Exceptional Care At Home (Barnet)

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 honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider demonstrated a positive learning culture, where safety concerns were reported, investigated and used to inform practice. Staff told us they received regular supervision and team meetings where feedback and learning from incidents were shared to support improvement.

The registered manager used learning from incidents and complaints to improve care delivery, including increasing consistency in staff practice and reducing recurrence of issues where concerns had been identified. For example, when a concern was raised about tasks not being completed, the registered manager investigated the issue, gave feedback to staff and improved practice, with no recurrence.

Quality assurance systems identified minor issues, and leaders took action to address these, which supported ongoing improvement and contributed to safer, more reliable care for people using the service.

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 effective coordination in practice. This included timely communication with professionals and clear arrangements to support people returning home from hospital, with care workers informed and prepared. Staff supported people to access healthcare professionals and appointments where required. Staff worked in partnership with services such as occupational therapists, district nurses and GPs to meet people’s needs.

The provider updated care plans and risk assessments in response to changes, including as part of discharge planning when people returned home from hospital, with changes clearly recorded and communicated to staff. Monitoring information showed care delivery, including real-time oversight of visits. Alerts for missed or late calls supported continuity and timely responses.

Rota management arrangements, including provision of staff travel time and coordination with local authority partners, supported safe and reliable delivery of care.

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.

Staff understood how to recognise, and report safeguarding concerns and explained how they escalated issues to senior staff and external agencies.

The provider recorded and monitored safeguarding concerns and followed these up. The provider worked with the local authority to manage risks. Evidence showed the registered manager investigated concerns, acted and shared learning through supervision and meetings to support improvements. People and their relatives told us they felt safe receiving care, which matched records reviewed. A relative told us they were confident in staff responses to concerns, saying they were, “Very confident in the carers. I trust them 100%.”

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.

Staff recorded changes in people’s needs in real time through daily notes, which were used to update care plans and risk assessments. Staff recognised people’s abilities and involved them in decisions about their care, ensuring their views and preferences were respected and reflected in how risks were managed. This matched feedback from people and relatives, for example, “I am very involved with [my relative’s] care and know what’s going on.”

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

Electronic care records helped staff access up‑to‑date information and respond to alerts relating to changes in people’s needs.

Staff assessed and managed risks within people’s homes, including environmental and individual risks. Staff worked with healthcare professionals, such as occupational therapists and district nurses, so appropriate support and equipment were available. These arrangements were effective in ensuring risks were identified, monitored and responded to in a timely and coordinated way. People and their relatives did not raise any concerns about safety within the home environment.

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

The provider monitored care‑visits and confirmed calls were completed as planned, including arrangements for travel time to support reliability. Data reviewed demonstrated a consistently high level of reliability in care delivery, with no evidence of missed or shortened calls, consistent with feedback from people and their relatives. A relative told us, “Care workers stay the allocated time.”

While some minor inconsistencies were identified in how visits were recorded, these did not impact on people receiving their planned care.

The provider carried out appropriate recruitment checks and staff received training, including induction, shadowing and competency sign‑off, and ongoing compliance was monitored. Staff had regular supervisions and appraisals to support learning and said they felt well supported and able to seek advice when needed.

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 maintained a suitable supply of personal protective equipment (PPE), which staff accessed and used appropriately in line with guidance. Staff demonstrated a good understanding of infection prevention and control procedures, supported by training and regular audits of practice, with findings used to maintain standards and address any concerns. Audits and spot checks confirmed that staff followed infection prevention control procedures in practice, and no concerns were raised by people or their relatives in relation to hygiene or infection control. These arrangements demonstrated that infection prevention and control practices were applied effectively in people’s homes.

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.

Staff followed clear procedures for the administration of medicines and recorded this appropriately using medication administration records (MARs). Staff monitored medicines management, including regular audits of MARs and PRN medicines (medicines used as needed). PRN medicines were supported by clear protocols, care‑plan cross‑referencing and staff competency checks, and people or their representatives were involved in PRN decision‑making.

Audits identified a minor issue in medicines management where 1 PRN record did not include clear timing instructions. The registered manager reviewed this and confirmed it did not impact people’s safety; however, it created a risk of inconsistent staff decision‑making. The manager updated the record to provide clear guidance and strengthened oversight of PRN documentation.

These actions improved the clarity and consistency of medicines administration, ensuring people received PRN medicines safely and in line with their needs.