In this guide we explain the key elements of a Care Home Manager’s job and the questions around working in Care Homes in the UK. We cover typical pay, CQC requirements as well as the challenges faced by Home Managers and Registered Managers.
Thanks especially to Liam Palmer for his insight into social care management and help with ensuring this page is an accurate place for Home Managers and others working in Care Homes to find out more about the role, the opportunities and the questions facing anyone working in the Care Home sector in the UK.
Registered Home Manager
Liam Palmer is the author of 2 books on raising quality standards in care homes through developing leadership skills. The 2nd is called "Leadership Secrets of Care Home Manager” inspired by several meetings with the Chief Inspector of the regulator, the CQC. Liam has been fortunate to work as a senior manager across many healthcare brands including a large private hospital, a large retirement village and medium to large care homes in the private sector and 3rd sector.
We asked Care Home Managers about the challenges that they face in care. We learned that the public perception of care is a huge concern to those working in the industry.
We spoke to Care Home Managers to learn more about their challenges, and a key takeaway was a concern over the public’s perceptions of care.
So we then asked members of the public what they thought about care, and the results were refreshing.
The feedback contained a lot of positive sentiments, showing us that the media doesn’t sway attitudes as much as many have feared.
The public are better informed than you may think. Find out what we learned.
The attitude of the general public may surprise you if you’re a Home Manager. Whilst we could see that the perception of the public was a major concern for virtually everyone we spoke to, there was a significant contrast between the way Care Home Managers think they are perceived, versus the way the public really think.
The Home Manager is legally responsible and accountable to ensure the service is running in accordance with the various laws pertaining to running the home – primarily, regulation from the CQC under their inspections framework and equally importantly, for the Health and Safety management of the building and all the safety regulations relating to it.
The CQC regulation framework for good care consists of questions that are asked also called key lines of enquiry (called KLOEs). e.g. “is the service safe, caring effective, well led, responsive”?
The CQC has defined ways of answering these questions and the expected standards in their guidelines.
The Home Manager is responsible to the provider within their employment contract to run the service as above and according to the measures of success they outline. It’s a broad area but the items below cover the most crucial areas for this role:
The provision of safe, effective residential care can be expensive. It is a fine balancing act to manage the income and expenditure of the home to make a fair return or surplus (charity).
The top three financial controls will always be:
How many beds are taken versus budget and what is the split between private paying residents and publicly funded?
The 2nd control is hours – how many are being used versus budget? It needs to flex with occupancy.
The 3rd control is the use of agency workers – if it is being used. Is the Home Manager working toward removing it and have they taken all other actions available, e.g. offered shifts out to everyone, half shifts for several staff etc, before booking it?
If they are running a Nursing Home, it is essential to have consistent Nursing cover – this is a number-one priority for the Home Manager, otherwise the service is in breach of their CQC registration, and the residents are at risk of harm. This means there must always be an actual nurse in the building 24/7, without exception.
The priority areas for the Home Manager in the day to day running of the home are usually – staff cover, is there enough adequately trained staff on at any one time and rostered (otherwise, the service could be unsafe).
The next priority is safeguarding - are the safeguarding alerts being used properly? (this is to protect residents from risk of harm / demonstrate openness and rigour in reviewing and acting upon what is found).
The next priority is CQC notifications – the Home Manager is legally required to send through notifications to the CQC on e mail, using standard forms, regarding deaths, abuse and other specified matters.
The other major focus for the Home Manager is CQC inspection – is the home rated as at least “good” and is an inspection imminent and are they prepared?
The way to be ready is, firstly, to have an adequate system of audits and quality assurance within the governance of the provider. These need to be used consistently with detailed and accessible record keeping evidenced.
The focus of the Home Manager is to regularly audit key areas of the home to maintain quality assurance in the running of the home and to take action that is evidenced based on the findings of the audits.
The other consideration is to ensure any items raised in the last CQC inspection have been completed. Furthermore, any actions from other quality visits (either internal or external) have been acted upon – showing the service is listening and responding to feedback.
There is a considerable body of good practice which Home Managers need to be aware of and practice in order to get a “good” rating and not be marked down. Some of this is very specific – e.g.
There are many small details which need attending to and are considered markers of a good service by the regulator, their absence a consideration of a poorly led service.
Lastly, the regulators will take a holistic view of the service. e.g.
A well-run provider should have most / all of these protocols in place within their policies, procedures and agreed ways of working.
The range is surprisingly broad – around £25K to £30K per annum to £80K. The highest I’ve personally heard is a package of £100K.
One group I know says £120K plus pay for a Home Manager is possible due to a bonus structure!
Before you ask who pays the most and how do I get my hands on that £100K salary (perfectly reasonable questions!), it may help to understand why this is such a broad range.
There are many inter-related points that push or affect salaries. These include resident fees, private / publicly funded split of beds, number of actual beds, specialisms, risks, compliance / CQC rating and Home Manager attrition, company culture, company status - charity or private company status or independent?
Let’s explore a little further…
Before we talk what makes up for different salary ranges – one key point to remember is the responsibilities are the same whether you are paid £28K or £120K. The legal responsibilities are exactly the same. However, there will often be an implied level of expectation around skills and execution of strategies at different salary ranges.
