Roxhsana Ltd Also known as Visiting Angels Manchester East’

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The provider had a positive learning culture, responding to incidents with transparency and a clear commitment to continuous improvement. Following events in both community‑based support and home‑care delivery, leaders prioritised the immediate safety and emotional wellbeing of people supported and staff, ensuring open communication and reflective practice in line with Duty of Candour. Staff were encouraged to share concerns within a safe, open‑door environment, strengthening trust and embedding learning into everyday practice. Organisational reviews led to meaningful improvements, including enhanced lone‑worker safety through personal alarms with integrated torches, structured medication learning following documentation errors, and targeted policy reinforcement to prevent recurrence. Across all incidents, leaders acted promptly, supported their workforce with compassion, and translated learning into tangible service improvements, evidencing a culture where continuous learning, staff wellbeing and safe care are deeply embedded.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider demonstrated robust and well‑embedded safe systems, pathways and transitions, ensuring people experienced consistently safe, coordinated and well‑managed care. Pathways for responding to deterioration, falls, skin integrity concerns and medication errors were consistently followed, with timely updates shared across the team to prevent recurrence. Transitions between hospital, community and home‑based care were managed with careful attention to accuracy, communication and continuity, supported by structured reviews and proactive liaison with external professionals. Staff understood their responsibilities within these systems and felt confident raising concerns, supported by open‑door leadership and a culture of safety.

A relative told us, “It has been brilliant, I mean genuinely, it’s a new experience for me to arrange this kind of care, as [Name] is 93 and has had one or two issues that they’ve dealt with. We started an hour a day in the morning and that’s gradually increased - so now it’s two carers for one hour first thing in the morning, an hour at lunch, an hour at tea, and an hour at bedtime.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had a proactive and person‑centred approach to safeguarding,underpinned by transparent communication, strong leadership and a culture where people felt safe, listened to and protected. The provider actively encouraged feedback from people, their families, healthcare professionals and the wider community, recognising, people’s experiences were essential to identifying risk, celebrating good practice and strengthening safeguarding awareness. Any safeguarding concerns had been reported to the appropriate authorities. Staff consistently demonstrated an understanding of safeguarding responsibilities. Most staff described leaders as visible, engaged and responsive, taking direct responsibility for addressing any concerning information, however some staff did say they didn’t always feel supported when raising personal concerns.

There was a clear and person‑centred approach to mental capacity and consent,ensuring decisions were made lawfully, respectfully and in line with the Mental Capacity Act (MCA). The provider ensured consent was gained from people they supported wherever possible, and when a person lacked capacity for specific decisions, consent was sought from the appropriate legal representative. For a person with a learning disability who lacked capacity, consent was obtained from their parent, who holds legal responsibility, covering the sharing and holding of essential information such as contact details, professional involvement, care plans, risk assessments, daily records, letters, property checks and health and safety documentation. The legal representative did not consent to photographs being taken, and this decision was clearly respected and recorded. This demonstrated a robust, rights‑based approach where consent was specific, informed and decision‑focused, and where the service consistently upheld people’s autonomy, privacy and legal protections.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks were identified clearly and proactively as part of the providers assessment process, ensuring staff have the information they need to support people safely while promoting independence. Where people required support with specific health‑related tasks, such as managing epilepsy - care records contained detailed, personalised guidance which identified known triggers, early warning signs and the precise actions staff should take if a seizure occurred. Risk assessments were reviewed regularly and updated whenever needs changed, ensuring they remained current, accurate and responsive. Staff received training and ongoing guidance to recognise deterioration, respond confidently in emergencies and follow protocols.

A relative told us, “The company…. for people with complex needs, who are unpredictable……. I think they are outstanding for that.”

Staff told us they had access to up‑to‑date risk assessments and felt confident supporting people safely because they generally worked with a small cohort of individuals. Working with the same people meant staff could identify triggers, early warning signs and deterioration quickly, and respond in line with personalised guidance recorded in care plans.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were robust, covering home layout, fire safety, waste disposal, lighting, flooring, pets, infection prevention and control (IPC) considerations and emergency evacuation arrangements. Where environmental risks increased, such as a rise in falls, the provider acted promptly by reviewing the home environment and identifying practical measures to reduce risk, including addressing clutter, adjusting mobility pathways and considering changes in the person’s physical presentation.

The provider made sure there were enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The provider demonstrated safe and effective staffingthrough strong leadership oversight, consistent training, and a clear commitment to ensuring staff were competent. The provider delivered all staff training, ensuring consistency, quality and direct oversight of how learning is applied in practice. The registered manager told us, “I know exactly what staff are doing out there,” enabling safe delegation, reliable care delivery and rapid identification of any gaps in competence.

All staff spoken with confirmed they had received training across a wide range of courses relevant to their roles, including the ‘Oliver McGowan’ Mandatory Training on Learning Disability and Autism, safeguarding, medication, infection prevention and emergency procedures. Staff told us they felt generally well‑equipped to support people safely and understood how to access further guidance when needed. However, some staff reported the basic life support training lacked the depth and practical content they required to feel fully confident in responding to emergencies.

Staff were supported with daily handovers and regular team meetings. The providers responsiveness out of hours was described as exceptional. However, some staff did say, they could not always attend staff meetings as they were arranged when they were providing care to people. The provider agreed to review this.

Staff were recruited safely, via a rigorous, values‑based recruitment and interview process which ensured only suitable, skilled and safety‑conscious employees progressed to employment. Interview notes captured a detailed employment and education history, motivations for entering the care sector, and an honest appraisal of strengths and weaknesses, including actions taken to address areas for development. Applicants were asked to evidence compassion, reliability and independent working through real examples, and to articulate their understanding of safeguarding, including recognising different forms of abuse. People confirmed they were generally supported at the right time and staff stayed for the duration of the call. However, some staff reported travel time could sometimes be restrictive, particularly at busy times and this could impact on the timeliness of people’s calls.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

The provider ensured staff had the knowledge, equipment and confidence to keep people safe. The provider supplied all necessary personal protective equipment, including gloves and aprons, and reinforced correct usage through structured IPC training. Staff understood the importance of good hand hygiene, safe waste disposal and maintaining clean working environments, applying this consistently during visits. These measures ensured people received care from staff who were well‑prepared, competent and able to minimise infection risks, supporting both safe and effective care delivery.

A relative told us, “[Name] can get ill very quickly so they wear the gloves and masks and aprons, because I did say they need to do that and they have acted upon that – because I don’t want [Name] to go into hospital.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medication assessments were detailed and robust, clearly outlining storage arrangements, allergies, administration routes, doses, frequencies and the clinical rationale for each medicine. This ensured staff had precise, person‑specific information to support safe and consistent administration. Staff told us they received training in the safe administration of medicines and completed competency checks, which assured the provider they were confident and skilled in administering medicines safely. A relative told us, staff assisted their family member with the application of prescribed creams safely.

Staff confirmed they felt confident to follow medication administration records and were able to contact the office staff for support when required.