Home Instead Rugby

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.

At our last assessment we rated this key question good. At this assessment the rating has changed to outstanding.

This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 88 (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.

Systems and processes were in place to learn from incidents, to prevent re-occurrence and promote safety. For example, a member of staff hurt themselves when transferring a person. Following the incident, staff with the relevant expertise provided tailored training for staff to ensure they were able to move the person safely. This was underpinned by referrals to occupational therapists requesting an assessment to identify if further equipment was required.

Staff were clear about accident and incident reporting, and escalation. A member of staff told us, “We always report accidents and incidents. I’ve arrived at a person’s home on a few occasions and found people on the floor. We make sure they’re safe and ring the ambulance or office. We wait with them. We never leave people on their own—that’s policy. We also have to record it on the app where you raise a concern.”

A relative told us, “The staff are well trained, all know what to do, very good at reporting any concerns.”

The provider always worked with people and 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.

The provider had a robust system and process, which ensured people received safe and continuous care, provided by a core team of staff who had been ‘matched’ to meet the person’s individual needs, with consideration to their expectations of the service they were commissioning.

Consultation meetings were held at the person’s home with them, and in some instances their relatives to identify the requirements of the person. This enabled the registered manager to identify which staff not only had the skills and knowledge best suited to the person, but also the personality and requirements of the person, to enable them to achieve their aims and objectives. A relative told us, “Home Instead are very good at matching carers [staff] to clients [people].” A staff member told us, “The clients I have been matched, I work well with. There is no pressure if we don’t gel with a person.”

Following the consultation meeting, staff were introduced to the person, and once it was determined the person was comfortable with the team of staff, the staff were left to develop a routine and relationship with the person. A 24-hour courtesy call was made to review how the first care visit went. A member of staff told us, “We never go into a client’s home without meeting them first—we always shadow someone.”

People, their relatives and staff consistently told us they were introduced to each other, prior to providing personal care and support. A relatives told us, “Any new carers shadow an experienced one.” Another relative told us, “[Person] has a group of 3 carers, and any new member of staff will shadow initially.” A member of staff said, “We never go to anyone we don’t know without shadowing first, never.”

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.

Safe and effective systems, processes and practices were in place and implemented to protect people from abuse and neglect. Safeguarding concerns had been raised with the appropriate local authority safeguarding team, to promote people’s well-being and protect them from abuse.

Staff were well trained to identify and report safeguarding concerns. Staff spoke with confidence as to what constituted a safeguarding concern, and how to report and record information. A member of staff told us, “Safeguarding—looking out for signs of abuse so we can safeguard people. I’ve had training that tells us the signs to look out for. I would call the office and make sure the person is safe at that very moment. I’m confident they would act.”

People and their relatives were confident to raise any safeguarding concerns and told us they had not experienced abuse from the staff who provided their care. A person told us, “I feel very safe with the carers visiting, know them all well, no abuse at all, heavens no, wonderful all of them.” “A relative told us, “My [person] feels very safe with all the carers, all are excellent, no abuse of any sort.”

People’s records included information relating to people’s capacity to make informed decisions. Where people had indicated they had a lasting power of attorney in place, the registered manager checked it had been registered with office of public guardian.

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

People spoke positively about how safe they felt when receiving care and support. A person told us, “I have a visit in the morning to help me shower and dress as I cannot use my arms very much, they dry me and are very helpful. I feel very safe with their care.”

Relatives were overwhelming positive about the safety of their family members. A relative told us, “Can’t speak highly enough, nothing but exceptional service, they support [person] with personal care and encourage them to be as independent as possible, whilst maintaining high levels of safety.”

Potential risks related to people’s care were assessed as part of the initial assessment and regularly reviewed. Following commencement of a package of care, the provider completed a next day courtesy call, followed by a 14-day review, to see how things were going, and identify if any changes were required to the person’s assessment to mitigate risk. Where changes were identified people’s assessments and care plans were updated.

