Quality Care Home Assessment Guide for Dementia Care

Choosing a care home for someone with dementia is one of the hardest decisions you'll ever make. This guide shows you exactly what to look for, what questions to ask, and how to spot the difference between a good home and a great one.

Why Your Assessment Matters

You're Making a Decision That Can't Be Undone Easily

Moving someone with dementia into a care home is a huge step. Once they settle in, moving them again can be really distressing and confusing for them. That's why getting it right first time is so important.

Not All Care Homes Are Created Equal

Two homes might charge similar prices but offer completely different standards of care. Some have well-trained staff who understand dementia. Others just warehouse people. The only way to tell the difference is to look properly.

Your Time Is Limited, But Your Decision Isn't

You're busy with work and your own family. You want to make this decision quickly. But your relative could live in this home for years. Spending a few extra hours now could mean the difference between them being happy or miserable.

Before You Visit Any Homes

Get the CQC Reports for Every Home on Your List

The Care Quality Commission inspects all care homes in England. Their reports indicate whether a home is rated outstanding, good, requires improvement, or inadequate. Never visit a home rated less than good. You can find all reports at cqc.org.uk.

Check When They Were Last Inspected

A good rating from five years ago means nothing. Standards can drop fast when management changes or staff leave. Look for homes inspected in the last 18 months. If a home hasn't been inspected recently, ask them why.

Read Between the Lines

CQC reports use careful language. "Staff were busy" means they're understaffed. "Improvements needed in record keeping" often means poor care planning. "Some relatives expressed concerns" is a red flag. Learn to spot these warning signs before you waste time visiting.

Talk to Your Relative's GP

GPs visit multiple care homes and see how residents fare. They know which homes actually provide good dementia care and which ones just claim to. Ask them straight out which homes they'd choose for their own parent.

What to Look For During Your Visit

Turn Up Without an Appointment First

Ring the doorbell and ask if you can look around. Good homes will say yes. Homes with something to hide will insist you book. The reception area tells you a lot. Is it clean? Does it smell fresh? Are there obvious signs of activity and life?

Watch How Staff Interact With Residents

Do staff members greet residents by name as they pass? Do they stop and chat, or just rush past? When helping someone, do they explain what they're doing, or just manhandle them? These small things reveal whether staff actually care about residents as people.

Look at Residents' Faces

Are people sitting staring at walls or watching TV nobody chose? Are they slumped in chairs, looking vacant? Or are some engaged in activities, chatting to each other, or pottering about? The difference between a good home and a bad one shows on residents' faces.

Check the Smell

All care homes have some smell. But there's a difference between a slight institutional smell and the stench of urine. If you can smell urine in communal areas, residents aren't being changed often enough. If you can smell it from the corridor, leave.

Inspect a Bedroom Thoroughly

Ask to see an actual resident's room, not a show room. Is it clean? Does it feel like someone lives there, with photos and personal items? Is there enough space to move around? Can they see outside? Would you be comfortable with your relative spending most of their day in this room?

Questions You Must Ask

What's Your Staff to Resident Ratio?

During the day, you want at least one staff member for every five residents with dementia. At night, at least one for every eight. Ask for their actual numbers, not what's in the policy. Ask what happens when staff call in sick.

What Dementia Training Do Your Staff Have?

All staff should have basic dementia awareness training. Care staff should have specialist dementia care training. Ask how often they refresh this training. Ask how they handle challenging behaviour without using medication.

How Do You Manage Incontinence?

This question separates good homes from bad ones. Good homes will discuss checking residents regularly, using appropriate continence products, and maintaining dignity. Bad homes will get defensive or vague. Your relative's comfort and dignity depend on getting this right.

What Happens If My Relative Needs More Care?

Dementia gets worse. Eventually, your relative will need more help. Will this home keep them, or will they have to move again? What's the extra cost? Can they provide end-of-life care, or will there be another traumatic move?

How Do You Handle Complaints?

Every care home gets complaints. What matters is how they respond. Ask for examples of recent complaints and how they were resolved. If they claim they never get complaints, they're lying. Walk away.

Red Flags That Mean Walk Away

Staff Who Don't Know Residents' Names

If you ask a care worker about a resident and they don't know who you're talking about, staff turnover is too high. Residents need familiar faces. Constantly changing staff makes dementia worse.

Locked Doors Everywhere

Some security is necessary. But if every door is locked and residents need permission to move around, that's not a home. That's a prison. People with dementia need safe spaces to wander, not to be locked in rooms.

A Medication Trolley in Every Corridor

If half the residents are sedated to make them easier to manage, that's not care. Ask what percentage of residents are on anti-psychotic medication. The national average is around 10%. Anything higher means they're using drugs instead of proper care.

Activities That Are Clearly Just Babysitting

Sitting in front of a TV isn't an activity. Colouring books for adults with dementia are insulting. Good homes have activities aligned with residents' past interests. They might do gardening, cooking, singing, or crafts. They treat residents like adults, not children.

They Won't Let You Talk to Other Relatives

Good homes will introduce you to other families. They'll suggest you attend a meeting with a relative. If they make excuses about data protection or privacy, they don't want you to hear what other families think. That's a massive red flag.

Comparing Different Homes

Make a Scorecard

After visiting several homes, they all blur together. Create a simple scorecard, rating each home on staff interaction, cleanliness, activities, food, and that gut feeling about whether you'd be happy for your relative to be there. Numbers help when emotions run high.