At the starter end of Home Manager salaries (£22K - £35K) can be smaller domiciliary care providers, 30 – 60 unit assisted living communities, smaller homes 5 – 35 beds.
These may include more socially funded residents, rather than private fee payers. This is sometimes due to the level of funding they receive and small profit margins which will put the salary ranges at a certain level.
Similar size homes will have similar cost / price dynamics and therefore that sets the salary at that range. Also there is an element to salary around the levels of specific skills – the deeper level of skills needed, the more structure is needed, more cost and more fees, which impacts salary levels.
Mid range for Home Manager salaries (£35K to £45K) can be midsized homes – 30 – 50 bed for corporate or independents. Sometimes there is a bonus based on occupancy – on hitting certain occupancy levels e.g. if you have 50 beds and the provider wants an average occupancy rate of 95% for the month, that will an average occupancy of 47.5 beds occupied per month.
This means some days it needs to be 49 to 50, some days it may go down to 45 as people leave, so a high average can be hard to achieve.
The rule of thumb for good Home Managers is aim for the bonus but don’t count on it as they are factors out of your control which may not allow you to achieve it.
As the Registered Manager, the most important thing is the safety of the home, the quality of care and maintaining a good reputation by upholding the highest standards. Don’t be tempted to drop your standards to hit a target. Your integrity and reputation are everything in this line of work!
High end range for salaries (£46K - £75K basic plus bonus). Mid point is many larger older peoples services average 50 to 80 beds averaging with a median of £50K - £55K give or take, depending on whether it is mainly private payers, a private company – more funding, higher customer service level of expectations can mean a higher set of leadership skills required in the Home Manager or perhaps charity run, often with a higher proportion of socially funded beds and therefore less fee income means less money to pay salaries.
Often Nursing Homes can have higher Home Manager salaries than residential homes. Generally Nursing Home beds are more expensive than residential only beds.
There are exceptions to all, this is a broad generalisation. Other factors can be – struggling homes with a poor CQC rating may pay more as the home is struggling and there may be some risk to the new Home Manager.
If several Home Managers have left, it can put the salary up as well for the same reason.
Large homes have larger teams. You need to be a strong, robust individual to credibly run a team of 100+ staff.
Also, large Nursing Homes with serious clinical problems may need a very experienced clinical manager and trouble-shooter – often coming with 20 – 30 years experience. These individuals are in short supply, will often not leave their current home, so it raises the salaries further.
The key thing is to find out the values of the owner / operations director / regional director.
Some experienced Home Managers are not willing to commute more than 40 minutes to an hour each way, as working hours can be long. This can create opportunities for deputies and other professionals to step up to the role. I think it is helpful to consider the following;
Are you confident that you can fulfil the duties of the Registered Manager / Home Manager position and can you back up this confidence with examples of where you have demonstrated you have the necessary skills, judgement and experience to meet these duties?
Are you likely to be competent to fulfil these duties and is it likely that the CQC will give you the registration?
See specific requirements from the Health and Social Care Act:
Health and Social Care Act 2008 (Regulated Activities) Regulations 2014: Regulation 7
The intention of this regulation is to ensure that people who use services have their needs met because the regulated activity is managed by an appropriate person.
This is because providers who comply with the regulations will have a Registered Manager who: Is of good character, is able to properly perform tasks that are intrinsic to their role, has the necessary qualifications, competence, skills and experience to manage the regulated activity. Has supplied them with documents that confirm their suitability.
The levels of rigour at the CQC interview process for registration are fairly high. In some instances, if a Home Manager has been previously registered, the interview may be less stringent.
The first time a Home Manager gets confirmed as a Registered Manager is a career milestone and needs to be prepared for carefully and taken seriously and celebrated!
The interviewer is simply assessing someone against the brief above and will ask as many questions as necessary to verify the proposed has this knowledge and aptitude and understanding to fulfil their legal responsibilities.
Level 5 in Social Care Leadership (it’s a Foundation Degree equivalent) is the best current qualification for Home Managers.
What we say is this: if you don’t have strong relevant equivalent level qualifications or higher and you aspire to be a Home Manager, get your Level 5 now!
That’s the headline. But this topic is worthy of some detail.
Adverts for Home Managers usually ask for NVQ Level 5 or RMA (Registered Managers Award) or similar. Many say this or “is willing to work toward it.” But the detail is important.
Here’s what we say…
There are three take-aways to consider around the question of Home Manager qualifications:
1. RMA (Registered Managers Award) is OK! (if you have the older qualification of the RMA you are fine)
2. Level 5 Social Care Leadership is great!
3. If a Nursing Degree, maybe… but still try to get your Level 5 Social Care Leadership Now!
So, what does the word “equivalent” mean in job ads for Home Managers? It’s broad – it could be a Nursing degree or similar.
The CQC links this to the Skills for Care standard which mainly recommends a Level 5 in Social Care Leadership (other qualifications which cover similar ground are accepted).
