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

The service demonstrated an embedded and highly effective learning culture. There was strong evidence that staff routinely analysed the work carried out with people, both following incidents and as part of regular reflective practice. This approach ensured learning was continuous, not reactive, and focused on improving outcomes for people using the service.

Case studies were effectively used to support this reflective process. These enabled the service to identify themes and trends, highlight areas of good practice, and recognise any shortfalls. For example, one case study considered an occasion when a person had an unwitnessed fall overnight but there was a delay in identifying her injury. Learning from this analysis led to clear actions and improvements in practice, demonstrating a commitment to openness, learning and continuous service development.

Learning was consistently shared with staff through weekly huddles, quarterly meetings, and targeted feedback sessions for specific care teams, as well as through structured workshops. The registered manager described how, following a series of medication errors, workshops were carried out to support staff to reflect openly on practice. These sessions promoted peer learning, with staff supporting one another to understand errors and identify improvements, reinforcing a culture of openness, shared responsibility and continuous learning.

The service demonstrated effective systems to ensure safe, well‑coordinated transitions for people using the service. Staff worked collaboratively with a range of partners, including health professionals, social care teams, and people’s relatives, to plan and manage transitions in a safe and person‑centred way. This partnership approach helped ensure continuity of care and reduced risks during periods of change.

There was a clear focus on building relationships from the outset. Staff were introduced to people prior to commencing support, which enabled trust to develop and ensured care was tailored from the very beginning. The registered manager explained how initial enquiries from people and their families were handled sensitively, with clear communication to manage expectations and ensure the person remained at the centre of all decision‑making.

The service responded proactively when people’s needs changed. Where individuals experienced a deterioration in their health or required more complex care, staff worked closely with families and professionals to prepare for and implement changes in support. Transitions were planned and executed smoothly, helping to minimise disruption and maintain people’s wellbeing.

Feedback from relatives reinforced this positive approach. One relative told us staff continued to support their loved one even during periods of hospital admission. This included visiting them in hospital and later in a discharge‑to‑assess placement within a care home. This demonstrated a strong commitment to continuity and ensured people felt supported throughout all stages of their care journey.

People were protected from the risk of abuse through effective safeguarding systems and a well‑trained staff team. Staff received regular safeguarding training and demonstrated a good understanding of their responsibilities to keep people safe. They were able to recognise the different types of abuse and understood the signs to look out for, ensuring concerns could be identified promptly.

Staff felt confident in raising safeguarding concerns and understood the reporting processes. One staff member told us, “I am confident with raising any abuse concerns via the office, if needed. I had a client that I felt had some financial abuse occurring; I escalated and reported to the office, who investigated and followed up, leading to a safeguarding put in place.” This showed staff were empowered to act and that concerns were taken seriously.

The service worked in line with local safeguarding procedures. Statutory notifications had been appropriately submitted for all safeguarding incidents, demonstrating transparency and compliance with regulatory requirements. Where concerns had been identified, investigations were carried out and any learning or improvements required were clearly identified and implemented.

There were effective monitoring systems in place to track the progress of safeguarding concerns and ensure they were responded to within appropriate timescales. This helped ensure risks were managed promptly and people remained safe.

The service was exceptionally proactive in involving people in managing risks in a way that consistently promoted independence, dignity, and quality of life. There was a strong, person‑centred culture where people were empowered to make choices about their lives, including decisions that involved a degree of risk. The service demonstrated a highly effective balance between respecting people’s rights to make unwise decisions and fulfilling their duty of care to keep people safe.

People were supported to take positive, well‑managed risks that enhanced their independence and wellbeing. Risk assessments were not restrictive but were used as enabling tools, allowing people to continue engaging in activities that were meaningful to them. For example, the registered manager described how one person, despite increasing frailty, was supported to remain involved in cooking their own meals. This was important to the person’s sense of identity and independence, and staff worked creatively to ensure this could be done safely through tailored risk management strategies.

Staff demonstrated a thorough understanding of risk and how to support people in a least‑restrictive way. They had access to detailed and regularly updated risk assessments through the care planning app, which provided clear guidance on how to mitigate risks while maintaining people’s autonomy. Staff told us they felt confident they had the information needed to keep people safe without unnecessarily limiting their choices.

The service’s approach was notably individualised and consistently applied. People and, where appropriate, their relatives were fully involved in discussions about managing risks, ensuring their views and preferences were central to decision‑making. This collaborative approach resulted in care that not only protected people but also empowered them to live fulfilling lives on their own terms.

The service ensured people lived in safe and well‑maintained environments through effective assessment and monitoring processes. Care plans included detailed environmental risk assessments, which considered a range of potential hazards within people’s homes. These covered risks such as fire safety, including the safe use of flammable emollients, as well as risks related to mobility, such as people being unable to exit their property safely in an emergency.

