The role of a Registered Manager differs significantly between Supported Living Services and Domiciliary Care Services, with key differences in legal frameworks, operational challenges, risk management, and leadership responsibilities.
Below is an in-depth comparison of the differences, high risks, and challenges faced in each role.
1.Key Differences Between Supported Living & Domiciliary Care
Aspect | Supported Living | Domiciliary Care |
Regulation | Service users typically have tenancies and are responsible for their own accommodation. The service provider supports them with care and daily living activities but does not provide housing. | Care is delivered in individuals’ homes, which can range from private residences to assisted living environments. The provider is responsible for visiting the service user’s home. |
CQC Registration | CQC regulates the personal care aspect of supported living but does not regulate the housing element. | CQC regulates all aspects of personal care and overall service provision. |
Service User Control | Service users have greater independence and choice, with tenancy agreements giving them legal rights. | Service users may be more dependent on carers and do not necessarily have direct control over their living arrangements. |
Care Delivery Model | 24/7 support is often available on-site with key workers and support teams. Staff may live or work in a shared service setting. | Care is provided on a visit-based model, where carers travel between multiple service users daily. |
Staffing | Staff work in shifts within a set location. The workforce often includes key workers and waking night support. | Staff must travel between homes, requiring careful rota planning and time management. |
Funding Models | Individuals may have direct payments, personal budgets, or council-funded support through Individual Service Funds (ISF). | Care is typically funded via local authority contracts, private payments, or NHS Continuing Healthcare (CHC). |
2. High-Risk Areas in Each Role
High-Risk Area | Supported Living Risk | Domiciliary Care Risk |
Safeguarding Vulnerable Adults | Risks of exploitation, financial abuse, or coercion, as service users often have their own tenancy agreements and financial independence. | Risk of neglect or missed care visits, especially when managing care across multiple locations. |
Medication Management | Risks associated with self-medication errors, overdose, or refusal to take medication. | Errors in medication administration due to time pressures and staff turnover. |
Emergency Response | Staff must be prepared to respond to mental health crises, self-harm incidents, and behavioural challenges. | Risk of delays in emergency response due to staff working remotely and travel constraints. |
Mental Capacity & DoLS Compliance | Greater responsibility in assessing mental capacity, supporting choice, and preventing undue influence. | Ensuring that care plans reflect capacity assessments and involve family & legal representatives appropriately. |
Staffing & Workforce Management | High staff turnover and burnout due to the intensity of support needs. Recruitment for night shifts can be challenging. | High risk of staff shortages affecting visit schedules and continuity of care. Travel time can impact efficiency. |
Quality Assurance & Compliance | Regular internal audits and support planning to ensure compliance with CQC and safeguarding standards. | High risk of missed care logs, rushed visits, and difficulties in monitoring quality remotely. |
Service User Wellbeing | Service users may experience social isolation or difficulties in adapting to independent living. Behavioural risks, including challenging behaviour, are also a concern. | Risk of loneliness and reduced engagement, as care is delivered in short time slots with limited interaction. |
3. Challenges of Being a Registered Manager in Each Service
Challenge | Supported Living | Domiciliary Care |
Maintaining Regulatory Compliance | Ensuring tenancy rights and care delivery do not overlap, as housing is not regulated by CQC but must be aligned with care provision. | Ensuring care visits are delivered on time, logged correctly, and meet CQC Fundamental Standards. |
Workforce Retention & Development | High emotional demands and complexity of supporting individuals with mental health issues, autism, learning disabilities, or complex behaviours. | High turnover due to travel demands, low pay, and risk of staff burnout from unpredictable rotas. |
Financial Sustainability | Balancing service costs, rent payments, and direct payments to ensure sustainability. | Managing thin margins due to local authority funding constraints and logistical challenges. |
Technology & Record-Keeping | Implementing digital care planning systems while ensuring accessibility for service users. | Ensuring electronic records are updated in real-time, despite staff working remotely. |
Crisis & Incident Management | Managing mental health crises, safeguarding incidents, and challenging behaviour with effective de-escalation strategies. | Ensuring effective lone worker policies are in place to protect staff in isolated home visits. |
Service User Empowerment | Supporting independent decision-making while ensuring safety and compliance with the Mental Capacity Act. | Balancing person-centred care with time constraints imposed by visit-based care models. |
Which Role is More Challenging?
Both roles carry significant responsibilities, but Supported Living Registered Managers face higher challenges in managing complex mental health and behavioural risks, ensuring service user independence, and navigating the intersection between housing and care regulation. In contrast, Domiciliary Care Registered Managers must tackle logistical complexities, ensure high-quality care is consistently delivered across multiple locations, and mitigate risks associated with remote staff management.
For an Outstanding CQC rating, both roles require:
✅ Strong leadership and governance to maintain high standards.
✅ A robust workforce strategy to reduce staff turnover.
✅ Effective risk management and safeguarding processes.
✅ A commitment to continuous improvement and compliance.