Home Instead Chichester & Bognor Regis

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question outstanding. At this assessment the rating has remained outstanding. This meant people’s outcomes were consistently better than expected compared to similar services. People’s feedback described it as exceptional and distinctive.
 

This service scored 92 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team always made sure people’s care and treatment was effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them.

People told us and relatives confirmed that they had been involved in a comprehensive holistic pre-admission assessment either in the person’s home or in some cases hospital prior to a discharge back home. These assessments were extremely detailed and effective by thoroughly assessing and reviewing their health, care, wellbeing and communication needs with them. Assessments considered people’s physical health, independence, routines, relationships and what mattered to them. Staff treated assessments as a continuous process and reviewed people’s needs after incidents, hospital admissions or changes in their presentation, working with people, relatives and professionals to update care plans. The impact of this was evident in improved outcomes for people.

Staff acted promptly when their observations showed that a person’s needs had changed. The person disliked the modified-texture diet introduced after their hospital admission. The provider sought a further Speech and Language Therapy (SaLT) assessment rather than leaving the person with the most restrictive option. Following professional reassessment, the person safely progressed to carefully prepared small pieces of food. Records showed their food intake and enjoyment improved, giving them greater choice whilst managing the risk of choking.

Staff also identified that another person was pocketing food in their mouth whilst eating. The provider escalated this concern for clinical review, updated the person’s care plan and used the internationally recognised International Dysphagia Diet Standardisation Initiative (IDDSI) framework to give staff clear instructions with terminology and definitions to describe texture modified foods and thickened liquids. Daily records showed staff consistently prepared the correct food texture, supported the person’s positioning, monitored their intake and gave prescribed nutritional supplements. This meant a frontline observation led to specialist assessment and a consistently safer approach.

Staff also identified changes in another person’s weight, swallowing and ability to remain safe at home. The provider introduced an additional visit, made a SaLT referral and continued to monitor their weight. Records were comprehensive and following review showed the person had gained some weight, providing an early measurable improvement following the reassessment and increased support while the continuing risk was kept under control.

The provider supported unpaid carers to ensure they had time for themselves promoting their wellbeing. For example, a family member was the only person who had been able to monitor their loved one’s blood sugar levels and administer their insulin. The provider took prompt action to train the live-in member of staff to complete this task enabling the family member to take a period of respite

The management team planned and delivered people’s care and treatment with them, including what was important and mattered to them. They did this in line with legislation and current evidence-based good practice and standards. Staff translated professional guidance into clear daily practice and adapted support around people’s preferences rather than expecting people to fit standard approaches.

Managers used the IDDSI framework to turn clinical swallowing guidance into practical instructions for one person’s staff team. Records showed staff followed the guidance consistently through food preparation, positioning, monitoring and nutritional support. For another person, staff followed initial swallowing advice but sought reassessment when the restrictions affected the person’s enjoyment. The revised professional guidance enabled them to eat food they enjoyed safely and improved both their intake and quality of life.

Evidence-based practice also supported people’s independence with medicines. A person’s care plan required staff to gain their verbal consent, record refusals and escalate repeated refusals. The person’s medication administration record was complete and showed when they declined pain relief. Staff identified the repeated refusals and requested a GP review to consider whether the medicine should be prescribed only when needed. This respected the person’s choice while maintaining clinical oversight and safe records.

The management team always worked well across teams and services to support people. Staff shared thorough assessments when people moved between services, so people did not have to repeatedly tell their story. The provider had developed a specific returning-home assessment which staff used to review changes in health, medicines and support needs with hospital staff before discharge. One person successfully moved from a nursing home back to their own home and achieved improved mobility within 5 months. This was achieved by staff following detailed mobility exercises from the occupational therapist and completing these regularly and consistently.