Equipment used to support people was also routinely reviewed, with service dates clearly recorded to ensure items remained safe and fit for purpose. This demonstrated a proactive approach to maintaining safety and preventing avoidable risks.

In addition to formal assessments, staff conducted ongoing checks during their visits to ensure environments remained safe and suitable. They demonstrated a strong awareness of how changing circumstances could introduce new risks. One staff member told us, “We are also completing daily risk assessments every time we visit our clients, i.e. if new furniture has been added or new equipment in the kitchen, living room etc. We ensure the office is aware and will raise concerns if we feel certain equipment is adding to hazards for the safe independence of our clients.” This approach ensured that risks were identified and addressed promptly, with clear communication between staff and the office to support timely action.

Overall, environmental risks were managed in a way that balanced safety with people’s independence, ensuring individuals could remain safely in their own homes.

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.

The service ensured people received safe and effective care through robust recruitment practices and a well‑trained workforce. Safe recruitment processes were consistently followed, including obtaining references, carrying out Disclosure and Barring Service (DBS) checks, and exploring any gaps in employment history before staff commenced their roles. This helped ensure only suitable staff were employed to support people.

The service adopted a person‑centred approach to staffing arrangements. Each person was supported by a small, consistent team of staff members; the numbers varied from one staff member for small packages to up to 14 for people who required care from two staff members at a time . This helped to build strong, trusting relationships and ensured continuity of care, as staff had a good understanding of people’s individual needs and preferences.

The registered manager explained that staffing levels were carefully planned to ensure reliability and continuity. They aimed to maintain a ratio of two staff members for each care package, which provided resilience within the team and ensured there was adequate cover for all eventualities, including sickness or annual leave. This approach reduced disruption to people’s care and ensured support was consistently provided by familiar staff.

Staff were supported to develop the knowledge and skills required to provide safe and effective care. They undertook a comprehensive programme of training, which included both mandatory topics and additional learning opportunities to enhance their practice. Training was flexible and accessible, using a combination of one‑to‑one sessions and online learning, allowing staff to develop in ways that suited their preferred learning styles and career aspirations.

Staff spoke positively about the quality and range of training provided. One staff member told us, “I think [the training] is excellent. We have one to one training and online. Basically, there’s training there however you want to progress or develop into more sectors.” This demonstrated a culture of continuous learning and professional development within the service.

People using the service also expressed confidence in staff competence. One person told us, “It’s pretty obvious they have good training.” This feedback reflected the positive impact that skilled and knowledgeable staff had on people’s care experience.

Overall, staffing arrangements were safe and effective, with strong recruitment processes, consistent staffing teams, and a clear commitment to ongoing training and development, ensuring staff were well equipped to meet people’s needs.

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 service had effective systems in place to prevent and control the spread of infection. Staff received appropriate training in infection prevention and control, including the correct procedures for the safe donning and doffing of personal protective equipment (PPE). This helped ensure staff had the knowledge and skills required to minimise risks to people.

Staff demonstrated a clear understanding of infection control practices in their day‑to‑day work. They described how they consistently used PPE when supporting people and followed safe hygiene practices. This included changing gloves and other PPE between tasks, such as moving from personal care to food preparation, to reduce the risk of cross‑contamination. The use of PPE was further overseen by the management team through regular spot checks carried out during care calls, helping to ensure good practice was consistently maintained.

People using the service and their relatives confirmed that staff adhered to these practices. They told us PPE was used appropriately and consistently, providing reassurance that infection risks were being effectively managed.

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.

Medicines were managed safely, with effective systems in place to support people to receive their medicines as prescribed. Staff followed clear procedures to ensure medicines were administered correctly and in line with best practice guidance.

There were clear protocols in place for ‘as required’ (PRN) medicines, which provided staff with detailed guidance on when these medicines should be given. This helped ensure people received their medicines appropriately and consistently, while also supporting staff to make safe decisions.

The service undertook regular audits of medicines management. These audits were effective in identifying any issues or discrepancies, and prompt action was taken to address these. This demonstrated a proactive approach to maintaining safety and continuous improvement. For example, one staff member told us, “Occasionally there are discrepancies between the medicine and what has been dispensed. I identified one of these issues this week and it was a pharmacy error that was rectified immediately.” This showed staff were vigilant and confident in escalating concerns to ensure people’s safety.

The service also worked in a person‑centred way to ensure medicines met people’s individual needs. One relative told us the service recognised their family member was struggling to take a medicine in tablet form and supported them to have this reviewed by their GP, resulting in the prescription being changed to a syrup. This helped improve the person’s comfort and compliance with their treatment.