity, the staff member should try to ensure the visit takes place – which may result in a failed visit or no reply and, if so, the steps in Section 4, Initial Actions if the Person does not Answer the Door should be followed.

3. Assessment and Record Keeping

Before the first visit, the adult’s records should – where possible – contain the following information, which will be needed in case of a no reply (or other urgent) situation:

  • names, addresses and telephone numbers (landline – if appropriate – and mobile) of the next-of-kin and other important contacts;
  • whether the person has a community alarm and, if so, the name of the provider;
  • name and contact details of nearest key holder;
  • their GP surgery details;
  • which hospital/s or day centre/s the person attends;
  • whether they have any serious health conditions such as epilepsy or a heart condition, or whether the person has known alcohol or substance misuse issues or if there are any known safeguarding concerns.

If the adult has already had a recent care and support needs assessment, this should provide information about whether they are housebound, are at risk of or experiencing abuse or neglect, are socially isolated or likely to get lost outside their home or are forgetful or confused. If there is concern that they may lack mental capacity, these concerns should be documented along with any mental capacity assessment that has been completed (see Mental Capacity chapter), including if a community Deprivation of Liberty is in place.

The adult and their family member / carer should be informed during the first contact and regularly reminded that they should let the practitioner or service know if they are not going to be at home for a visit or if they are going away.  Sending reminders (for example by text message) for a planned or agreed visit closer to the time can help avoid a no reply incident.

Family members should also be asked to inform practitioners who have planned to visit if the adult is admitted to hospital, if possible.

4. Initial Actions if the Person does not Answer the Door

All staff working with an adult who is receiving care and support services have responsibility to act if the person does not answer the door.

Staff should remember that sometimes a person may be at home but has decided not to let anyone in or is unable to do so for a number of reasons.

If the adult is not very mobile or has been asleep, it may take them longer to get to the door to answer it. They should be given time to answer, before the practitioner leaves and takes next steps.

When there is no reply after knocking / ringing the bell, the practitioner should, where possible and depending on the type of property:

  • look through the front and back windows;
  • call and look through the letterbox;
  • try to contact the adult by telephone;
  • check with their office to make sure they have the right address (if it is the first visit);
  • look for signs of concern, such as milk deliveries untouched, unopened post, closed curtains, unpleasant smells etc;
  • check with any neighbours to see if they have had contact with the person or have seen them.

If the adult lives in a block of flats and it is not possible to gain access into the block to carry out the above initial checks, this should always be reported as a no reply.

If the adult can be seen but is unresponsive or on the floor of their home, the practitioner should call the ambulance service on 999.

If – having done initial checks – there is still no reply, the practitioner should contact their line manager as soon as possible to agree between them who will contact the adult’s designated social worker (if it is not them who has done the visit), emergency duty team or other relevant team to investigate the no reply incident.

They should inform ASC of the situation, giving details of the adult concerned, a summary of the care and support the adult receives, what steps they have already taken to try to locate or contact the adult and any specific vulnerabilities or concerns there are about them.

4.1 Prioritising no replies

No replies are a high priority. If the practitioner being informed of and tasked with investigating the no reply cannot respond immediately, they should inform their manager who should organise for another member of staff to conduct the investigation or carry out the checks themselves.

Under no circumstances should any practitioner delay informing ASC of the no reply until the end of the working day. Responding quickly and effectively to such an incident may help save someone’s life or prevent a serious health emergency or safeguarding concern from developing.

5. Investigating a No Reply

When a no reply incident has been reported to ASC, details about the actions taken by the referring practitioner who conducted the initial visit should be recorded and reviewed by the investigating social worker.

5.1 Carrying out further checks

Initial checks by the investigating social worker should include:

  1. checking the adult’s assessments for information about their level of vulnerability or exposure to risks;
  2. telephone the adult’s contact numbers again (mobile and landline if available) to see if they have returned home;
  3. contacting their next of kin, friends or neighbours, wardens or any other contacts recorded in their records to see if they have seen them or know where they are or may be;
  4. telephone day centres, other providers they attend, or any other places they are known to go;
  5. find out whether keys are available, from a family member, neighbour, care agency, caretaker or community alarm provider for example. Check whether keys are in a key safe at the property and who has the code;
  6. contact other relevant agencies who are involved such as home care agency, district nurse, community psychiatric nurse, GP etc to gather information, inform understanding and help decide what further action to take. The social worker should find out when the adult was last seen or heard from by the practitioners / services, by who and where and the type of interaction;
  7. contact the adult’s family members wherever possible. If they can be contacted, the social worker may agree that they should investigate the situation themselves and report back to the social worker. The family should be asked to feedback within an agreed timescale, even if they do not have any news about the adult’s whereabouts. If the family does not make contact, the social worker should contact them for an update and record this.

