Visiting Angels Northamptonshire

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 since it was registered in April 2024. This key question has been rated Requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to staff recruitment and training at the service.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Safety events were reported but not investigated robustly. Lessons were not always learnt to continually identify and embed good practice.

Although the provider had systems in place intended to support learning and improvement, these were not used effectively in practice. Care staff could report incidents and accidents through the digital care system, and the manager reviewed individual events. However, there was no evidence these were analysed collectively to identify trends, recurring issues, or opportunities for improvement.

While people told us staff were generally on time and staff used a digital system to record their arrival and departure times, the provider and manager were unable to demonstrate effective oversight or analysis of care delivery. There were no formal processes to routinely monitor service performance.

In addition, there was no evidence that learning was documented, shared, or discussed with staff, for example through team meetings. This meant opportunities to identify patterns, learn from concerns, and make improvements to prevent similar issues from recurring were missed. As a result, the provider could not demonstrate an open and effective culture of continuous learning and improvement.

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.

Staff and the manager worked well with external healthcare professionals. People’s care records contained detailed information about their ongoing health needs, including when referrals or appointments with other services when required. Care plans kept in people’s homes were accessible to visiting healthcare professionals.

Records demonstrated staff supported people to seek appropriate medical advice when needed. Care plans included professional’s guidance such as Speech and Language Therapy (SALT), which staff followed to support a person with eating and drinking needs. Staff had access to the necessary information to contact relevant services, including GPs, district nurses, and emergency services using the digital care systems.

The provider did not have robust processes in place to monitor and audit safeguarding practices, and incidents were not consistently reviewed to identify potential safeguarding concerns. Despite this, staff ensured people lived safely, and protected their right to live in safety, free from bullying, abuse, avoidable harm and neglect.

The provider’s oversight of safeguarding concerns, accidents, and incidents was not always effective. While individual concerns were investigated and where appropriate, reported to external agencies, there was limited oversight or analysis to identify trends, monitor outcomes, or support learning. The provider told us they were investigating missing paper and electronic records. As a result, they could not be assured that all significant events had been accurately recorded, fully reviewed, or managed consistently. This reduced their ability to identify patterns, learn from incidents, and take preventative action to improve people’s safety.

Despite these oversight concerns, staff demonstrated a good understanding of their safeguarding responsibilities. They were able to clearly explain how they would recognise potential abuse, record concerns, and report them appropriately to help keep people safe.

People using the service and their relatives provided positive feedback, stating they felt safe with the staff and the care provided. One relative told us staff ensured the property was secured, providing reassurance that their family member was safe in their own home.

The provider worked with people to understand and manage risks. Whilst staff provided care and support people needed in a safe and supportive way enabling individuals to do the things that mattered to them, staff practices were not always checked.

Leaders assessed, planned for and monitored all risks related to people’s care and support needs. A person said, “I am not very good on my legs, they help me with my shower.”

People and relatives were involved in the care planning process. A relative told us, “They did an assessment before the care package started, asking about likes and dislikes and levels of support required.” Care plans provided clear guidance for staff and included details of equipment required for care, such as hoists, as well as relevant instructions from healthcare professionals.

Staff demonstrated a good understanding of risks and how to support people safely. They had access to detailed risk assessments and care plans by using the handheld devices.

The provider had agreed to deliver a delegated healthcare task involving a specialist clinical intervention. A delegated healthcare activity is an activity that a regulated healthcare professional, such as a nurse, nursing associate, occupational therapist or speech and language therapist, delegates to a care worker or personal assistant. Staff told us they had received training to carry out this task; however, there was no evidence that their competency had been assessed. Although we found no evidence of harm to people, we discussed the potential risks with the manager and provider so that appropriate action could be taken to ensure staff were competent to perform the task safely.

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 provider completed environmental risk assessments of people’s homes at the initial assessment stage, with evidence these were regularly reviewed. Identified risks helped ensure there was adequate space for staff to deliver care safely, particularly when using equipment.

Staff also monitored people's home environments for potential safety risks. When concerns were identified, they took prompt action to reduce risk, either by addressing the issue directly or escalating it to relatives or relevant professionals when needed. This demonstrated that environmental risks were appropriately monitored and managed to help keep people safe.

The provider did not ensure staff were recruited safely or received effective training, support, supervision, and development to carry out their roles. Although there were enough staff to meet people’s needs and staff worked collaboratively to manage rota changes, arrangements for care delivery were not always reliable.

Records showed staff were appointed without completing an application form or having the required pre-employment checks, including references and Disclosure and Barring Service (DBS) checks. New staff were working unsupervised before their competency had been assessed. Training was not consistently completed, some mandatory courses had lapsed, and there was limited evidence of competency checks. In addition, there was no ongoing process to ensure staff remained competent to carry out delegated healthcare tasks safely. These practices were not in line with the provider’s recruitment and training policies and increased the risk of people receiving unsafe care. We raised these concerns with the provider, who took some action, and we told them improvements were needed.

People and relatives were positive about their team of staff who they described as ‘regular and reliable.’ A relative said, “[Person name] has the same team of 4; well trained, since day one; they are reliable and always turn up for the 4 daily visits.” However, some people told us that when their regular staff was absent this was not always communicated.

Rotas were planned and staff accessed them through a digital care system on their mobile phone. However, feedback from staff about rota management was mixed, particularly regarding communication of changes to visit times. Staff told us call times were changed at short notice, which contributed to them arriving late for visits.

Although the manager monitored alerts generated when staff did not record their arrival, these alerts were not consistently followed up or resolved. In addition, there were no effective systems to monitor the wider impact of rota changes, missed calls, or late visits. This meant the provider could not be assured that people received their care as planned.

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 policies in place to prevent and control infection. Staff completed infection prevention and control training. They followed appropriate hygiene practices when delivering care in people’s homes and understood their responsibilities in preventing and controlling infection. One staff member said, “Good infection control means washing your hands regularly and using fresh set of PPE (personal protective equipment) for each task.”

People and relatives told us that staff used PPE consistently when supporting them. People’s care plans identified when PPE was required, such as during personal care or when handling soiled items. This showed that infection prevention and control practices were embedded in day‑to‑day care and helped to keep people safe.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People were involved in planning their support with medicines. One person told us they manage their own medicines and said, “Staff always ensure I have a glass of water to take them with.”

People’s care plans had clear information as to the role of staff supporting them and included specific instructions regarding ‘as required medicines and use of topical creams.

Staff demonstrated an understanding of safe medicines administration, and records confirmed they had completed the required training. However, their competency in administering medicines had either not been assessed or had not been fully evaluated. Clear guidance was available for delegated healthcare tasks, and staff reported receiving relevant training; however, competency assessments for these tasks had not been completed. These concerns were discussed with the manager and provider.

A sample of digital medicines records showed staff documented when medicines were administered or observed to be taken. However, recording gaps were identified, particularly for topical creams, with reasons for non-administration not consistently documented. While there was no evidence of harm or impact on people’s health, these omissions had not been identified through audits or manager spot checks, indicating a need for improved oversight and monitoring of medicines management practices.