Visit at Different Times

The home you see at 11 am on a Tuesday looks different at 7 pm on a Saturday. Visit during mealtimes. Visit in the evening. See how they cope when they're busy. A home that looks great during a morning visit might be chaos after 5 pm.

Trust Your Instincts

You know something's wrong even if you can't explain it. Maybe the manager was too smooth. Maybe the staff seemed stressed. Maybe it just felt off. Listen to that voice. Your instincts are picking up on things your conscious mind hasn't processed yet.

Making Your Final Decision

Take Your Relative to Visit

If they're still able to have a view, take them to your top two choices. Watch how staff interact with them. See if they seem comfortable. Sometimes the home you thought was perfect doesn't suit them.

Ask for a Trial Stay

Some homes offer respite care. Book your relative in for a week. See how they cope. See if the care matches what you were promised. It's much easier to cancel a permanent placement than to move someone who's already settled.

Read Every Word of the Contract

Care home contracts are complex. What costs are included? What's extra? How much notice do you need? What happens if fees go up? Get everything in writing. Verbal promises mean nothing when there's a dispute.

Plan How You'll Monitor Care

Choosing a home isn't the end of your involvement. Decide now how often you'll visit. Will you vary your visit times? How will you know if care standards slip? The best protection for your relative is a family that stays involved.

The Emotional Reality

This Decision Comes With Guilt

You'll feel guilty whatever you choose. Guilty about moving them. Guilty about the cost. Guilty that you can't care for them yourself. Know that this guilt is normal. Every family carer feels it. It doesn't mean you're making the wrong choice.

Perfect Doesn't Exist

There is no perfect care home. Every home has flaws. Staff will have bad days. Mistakes will happen. What matters is finding a home that's good enough. A place where your relative will be safe, comfortable, and treated with dignity most of the time.

You're Doing Your Best

You're juggling work, your own family, and caring for your relative. You're probably exhausted. You're definitely stressed. The fact that you're reading this guide shows you care. You're not abandoning them. You're finding the professional care you can't provide yourself.

After They Move In

The First Few Weeks Are Hard

Your relative will probably be distressed. They might ask to go home every time you visit. This is normal and doesn't mean you've made the wrong choice. Most people settle within four to six weeks once routines become familiar.

Visit Often at First, Then Establish a Pattern

Visit frequently in the first month while they settle in. Then establish a regular pattern. Too many visits can actually make settling harder because they're constantly reminded of their old life. Find a balance that works for both of you.

Build Relationships With Staff

Get to know the care workers. Learn their names. Thank them when they do something well. They're more likely to give your relative extra attention if they know you appreciate them. You're building a team to care for your relative, not just paying for a service.

Keep Monitoring

Standards can slip. Visit at different times. Check your relative's room. Look at their care notes. Ask them how they're being treated, even if dementia makes their answers unreliable. Stay involved. Your presence keeps everyone on their toes.

What to Do If Things Go Wrong

Document Everything

If you're concerned about care, write down what you saw and when. Take photos if appropriate. Keep copies of all correspondence. You might need this evidence later if you have to make a formal complaint or move your relative.

Raise Concerns Immediately

Don't wait and hope things improve. Speak to the manager the same day you notice a problem. Follow up in writing. If they don't respond properly, escalate to the owner or head office. Waiting just means poor care continues.

Know When to Move Them

Sometimes a home isn't right despite your best efforts. If care doesn't improve after complaints. If your relative is clearly unhappy or deteriorating. If you spot abuse or neglect. Moving them will be disruptive, but leaving them in a bad home is worse.

Serious Safeguarding Concerns

If you suspect abuse, neglect, or illegal behaviour, contact your local authority safeguarding team immediately. Don't wait for the home to investigate itself. Don't worry about making a fuss. Protecting your relative is more important than being polite.

Understanding the Costs

Care Home Fees Are Not Simple

The weekly fee is just the start. There are extra costs for incontinence products, chiropody, hairdressing, and outings. Some homes charge for everything. Others include basics. Get a complete list of what's included and what costs extra before you sign anything.

Local Authority Funding Pays for Basic Care

If your relative qualifies for local authority funding, they'll pay the local rate. This might not cover the home you want. You can top up the fees yourself, but make sure you can afford this long term. Care can last for years.

NHS Continuing Healthcare Might Apply

If your relative has complex health needs, they might qualify for NHS Continuing Healthcare. This pays all care costs. Most people don't qualify, but it's worth checking. The assessment is free, and you can appeal if refused.

Plan for Fee Increases

Fees go up every year, usually in April. Increases of 5% to 10% are normal. Make sure you can afford this. Some families drain their savings in the first year and can't afford the increases. Think long term when you budget.

Final Thoughts

This Is One of Life's Hardest Decisions

Finding the right care home for someone you love is exhausting and emotional. You're making huge decisions while grieving the person they used to be. Be kind to yourself. Accept that you're doing the best you can in a difficult situation.

Good Care Exists

There are excellent care homes out there. Places where staff genuinely care. Where residents are treated with dignity and kindness. Where your relative can still have a quality of life. Finding them takes time and effort, but they do exist.

You're Not Alone

Thousands of families go through this every year. Use the support services listed below. Talk to other families. Join support groups. Sharing the burden makes it lighter. And remember, choosing a care home isn't giving up. It's making sure your relative gets the care they need.