In my experience working for corporate level care providers, if you don’t have a Level 5 in Social Care Leadership, they put you on it when you join and expect you to complete it within 12 months.
Often they are accepting when this isn’t possible due to work pressures. It is quite hard to do a Level 5 in Social Care Leadership (Foundation Degree equivalent) when you are busy learning your new job.
I completed my Level 5 in 9 months but the average is a 12 to 18 months. In my experience the CQC is very focussed on you having a Level 5 because on a practical level it means you have been assessed against all the key requirements of the role.
The moral of the story is fairly clear…. If you don’t have strong relevant equivalent level qualifications or higher and you aspire to be a Home Manager, get your Level 5 now!
Once you are appointed as a Home Manager it is usually with a condition that you get the registration - after all they are employing and paying you to become their “CQC Registered Manager”.
The provider can be fined if they do not have a Registered Manager, so they are keen to fill these posts.
Their recruitment process (if well designed and robust) will often have *competency based questions for you to prove you have the knowledge and skills to do the job. This gives them a sense of confidence that the CQC will likely register you.
* Questions that require you to evidence either your understanding or give examples that demonstrate you’ve demonstrated this skill / level of knowledge.
A deputy Home Manager supports the Home Manager to keep the home running safely – usually in regards to staffing and resident care, together with any other ad-hoc duties as per their individual split of work.
This is often support with audits, care plan reviews etc, interviewing, holiday planning, return to work interviews, absence management.
The first priority is the actual care and well-being of those living in the service and ensuring they are taking action on concerns or queries in a timely way and communicating clearly with those affected; for example, if a resident is moving towards passing away there are various protocols in place regarding liaison with the doctor, nurse team, family etc. These matters are time sensitive, any delay could have far reaching consequences.
The 2nd priority is staffing and the rota. The rota needs to be planned ahead to ensure there are sufficient staff on every day as per the occupancy and hours budget. It is important that staff have agreed those shifts. The planning of the rota needs to take into account the physical layout of the home, the levels of need for the residents in the different parts of the home and the levels of training and competence of the staff working together – “the staff mix”. This is a key factor for having good care days – adequate and effective staffing.
After these 2 is everything else – holiday planning, sickness reviews, interviews, audits, supervisions, “being on the floor” – being visible and interacting with residents and families.
This is work shared with the Home Manager and is dynamic according the needs and priorities on the day according to the needs of the many stakeholders who interact with those running a Care Home.
As per Home Managers, salaries vary according to whether it is private or a charity, Nursing, residential or both as well as location. In my experience residential only salaries are often £22K to £35K, with Nursing qualified deputies often being £30K - £45K.
The deputy is not registered with the CQC but instead supports the Home Manager who is typically the Registered Manager. Occasionally a nurse qualified deputy will be the Registered Manager for a Nursing service.
In my experience a Care Co-ordinator is often someone who works in an administration / supervisory role within a home care provider.
Different to a residential care provider (Care Home), they co-ordinate care calls to people’s homes. These includes juggling visit times, hours budgets and service user needs with the carers available.
A new customer brought onboard is referred to as a new “care package”. A two and a half hour weekly care package could be care calls (visits) for 5 days per week, 30 mins per day.
(Also read what a Home Manager does and what a deputy Home Manager does, for a deeper context.)
Where a very large home (say 150 beds) may have 5 separate buildings in a cluster shape, a Unit Manager / Care Manager will have operational responsibility for those 30 residents.
An 80 bed home could similarly be split into 2 units over 2 floors with the same structure. This role may include responsibility for care plans, residents, liaising with GP’s and families.
There may be an assigned staff team for that unit. It is usually a FT role, with delegated responsibility from the Home Manager working in conjunction with the deputy. In some instances there may be a Unit Manager for a Nursing Home where the Unit Manager is an experienced Care Management Professional (non-nurse.)
This is different from the Unit Manager / Care Manager role as it is often a post that is with a team supporting 24/7 cover, like a shift manager. The incumbent has defined managerial responsibility for their shift only.
The CQC regulations require a person be nominated to act as their main point of contact for the service. The conditions for selecting this person are below; (from the CQC website are below)
“The nominated individual must be employed as a director, manager or secretary of the organisation (i.e. they should be a senior person, with authority to speak on behalf of the organisation).
They must also be in a position which carries responsibility for supervising the management of the carrying on of the regulated activity (i.e. they must be in a position to speak, authoritatively, on behalf of the organisation, about the way that the regulated activity is provided).”
Ideally that person should be separate from or senior to the Registered Manager so that there is an escalation process if needed.
Episode 8. with Tim Dallinger Registered Manager and Trainer
with Angela Fletcher CEO of Happy Futures
with Medical Director Dr. Umesh Prabhu
5 with Isaac Theopholis, author of 'How to get Outstanding'
with Neil Eastwood, Recruitment Specialist
with Dr Keren Wilson, Retirement Villages pioneer
with Samuel Barrington, CEO of Care Improvement Associates
with Jeremy Walford CEO of Middleton Hall
Nurses.co.uk lists jobs for Home Managers and Nursing Home Nurses.
Our sister site lists jobs for Care Assistants and Registered Home Managers.
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