In instances where people became anxious or distressed, staff fully understood the needs of the person, enabling them to offer personalised care. A member of staff told us, “I’ve had dementia training with the company, where I learned about redirection when someone is confused. They gave us lots of examples, and I use redirection daily. For example, a person I support says “see my mum, see my mum,” I change what they’re doing, talk about something else, or switch the TV over. It’s all about engaging. They love Songs of Praise, and we sing the hymns together, clapping and singing along.”

Risks associated with people’s individual care and treatment needs had been assessed and were regularly reviewed. This included the risk of falls. Staff encouraged and used equipment to promote people’s safety, for example the use of walking frames. A person told us, “I use a walking frame and a scooter.”

Risk management included guidance for staff on how to manage and mitigate risks in relation to people’s physical health conditions, mental health and emotional needs. For example, where people lived with diabetes, clear guidance was in place, including information as to monitoring blood glucose levels.

Professional, supportive relationships between staff and those they cared for empowered staff to encourage individuals to keep themselves safe, where their actions, including sexual safety concerns, had the potential to place themselves at risk and exploitation. Measures agreed with people were put in place to mitigate risks, which had included the use of equipment, which recorded visitors who approached their front door.

Staff had undertaking training to promote people’s safety, in several key safety areas, which included, moving and handling people and basic life support. A member of staff told us, “I support one person who requires moving and handling. It’s always a care call which requires 2 staff, we go in and out together. That’s the rule. We’ve had training and refreshers, especially when new equipment is introduced. It’s all face-to-face, with assessments to ensure we’re using everything correctly.”

Staff had their competency regularly assessed to promote people’s safety. A member of staff member told us, “We have our competency checked for moving and handling. That was face to face training with lots of different equipment. I think it is really important they assess me regularly.” This ensured people received safe care.

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

Potential risk related to people’s home environment were assessed to promote both the safety of people and staff. Assessments focused on potential trip hazards such as rugs or uneven floor services and considered the tasks to be undertaken by staff in the delivery of people’s care. Consideration was given as part of the home assessment to fire alarms and carbon monoxide alarms. If these were not present, then permission from the homeowner was sought to have these installed. In support of safety, fire evacuations plan were in place which detailed exit strategies.

Important information about people’s homes was documented, to enable staff to take appropriate action in the event of an emergency. For example, the location of utility services and how these could be isolated in an emergency.

Potential risks to staff when working alone were assessed. For example, occupants of the home, including any pets. The provider had a lone working policy and an out of office procedure which staff could use to contact for support or advise.

The provider made sure there were always 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 used an electronic scheduling system to plan and monitor care visits. This allowed the provider to see in real time when staff arrived and left the person’s home. The information could also be accessed by those using the service and their relatives. A person told us, “The Birdie App is brilliant, I can know exactly what they have done and when and who is coming.” A relative told us, “All visits are recorded on the Birdie App.”

People and their relatives overwhelmingly told us that staff were highly trained, dedicated and reliable. A person told us, “All trained extremely well, no concerns.” A relative told us, “All the girls are extremely well trained, a brilliant team.” Another relative told us, “Carers are very well trained with regular updates on medication, safeguarding and dementia.”

People and their relatives were consistent in praising the reliability of the service. A relative told us, “Carers are always on time, never late, extremely punctual and never missed a call, stay their full time and would offer extra.” Another relative said, “They see the same 3 or 4 carers, we like consistency and continuity, always on time, can’t speak highly enough, very friendly, professional, respect her property, carry out what they are meant to do and are well trained.”

Records showed staff had undertaken training in a range of topics related to health, safety and welfare. Staff had also undertaken training specific to people’s needs which included training on improving skills and understanding the needs of people with a learning disability or those living with dementia. A GP had provided training to staff to support a person monitor their blood sugar levels via a sensor.

Staff were knowledgeable about the needs of people, and spoke positively of the training they received, and how it supported them in providing good quality and safe care. A member of staff told us, “They offer extra training, for Parkinson's Disease and Dementia. They want you to go as far as you can training wise. They encourage us to continually learn and keep up to date with changes. The training gives me the confidence to do my job. The training has taught me that I do know what I am doing. For example, when a lady I cared for had a stroke. I knew something wasn't right and I didn’t hesitate in ringing. The training gave me the skills to be able to identify the stroke.”

