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• 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. At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 84 (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 honesty. Staff listened to concerns about safety and investigated and reported safety events.For example, a staff member’s vigilance beyond routine care identified a fire hazard in a person’s home. This was addressed and communicated to the family. The staff member also went above and beyond when supporting the person with moving as this was causing the person stress and anxiety. They provided reassurance and companionship through packing and preparing for the transition, whilst working with the wider family to make the move as easy as possible.

Lessons were learnt to continually identify and embed good practice. The registered manager told us how feedback from people and care professionals informed changes within the service. For example, as a result of staff feedback, the provider changed the way they reviewed staffing hours, to better meet the needs of both people and staff. The registered manager told us, “It’s about looking at the bigger picture. The scheduling team have worked on this. We also communicate better with our clients about who was going to visit them. We always aim to introduce staff to people before they start visiting.”

The registered manager understood their role under the duty of candour and demonstrated how they had used this. They explained, “When it came to light we had concerns about a member of staff, we took appropriate action without delay, such as informing the police, the safeguarding team and CQC.

Surveys to seek people’s opinion of the service were distributed each November. The provider analysed these to introduce changes and make improvements as a result. They also gave people the opportunity to discuss any concerns they may have during visits or telephone calls. For example, one person told us, “When me and a gentleman carer didn’t gel, [they] took it on board, and I only get female carers now.”

The provider had procedures for dealing with incidents, accidents and complaints. They investigated these and developed plans for improvements. These were shared with the staff. The staff confirmed the registered manager discussed adverse events with them so they could learn together. Relatives we spoke with told us they were well informed when things went wrong, and they were confident improvements were made as a result.

The provider had a learning culture which was adopted by all staff. When things happened, there were discussions and meetings to explore any shortfalls and systems were put in place to make improvements.

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

For example, staff had identified a person’s 400mg tablet needed to be split to deliver 200mg, they had contacted the hospital’s haematology department who confirmed that 200mg tablets would be couriered without delay. This prompt action prevented an avoidable medicines risk and ensured continuity in the person’s medicines administration.

The provider carried out thorough assessments of people’s needs, consulting with the person, their representatives and other professionals involved in their care.

The provider supported people when they needed to transfer to another service, for example a care home or hospital. The registered manager told us, “Typically we speak to clients and family and see what is best for people. In terms of transitioning to a care home, we supported a person to have a video call with the care home for an assessment. We helped [them] with the assessment. [They] felt it was the best decision for [them] and we helped [them] with the move.” The nominated individual added, “We visit a lot of people in care homes, we do a lot of signposting to people when this is needed. We give recommendations if they request this. It’s about the right place for the person and we are more than happy to help.”

The service had up to date policies and procedures in place. Staff were required to read, understand and follow these.

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.

People told us they felt safe from harm and abuse. Their comments included, “It`s like friends coming and I feel safe and I can trust them” and “Very safe as I have the same one carer who comes twice a week.” A relative agreed and said, “They treat [family member] with total respect as [they have] dementia. [They] had a recent fall in the house. The carer found [them], stayed with [them] and rang for the hospital. That was really good of [the care worker] as [they] had other people to see.”

Staff were aware of their responsibility to safeguard people and who to contact in the event of any safeguarding concerns. One staff member told us, “If I had a safeguarding concern, I would contact my care manager straight away by telephone or email, if [they were] away, I would speak to another care manager on duty” and another stated, “If I had a safeguarding issue with any of my clients, I would contact the appropriate care manager, who would then take the necessary action, for example contact the social services department.”

One person had started to display uncharacteristic fear, behavioural distress and self-harm. A member of staff later reported witnessing rough handling and demeaning communication by a live-in staff member. The provider took prompt action to remove the staff member and involve the relevant agencies. Following this intervention, records described the person to be calmer and positively engage with care staff. There were no further incident of self-harm.

There were a safeguarding policy and procedures in place, and the staff were aware of these. Staff received safeguarding training and knew how to report any concerns.

The provider was proactive in raising safeguarding concerns with the local authority and CQC. They worked with the relevant professionals to investigate concerns when incidents occurred. We saw evidence of this in the documents we viewed during our visit.

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. People said staff knew their needs and met these safely.

Positive risk-taking was embedded in the provider’s approach to care. People were supported to retain independence and meaningful activity whilst remaining safe at all times.For example, following hospital discharge, a person’s needs had significantly increased. The provider liaised with a range of professionals including the GP, paramedics, hospital, SALT and physiotherapy, to ensure the person’s activity was adapted rather than withdrawn. As function returned, outings were reintroduced. When the person’s walking was recorded as back to normal, vehicle and stair transfers resumed, and the person resumed to their normal activities. The provider stated, “The benefit was regained mobility, confidence and community life alongside controlled clinical risk.”

