Understanding care homes safety: safety culture and sensemaking in non-mainstream care settings

In England, 450,000 people receive care in nursing and residential homes. With residential homes accounting for 73% of care homes in England. No nursing provision. Despite rising demand, care homes remain poorly understood sites for long term care, many without any systems for capturing outcomes, audit data or improvement strategies. A number of reports and high-profile scandals have raised significant concerns about the quality of care provided within this environment, with 10% of adult social care services rated as ‘inadequate’ for safety. Care homes also face many organisational and workforce challenges, which include increasing service demands, national cuts to adult social care budgets, significant workforce shortages and a largely unregulated workforce, of which almost 40% possess no qualifications.

Safety culture in care homes remains unexplored and requires an ethnographic approach to capture the essence of culture.

An ethnographic study will be undertaken to answer the research questions:
Question 1: How do care home employees, managers, residents and family members make sense of, seek to learn about and promote quality and safety?

Question 2: How is responsibility for safety negotiated in the management of ‘at risk’ or ‘dependent’ residents? 

Question 3: What are the sources of safety in terms of clinical and non-clinical skills, and organisational and institutional factors?