Roxhsana Ltd Also known as Visiting Angels Manchester East’

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

This is the first assessment for this service. This key question has been rated outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 93 (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 very clear shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and an exceptional understanding of the challenges and the needs of people and their communities.

The provider demonstrated an exceptional shared direction and culture,driven by visible, values‑led leadership and a deep commitment to improving the quality, accessibility and experience of care across the local community. The nominated individual’s personal insight—shaped by years of navigating inconsistent care for their family, had created a powerful organisational mission rooted in dignity, respect, inclusion and genuine compassion. This lived experience informed a clear vision to reform local care provision by listening to families and delivering personalised, relationship‑centred support.

Leaders were highly engaged, proactive and accountable. They took direct responsibility for addressing regulatory shortfalls, completing high‑risk Tier 1 actions such as correcting the Statement of Purpose, submitting outstanding notifications and evidencing specialist learning disabilities and autism competence. A relative told us, "[Registered manager] has all the time in the world to listen...... any issues I have, get resolved."

Staff described feeling valued and appreciated by leaders and this translated into high morale, strong retention and consistently compassionate care. The organisation’s feedback display showcased thank‑you cards, letters and messages from clients and families, used not only to celebrate good practice but to reinforce values, strengthen morale and keep people’s voices central to service development.

Specialist champion roles further strengthened the organisation’s culture and direction. The Dementia Champion promoted best practice, coached colleagues and ensured culturally sensitive support for people whose first language was not English. The Learning Disability and Autism Champion used extensive experience to guide staff, promote reasonable adjustments and champion neurodiversity. These roles improved outcomes, enhanced staff confidence and demonstrated an organisational commitment to equality, diversity and inclusion.Staff demonstrated a clear understanding of core care principles, including confidentiality, person‑centred care, infection prevention and safe medication recording, reflecting a strong learning culture. Where gaps in staff’s regulatory knowledge were identified, such as safeguarding routes, duty of candour and legislative understanding, leaders acted promptly to strengthen training and governance.

The organisation’s culture was also reflected in its strong community presence and sector recognition. Media coverage highlighted innovation awards, charity fundraising, leadership achievements and national recognition for care innovation. External commentary praised the service’s values and impact, with one public compliment stating, "I wish they had cared for my other."This demonstrated the provider’s growing reputation for excellence and its positive influence across the area.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Leaders demonstrated exceptional capability, compassion and inclusivity, creating a culture where staff felt supported to deliver high‑quality, person‑centred care. Leadership was visible, proactive and deeply rooted in the organisation’s values, with many staff consistently describing leaders as approachable, responsive and committed to their wellbeing. National recognition further reflected the strength of leadership with the nominated individual being honoured as a 'Woman Achieving Greatness in Social Care',at the House of Lords, commended for compassionate leadership.

Leaders demonstrated accountability and regulatory competence,taking decisive action to strengthen governance and compliance. They embedded improved medicines governance, including ensuring epilepsy rescue medication travelled with clients in the community. Risk management was significantly strengthened through lone‑working assessments, infection‑control oversight and specialist training pathways for Percutaneous Endoscopic Gastrostomy (PEG), epilepsy, continence and diabetes care. These actions demonstrated a leadership team that not only understood regulatory expectations but exceeded them through proactive, preventative and person‑centred governance.

Leaders also fostered a high-performing learning culture,with structured training, spot‑check development sessions and regular team meetings reinforcing professionalism, documentation standards and person‑centred practice. Meeting minutes showed leaders emphasised care notes were legal documents which must be factual, person‑centred and protected both staff and people using the service. Staff were supported through clear escalation pathways, additional training and coaching which demonstrated leaders’ commitment to development.

Leaders were inclusive and community-focused,championing diversity and representation. The nominated individual dedicated their House of Lords award to the team and expressed hope that their achievement would inspire other women, particularly from Asian communities, to pursue leadership roles. Leaders also engaged in national conversations about workforce conditions, with the registered manager discussing contract challenges and the need for systemic reform on nation radio, BBC Radio 5 Live.

Exit interview feedback was overwhelmingly positive, with most staff leaving due to role suitability rather than organisational concerns, indicating a stable, supportive and values‑led culture. Leaders also undertook a questionnaire to understand staff knowledge of CQC principles, identifying strengths in confidentiality, person‑centred care and medication recording. The provider addressed gaps in safeguarding routes, duty of candour and legislative understanding. This reflected capable and reflective leadership committed to continuous improvement.

The provider fostered a positive culture where people felt they could speak up and their voice would be heard.

The provider promoted a positive culture of openness, where staff generally felt able to raise concerns, seek guidance and speak up without fear of negative consequences. Staff told us leaders were approachable, responsive and willing to listen, with several describing how managers returned calls quickly, provided clarification at any time of day and encouraged them to ask for support whenever needed.

Spot‑check training and documentation workshops reinforced expectations around safeguarding, professional boundaries and reporting concerns, helping staff understand their responsibilities and the importance of escalating issues promptly. However, some staff told us they had been advised by leaders that CQC would be speaking with them and were asked to provide a copy of the questions inspectors had asked. While this did not appear to prevent staff from speaking openly during the inspection, and the provider reassured us, it was a supportive measure to support those staff who were nervous.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

The provider demonstrated an exceptional commitment to equality, diversity and inclusion,ensuring staff were supported to remain in employment through flexible working arrangements, childcare‑friendly scheduling and personalised rota planning. Leaders continually reviewed organisational culture to ensure it remained inclusive, fair and reflective of staff needs. Staff received comprehensive training in equality and diversity, and their rights were protected through clear policies, procedures and transparent communication.