The management and staff worked well with people and professionals to manage risks. There were processes to help ensure risks to people were assessed and mitigated effectively. The registered manager reviewed each incident or accident to establish the cause and what actions were needed to reduce the risk of re-occurrence. Documents we viewed confirmed this.

There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff.

People were protected from the risk of avoidable harm. Where risks were identified, there were managed, mitigated and regularly reviewed. For example, there were clear and detailed risk assessments in place where people were prescribed emollient creams. Certain creams, particularly those containing paraffin or oil-based ingredients, can be flammable and may pose a fire risk if exposed to open flames, heat sources or smoking materials. Staff were expected to follow all safety guidelines when applying these creams.

A person was at moderate risk of developing pressure ulcers due to being cared for in bed. We saw the provider had ensured all pressure-relieving equipment was in place. Staff were required to be vigilant in monitoring the person’s skin condition and report concerns promptly to the office. Checks on equipment were carried out regularly.

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

The management team ensured they carried out a full assessment of people’s living environment to help ensure this was safe, taking into account each person’s specific needs. Where risks were identified, the registered manager took appropriate action, which include liaising with the relevant professionals and relatives.

For example, it was identified that 2 rugs in a person’s home presented a trip hazard. However, the person did not want these removed or stuck down. This was discussed with the family members to make them aware of this risk and a robust risk assessment was in place.

For another person, a member of staff identified that their existing bathing arrangements had become difficult to manage safely. They suggested showering as a safer option, and specified the equipment required. The office contacted the family that day and the equipment was purchased. This enabled the person to continue to enjoy personal care in a safer environment.

Where people received live-in care, the live-in staff were instructed to carry out monthly checks on all alarms at the person’s home.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staffing levels were determined during the initial assessment of people’s needs. For example, some people only needed one care worker to visit a couple of days a week for companionship or low-level support, and others required two care workers to support them several times a day. People’s needs were regularly reviewed and the level of support adapted to these.

People and relatives said they were happy with the care workers who provided care. They said they usually had regular staff who knew them well and who they could trust. They told us staff were usually on time for their visits. Their comments included, “The carers come on time and stay more than the full length of time”, “We are very happy with the service, they come on time and stay for the full time and never miss a call”, “Happy? Absolutely, they are incredibly punctual, you can set your clock by them, and they never leave until they are finished.”

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

People were supported by staff who were well trained and supervised. Staff received a thorough induction before they were able to deliver care and support to people who used the service. This included an introduction to the service, policies and procedures, and training. This was followed by a period of shadowing more experienced care workers before being assessed as competent to provide care and support to people.

We saw evidence care staff were being consistently matched to the hours people needed. Records showed there were no missed visits from January to July 2026. This provided assurance the service was dependable and safe. The provider ensured they filled unallocated visits two weeks in advance. This indicated a proactive and forward planning culture and a robust scheduling system that was well managed.

We viewed the provider’s training matrix which indicated all staff were receiving regular training. In addition to training the provider identified as mandatory, staff received training specific to the needs of the people who used the service, such as equality and diversity, end of life care and dementia.

The staff were subject to regular spot checks, supervision and had their competencies assessed to help ensure they were providing good effective care to people who used the service. All staff received regular appraisals and 2 staff were supported to progress in mentor roles.

People told us they felt safe from the risk of infection and cross contamination. They told us the staff followed safe infection control practices and wore their personal protective equipment (PPE) appropriately.

Staff were provided with PPE as needed. The registered manager told us, “They receive PPE from the office. We discuss infection control in supervisions. We give training and competencies are checked regularly.”

However, we did identify a member of staff who was not following the providers policy for safe infection prevention and control. The provider took this seriously and assured us they would take action without delay. This included addressing this with the staff member and reiterate the policy to all staff. The staff received re-training in infection control.

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.

The staff escalated any medicines concerns promptly to pharmacies and clinical teams, such as supply gaps or any side effects. This helped ensure people received their medicines safely and as prescribed.

People confirmed they received their medicines correctly and as needed. The provider had processes in place to ensure people received their medicines safely and as prescribed. Electronic medicines administration records (eMARs) were all completed in accordance with the provider’s medicines administration procedure.

Staff received training in the administration of medicines and had their competencies assessed regularly. The administration team undertook checks to ensure when staff were due training, spot checks or competency checks, these were carried out.

The management team undertook monthly medicines audits. This included all the eMAR charts for every person. They also ran a report of this, to identify any errors or trends. Records showed there had not been any medicines errors recently.