After these checks have been conducted and the adult has still not been found, the social worker should contact the admissions and accident and emergency departments of any hospital where they could have been admitted.

Social workers need to ensure that they have documented all actions within the case records including completing the no reply checklist (see Appendix 1).

5.2 Next steps

If the above tasks have been completed and the social worker has still not been able to contact or locate the adult, they should discuss the situation with their manager or designated other manager.

Having considered all the information gathered and the adult’s history, the manager will agree next steps. Issues to consider include:

  1. whether this is a regular occurrence, and if a check needs to be made later that day or the next day;
  2. whether another home visit should be attempted;
  3. whether to gain entry with the police;
  4. if another visit is planned, or the police have been requested to gain entry, where possible, arrangements should be made to meet with the next of kin, or family / friends at the property. A list of important contact numbers should also be taken so the right people can be contacted from the property.
  5. if the adult is found in the property and in need of urgent hospital treatment, the ambulance service should be called dialling 999.
  6. if the adult does not require urgent treatment but they need a medical assessment, the social worker should ensure that they either have a GP appointment or are taken to a walk-in health centre. This may be arranged by a family member / friend who may accompany them, or a care worker may accompany them.
  7. consideration should be given to securing the property by contacting the housing provider / property owner / family or council emergency service / locksmith if out of hours.

If the manager decides it is necessary to enter the property, before contacting the police for them to gain entry, they must be able to evidence that:

  • the risk is sufficient to justify such an intervention involving the police;
  • that all other options to locate the adult have been unsuccessful.

They should recheck the adult’s case records as contain information about health condition (for example, heart problems) and / or risk considerations.

If the police have to force the door to gain entry, an agreement should be arrived at with them as to who will be responsible for securing the property before it is left unattended.

The outcome of the visit should be recorded, along with any interventions the adult requires. This should include the reasons why they were not answering the door, whether they were unwell, did not hear the door or were out etc.

Where the adult was simply out or had gone away, this should be discussed with them and their family / friends at the next planned visit and arrangements put in place to try to ensure this does not happen again. These should be recorded in the adult’s care and support plan.

All actions taken and at each stage, should be recorded in the adult’s records.

Appendix 1: No Reply Checklist

Action Comment
1. Make sure the adult has enough time to answer the door.
2. Knock on the front and back doors and all downstairs windows (if relevant).
3. Look through doors and windows, if possible, for any signs that someone is there.
4. If you have not visited there before, check that the address is the right one. This should include checking with your manager / business support staff and asking the neighbours who lives at the property.
5. Call and look through the letter box and check to see if you can see anyone (they may be lying on the floor) or smell anything unusual.
6.Are there any post, milk or paper deliveries that have not been touched or are piling up? Are there curtains or blinds that are either open or shut?
7. Listen for any sounds such as TV, radio or running water.
8. Try to ring the adult. Record at what time, how many times and what number you called.
9. Check with neighbours, on-site staff (if appropriate), next of kin, family, friends or any other relevant people or services whether they have seen the person or have any information on where they may be.
10. If this does not result in seeing the adult or finding out where they are within fifteen minutes, contact your office to report the no reply incident.
11. Review the adult’s records for any relevant information, for example whether the adult goes out to regular events / never leaves their home; is on holiday; reported feeling unwell recently.
12. Record the name of the provider / service or other person who has requested this No Reply visit.
13. If you have a physical description, record their details.
14. Reasons for vulnerability: mental capacity Issues, deteriorating physical health, recent hospital discharge, lives alone, is at risk of falls, any other concerns.

Appendix 2: Roles and Responsibilities

ASC social workers:

  • receive the adult’s no reply incident referral;
  • confirm all checks required have been completed;
  • notify the relevant team manager of the no reply incident.

ASC team manager:

  • decide whether a welfare visit is required;
  • send information to the relevant team if a welfare visit is to be carried out;
  • decide whether the police should be notified;
  • support allocated officer to escalate concerns to the Media Team and Director of Adult Social Care, if required (for example if the adult is found deceased at home or elsewhere).

Team conducting welfare visit:

  • initiate internal processes (see Section 5, Investigating a No Reply) after receiving the notification;
  • complete a welfare visit if initial processes do not resolve issue;
  • update the adult’s records with outcome of the welfare check and inform all other parties / teams involved.

Service manager:

  • be kept informed of any change in the incident, including actions being taken and if the adult has been located
  • escalate and keep informed the assistant director / director, if required.
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