Managers demonstrated particularly strong multi-agency working when a person’s health and wellbeing deteriorated. Staff identified repeated hospital attendances, diabetes and medication risks, self-neglect, poor nutrition, distressing beliefs and risks to their mental health. The team recognised that short domiciliary visits could no longer meet the person’s needs safely. The registered manager and nominated individual made and updated a safeguarding referral and contacted the person’s social worker, community psychiatric nurse, crisis services, hospital mental health teams and adult social care. This brought psychiatric, safeguarding, health and social care concerns together rather than treating them as separate issues.

Feedback from health and care professionals demonstrated that staff worked exceptionally well in partnership with other professionals to support people’s health needs. NHS colleagues and community health professionals described Home Instead staff as patient, compassionate and highly responsive, with clear and timely communication that enabled effective joint working. A home-visiting podiatrist who worked alongside the service commented that care staff “always worked with me, rather than alongside me” and consistently followed professional recommendations, providing any suggested follow-up care. Professionals also highlighted staff’s proactive approach in identifying and reporting changes in people’s health, their willingness to act on advice, and their commitment to ensuring individuals received personalised, high-quality support. Overall, feedback reflected a service that values collaborative working, maintained strong professional relationships and placed people's wellbeing at the centre of care.

The management team also worked with families, hospice staff and community nursing teams to maintain continuity at the end of life. Another person returned home from hospital after choosing comfort rather than intrusive treatment. A live-in care professional initially supported them for 2 weeks while the provider worked with their family, the hospice and community nurses. The person’s ReSPECT form, including their do-not-attempt-resuscitation decision, was in place and anticipatory medicines were available.This coordinated approach enabled the person to remain in familiar surroundings with their family, receiving care that prioritised comfort, dignity, reassurance and choice.

Relatives confirmed the impact of this responsiveness. One said, “I contacted Home Instead and the manager visited him in hospital, and she was really good and they put the care in place ASAP and he came home very quickly which was what he needed.” This supported the person’s quality of life as they were able to be discharged back to the comfort of their own home in a timely way.

Managers always supported people to manage their health and wellbeing to fully maximise their independence, choice and control. Staff supported people to live healthier lives and, where possible, reduced their future need for care and support. They identified barriers to good health, sought specialist advice and adapted care around each person’s abilities, routines and goals.

Staff worked proactively with people, families and healthcare professionals to identify risks and implement personalised solutions that improved health outcomes and reduced the risk of deterioration. For example, when one person was struggling to maintain adequate nutrition and prepare meals independently, staff explored options with them and supported them to access a meal delivery service. This resulted in the person eating more regularly, enjoying their meals and being able to manage them independently.

Staff responded promptly when people experienced nutritional concerns. A person who preferred finger foods was supported with an adapted diet following discussions with their family, which improved their food intake. When prescribed nutritional supplements were not tolerated, staff liaised with the GP to secure a suitable alternative. As a result, the person was able to receive additional nutritional support in a way they enjoyed and accepted.

Staff were also strong advocates for people's healthcare needs. When a person began declining medication due to swallowing difficulties, staff worked closely with the GP and pharmacist to review their medicines. Alternative dispersible and liquid forms of medication were introduced, enabling the person to take their prescribed medicines more safely and effectively. These examples demonstrated how staff worked collaboratively with healthcare professionals to achieve positive outcomes and support people to maintain their health and wellbeing.

Staff demonstrated an exceptional understanding of their role in helping people remain healthy and independent at home through health monitoring, medication support, risk management, promotion of wellbeing, and early intervention to prevent avoidable hospital admissions.

Care plans and risk assessments brought together people’s mobility, nutrition, hydration, medication and social wellbeing. Staff encouraged people to complete personal care tasks at their own pace, enabling people to remain as independent as possible. A member of staff said, “We encourage independence by involving people in decisions about their care and supporting them to do tasks for themselves where possible.” Staff supported people to prepare food, encouraged drinks and supported meaningful interests such as newspapers, crosswords, sport and contact with friends. Visit records showed staff monitored changes in appetite, mobility, fatigue and urine colour, increased encouragement with fluids when needed and shared information through the communication book. A relative said, “The staff are very good and have picked up on a lot of other minor health issues and contacted their GP or the district nurse for me.” These actions supported people to retain independence, remain healthy and promote an enhanced quality of life.