Recruitment practices were inclusive and designed to remove barriers, ensuring opportunities were accessible to all. Staff wellbeing was prioritised at a high level, with managers actively signposting individuals to supportive resources and maintaining an open, compassionate culture. Staff reported being supported when they face periods of anxiety and they felt valued, supported and respected, reflecting a culture where wellbeing, inclusion and personal growth were embedded into everyday practice.

The provider was strongly committed to equality, diversity and inclusion by actively supporting the religious and cultural needs of its workforce. Following feedback from staff, leaders recognised staff, particularly women, experienced challenges finding suitable spaces to complete daily prayers while working in the community. In response, leaders created a dedicated prayer area within the office, providing a clean, quiet and respectful environment where staff could pause between calls to fulfil their religious observations. Facilities were also introduced, ensuring staff could prepare for prayer with dignity and comfort. Where requested, the registered manager was able to facilitate Friday congregational prayers and offered additional spiritual support.

The provider had recognised, some staff required a calm, supportive and person‑centred office environment where they felt valued, understood and safe. Leaders recognised sensory and fidget resources could offer meaningful support to staff, experiencing anxiety or moments of overwhelm. In response, a selection of fidget and sensory tools were introduced within the office for staff to use. These resources provided comfort and emotional regulation during busy or stressful periods, helping staff maintain positive communication and resilience throughout the working day. By creating a nurturing environment where small but thoughtful adjustments were prioritised, the service reinforced its commitment to compassion, inclusion and supporting staff holistically.

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver good quality, sustainable care, treatment and support. They acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

The provider had effective governance arrangementsin place to oversee safeguarding, accidents and incidents, late and missed calls, complaints and medication errors. Safeguarding concerns were logged with the local authority, investigated appropriately and recorded using the provider’s safeguarding documentation, with statutory notifications made to CQC where required. Accidents and incidents were reported in a timely manner, investigated comprehensively and documented using the provider’s incident records, with reportable injuries notified to CQC and other agencies where applicable. Late and missed calls were logged, analysed for trends and investigated with safeguarding referrals made when missed care resulted in risk. The provider took action to prevent reoccurrence, although lessons‑learned documentation could be strengthened.

Complaints were responded to within policy time frames, investigated thoroughly and closed with appropriate actions, with opportunities to embed more consistent lessons‑learned processes. Medication incidents were reported promptly, investigated and recorded, with safeguarding notifications made where required and actions taken to reduce future risk.

Overall, governance systems were organised and demonstrated a good level of compliancewith clear processes in place to ensure safe practice, statutory reporting and continuous improvement.

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

The provider was committed to partnership working and active engagement within the local community. A dedicated noticeboard in the office reception area showcased newspaper articles, award recognitions, newsletters, media coverage and community initiatives, evidencing transparency and celebrating the organisation’s contribution to the community. The service further supported community connection through its comprehensive Oldham Community Guide, which brought together essential contacts for social care, mental health, housing, domestic abuse support, food provision, bereavement services, transport, volunteering and emergency help.

The provider also demonstrated strong community values through regular fundraising for a local Hospice, including raising £550 through a Christmas raffle supported by staff, people supported and local residents. The donation was in honour of the exceptional end‑of‑life care provided to 2 people and reinforced the organisation’s commitment to partnership working and giving back to local services.

Partnerships with specialist healthcare professionals and pharmacies ensured staff received up‑to‑date clinical guidance, targeted training and practical support. The provider had a close relationship with the pharmacy which ensured timely access to prescriptions, emergency medication support and seamless communication between healthcare teams.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

The provider had a deeply embedded learning culture where continuous improvement, innovation and reflective practice were central to how the service was led. The organisation has been recognised nationally and regionally for excellence and innovation, including achieving runner up Brand Champion of the Year 2023, Great British Care Awards Regional Winner 2023, Care Innovator Award 2023, and Regional Winner – Home Care Employer Award 2025. These achievements independently validated the service’s commitment to high‑quality care, forward‑thinking leadership and outstanding workforce culture.

Staff feedback demonstrated a culture of continuous learning, improvement and innovation. One staff member told us, "[Registered manager] supports me by providing clear guidance, supervisions and regular feedback. This way, I carry out my job effectively." Another said, "My manager supports my wellbeing by providing regular supervision, where I can discuss any concerns, workload or challenges. [Registered manager] encourages a healthy work-life balance and makes sure I have access to training and support and promotes a positive and respectful working environment.This feedback showed leaders used supervision not only to monitor performance but to coach, develop and empower staff,creating space for reflective practice and shared learning. Staff described an environment where ideas were welcomed, improvements were acted upon and innovation was encouraged, with leaders modelling openness, curiosity and a commitment to professional growth. This approach ensured staff felt confident, valued and equipped to deliver high‑quality care, reinforcing a culture where learning and improvement were embedded into everyday practice.