A second member of staff told us, “I’ve done the Oliver McGowan training 2 or 3 months ago. It was brilliant and face to face. People with lived experience delivered the training, which was really, really good. There was one thing they made me more aware of, that when I’m out with a person I support, I always make sure they feel important. The training taught me to not stand in front of the person; you give them the chance to have the first interaction with someone who they might meet, which I always remember.”

Staff were recruited in a safe way. Appropriate checks were carried out prior to people commencing work, to enable the provider to be confident suitable staff with the right skills and experienced were employed. A member of staff told us, “I had an interview face to face. DBS and references. I had an induction which was 3 days. Welcome to the team session, and all the training I needed. I also shadowed all of the clients.”

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 had a policy for infection prevention and control (IPC), which all staff were required to read and sign. Care staff completed infection prevention and control training. Potential risks related to infection were assessed, and any concerns were shared with the appropriate agency.

Where people’s assessments had identified they were at risk of acquired infections, additional measures were undertaken by staff to protect them. A person told us, “Carers wear gloves, aprons and masks as I have problems with immunity.”

Relatives confirmed staff wore PPE. A relative told us, “PPE is worn and documented.” A second relative told us, “Carers wear gloves and aprons.”

Staff were provided with personal protective equipment (PPE), for example, gloves and aprons. Checks were undertaken to ensure staff adhered to IPC policies and training. Staff training records confirmed staff had completed IPC training. A staff member told us, “Gloves, aprons, everything is gone through with us. Plenty of PPE here.”

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

People and their relatives expressed their satisfaction with how staff managed all aspects of medicine, where applicable, which included ordering medicine in a timely way to ensure there was sufficient medication. A relative told us, “Medications are administered very carefully, staff are extremely careful on checking supplies, kept in blister packs. Always go through with [person] what they are taking, name and checked following guidelines. Staff would phone the office if any queries or concerns. For example, the colour of a capsule changed so the carer checked that it was the same dose, very thorough.” A second relative told us, “Tablets are ordered from the pharmacy. Carers give [person] the medication from blister packs, logged on ‘Birdie’ (accessible APP giving access to electronic care records and care interventions).

Effective systems and processes ensured any changes to people’s prescribed medicines were effectively communicated, documented and implemented. A relative told us, “Any changes like a recent reaction to a changed dose of medication for Parkinson’s was dealt with swiftly and a different dose prescribed.”

Staff received training, which was regularly updated and included checks to determine staff’s competence. A member of staff told us, “I give medicines, and they do competency assessments with me to check I was doing everything correctly. Every 6 months they also do a review and check I am still competent.”

Staff had undertaking training in delegated health care tasks related to the administration of medication, which included, eye drops, application of transdermal (medicated adhesive patch) patches, and the application of topical creams.

Staff spoke with authority and confidence in their role in supporting people with their medicines, including tailored instructions for recording the administration of people’s medicine. A member of staff told us, “I feel confident giving medicines. It’s all on the app (electronic care record). For example, one person the app states ‘two tablets before breakfast on an empty stomach’. The app tells us to do that first, then we will do personal care and breakfast and a drink and then it will be time for the other medicines. You can't go wrong with the app really. I also give eye drops and patches. For patches, we use a body map to rotate its placement, as you can’t apply a patch to the same place on the body for 14 days.”

People in some instances lived with Parkinson’s Disease, for those people, medicines had been prescribed which were known as ‘time critical’. Staff were aware of the significance of administering these medicines on time. A member of staff told us, “I support a person whose medicines are spaced out throughout the day, and I understand the importance of giving medicines at specific times.”

The provider had policies related to medicine in place, which included a separate policy specific to the needs of people with a learning disability, which referred to both supporting and encouraging people living with a learning disability to seek regular checks ups regarding their medication, and the exploration of non-drug therapies and advocacy services. Both polices included references to legislation and guidance, which included NHS England guidance for Stopping over medication of people (STOMP) specific to people with a learning disability.

People’s care records, where applicable, included information as to the medicines they were prescribed and the role of staff in their management and administration. Staff signed medicine administration records when medicine was administered.