The management team promoted social and emotional wellbeing alongside physical health. Its Cloud Nine approach started with people’s own ambitions. Examples included a person fulfilling a lifelong wish to see big cats at a zoo, another returning to the theatre and 2 people enjoying afternoon tea together. These experiences increased confidence, wellbeing and social connection and showed that support focused on meaningful lives rather than completing care tasks alone.

The management team monitored all people’s care and treatment to continuously improve it. It ensured outcomes were positive and consistent and fully met both clinical expectations and people’s own expectations. Staff used daily records, care reviews, medication records, feedback, incident analysis and professional advice to identify patterns, change support and check whether the change had improved people’s lives.

The outcomes people wanted to achieve from receiving caring support had been thoroughly detailed within their care plan and were regularly monitored. For example, to retain the person’s independence and remain within their own home. Monitoring also produced measurable and person-centred outcomes. Following additional support and specialist referral, a person at risk of malnutrition gained weight following staff support. Another person’s intake and enjoyment improved after revised swallowing guidance enabling the person to maintain their health whilst enjoying eating meals again. Complaints led to staff changes, updated care plans and improved communication, including the removal of a member of care staff from one person’s visits after their relative raised concerns. The relative confirmed they were satisfied with the action taken.

Management reviewed accidents and incidents individually and analysed them each month to identify patterns and further action. When one person experienced an increased number of unwitnessed falls, staff examined the incidents in detail to identify possible hazards. Following a fall that led to hospital admission, staff completed a returning-home assessment and reviewed the person’s care plan and risk assessments. Clinical monitoring tools were used which were kept under constant review. This ensured the person’s current needs informed their support after discharge.

The management team used Care Copilot (an AI-assisted tool designed to support home-care organisations to manage care navigation) alongside professional judgement to review a person’s historical care records, visit notes, medicines and escalations. This identified repeated refusal of personal care, hidden continence pads, missed medical appointments, inconsistent nutrition, skin concerns, increasing forgetfulness and anxiety. The system helped managers bring together patterns from a large volume of records, while the management team assessed their significance and decided what needed to change.

People’s feedback supported the wider positive impact. The 2025 survey recorded that all respondents rated overall service quality positively, all respondents felt care professionals understood their needs and were compassionate, and 87% felt the service adapted well to changing needs.

The management team always carefully explained people’s rights around consent, made sure they understood them and fully respected these rights when delivering person-centred care and treatment. Staff involved people in initial consultations, reviews and decisions, adapted communication where needed and understood that capacity could fluctuate depending on the decision and time of day.

Records showed for a person that had capacity to make their own decisions, their care plan required staff to involve them in choices about personal care, meals, medicines and daily routines. Staff recorded when the person declined personal care, food or pain relief and continued to offer appropriate support without overriding their decisions. The person’s medication plan required verbal consent for every administration and set out the action staff must take if they refused.

Managers also supported people to make complex and forward-looking decisions. A person’s advance care plan recorded where they wanted to die, who they wanted with them and the personal belongings they wished to keep nearby. Staff acted as an advocate for the person and worked with healthcare professionals and planned continuity around their informed choice. The person remained at home and was supported to die in the place and way they had chosen.

Another person chose not to receive intrusive treatment and declined a catheter. Staff respected their decision and coordinated care with their family, hospice and community nurses so they could return home. The person’s care remained aligned with their recorded wishes and prioritised comfort, dignity and choice.

People told us and relatives confirmed that staff sought consent and respected people’s wishes prior to any care or support task respecting people’s right to decline care or treatment. The provider trained staff in the Mental Capacity Act 2005 and expected them to consider capacity for each specific decision. Where a person could not make a decision, staff involved appropriate representatives and professionals and sought the least restrictive option. This approach protected people’s rights while enabling positive risk-taking and maintaining independence.