Home Instead Chichester & Bognor Regis

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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 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 91 (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 had embedded a strong proactive open culture of learning and continuous improvement to identify and embed good practice. Management actively listened to any concerns about safety from people, relatives or staff all of which were thoroughly investigated and reported to the correct authorities. Lessons were continually learnt and embedded to promote safe care and improve outcomes.

There was a strong focus to proactively identify and manage risks before safety events occurred. Staff identified early signs of deterioration, such as urinary tract infections or risks of falls, and worked promptly with healthcare professionals to implement interventions, including referrals to falls prevention teams and timely clinical input.

Staff working alongside healthcare professionals actively identified emerging risks, shared concerns and worked collaboratively to review care arrangements as people's needs changed. Records from a Team Around Client (TAC) meeting showed staff responded promptly to significant changes in a person's health needs. Staff recognised the rapid progression of the person's specific health condition and openly discussed the impact this was having on mobility, transfers, breathing difficulties and overnight support. Healthcare professionals and care staff reviewed current practices and identified that existing moving and handling arrangements were becoming unsafe. The team explored alternative approaches, including the introduction of a ceiling hoist, increased care support and environmental adaptations to reduce the risk of harm to both the person and staff. 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, they have been a great help to me as I live an hour and a half away.”

Management displayed a strong proactive and positive culture of safety, based on openness and honesty. Staff actively reported accidents, incidents and concerns, and management systems ensured these were thoroughly reviewed, investigated and used as opportunities for learning and service improvement. Accident and incident forms were completed with detailed information by care staff and reviewed by members of the management team, who documented actions taken to reduce the risk of recurrence. The management team used an electronic artificial intelligence (AI) supported care system to undertake monthly analysis of all incidents and accidents, enabling managers to proactively identify patterns, trends and emerging risks.

Where trends were identified, the management team undertook further investigation and acted promptly to improve outcomes for people. For example, when analysis identified a person had experienced an increased number of unwitnessed falls, managers completed a detailed review of each incident to identify contributing factors and implement measures to reduce risks. Following an unwitnessed fall which resulted in a hospital admission, the management team ensured a return home assessment was completed and reviewed the person's care plan and risk assessments to ensure they reflected their changing needs and contained clear guidance for staff. These examples enabled people to return and remain safe in their own homes and the number of falls reduced for the person following the implemented changes.

The management team worked in partnership with health professionals to ensure risks were thoroughly assessed and that learning informed future planning. Health professionals spoke highly of the collaborative way of working and praised the high level of communication they received from the service. Discussions demonstrated how staff balanced safety considerations with the person's wishes and independence, ensuring decisions remained person-centred while reducing foreseeable risks. This collaborative approach enabled the management team to anticipate changing needs, implement safer practices and continuously improve the quality of care delivered.

The management team demonstrated a commitment to proactive risk management through regular multidisciplinary reviews and timely escalation of concerns. The provider also reflected openly on incidents and recognised where processes could be strengthened. For example, following concerns regarding communication about introductions and shadow shifts, managers identified the need for a more structured approach and introduced plans to improve oversight and communication with people and their families. Learning from complaints, incidents and feedback was embedded into practice through care plan reviews, risk management updates, staff discussions and ongoing monitoring, demonstrating a culture of continuous learning and improvement.

The management team 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 and changing care needs.

Robust systems were in place to assess people before hospital discharge, review risks and update care plans to reflect changes in health and support needs. Staff undertook returning home assessments and maintained close communication with hospitals, community services and family members. This helped people return home safely and avoid unnecessary delays in receiving care. One relative described how urgent support was arranged following a hospital admission, enabling their family member to return home quickly and improving their wellbeing.

The management team also recognised when people required additional support, escalating concerns to health and social care professionals to ensure timely interventions. These approaches helped people maintain independence, receive care in their preferred environment and experience safer outcomes during periods of change.

People experienced safe and well-coordinated transitions between services. Staff worked closely with individuals, families and other professionals to plan and manage changes in care, including hospital discharges and referrals. The service used ongoing assessment to ensure care remained responsive to people's changing needs during transitions. Feedback from management demonstrated the team's ability to support people with complex needs moving from other care settings into community-based support, helping them achieve positive outcomes and maintain continuity of care. Examples were also shared of the service successfully supporting people whose circumstances had changed, ensuring appropriate care and support were put in place promptly.

The management team 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.

People were protected by a strong safeguarding culture where concerns were recognised quickly, acted upon appropriately and reviewed to ensure risks were reduced. Staff completed safeguarding training and understood their responsibilities to protect people from abuse, neglect and self-neglect.

Safeguarding referrals were made promptly when risks were identified and management maintained robust oversight through safeguarding audits and tracking systems. Staff worked collaboratively with safeguarding teams, mental health services, social workers and healthcare professionals to ensure people received appropriate support. For example, concerns regarding a person experiencing self-neglect and deteriorating mental health resulted in safeguarding referrals, multidisciplinary involvement and specialist intervention. This proactive approach meant people at risk received timely support, reducing the likelihood of harm and helping them remain safe within their own homes.
 

The management team 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.

Management had developed a positive risk-taking culture within the service that meant risk was not seen as a potential barrier to people achieving their hopes and dreams. The entire team proactively sought to identify and act on all available opportunities to maximise people’s involvement, choice and independence while managing risks and supporting the person to stay safe. Risks had been identified, assessed, thoroughly recorded, mitigated, and regularly reviewed to help keep people safe. People and relatives described an open culture where they felt confident about their safety and the exceptional ability of staff to meet their needs.

The entire team had worked closely with people and other partners to overcome safety situations to support people’s independence and wishes. For example, a person who required mobility aids used a mobility van to access the community. This vehicle broke down and was out of action meaning the person had not been accessing the community like they had wanted. The staff team worked in collaboration with the person reducing and removing barriers enabling the person to use public transport to access the community. This included the process of risk assessing routes and the accessibility and safety of the public transport for the person and included staff walking the route prior to ensure its safety. This was implemented promptly to ensure the person continued doing things important to them while reducing avoidable harm.

Staff worked alongside the GP to support another person to safely travel on a plane as they had expressed a wish to but had been unable to due to safety concerns. This was made possible for the person with the completion of a thorough and detailed risk assessment ensuring the person’s wishes remained at the centre as well as involvement from relevant health professionals.
People were involved in assessing and managing risks associated with their care. Another person’s care plan supported them to remain involved in decisions about their daily routine while managing risks relating to mobility, nutrition and medicines. For example, following a decline in a person’s mobility, rather than restricting their movement, staff encouraged the persona decline in a person’s mobility staff encouraged the person to continue making decisions about their daily routine and to remain as independent as possible. The person was supported to mobilise using their walking frame on a regular basis with increased visits, complete tasks at their own pace and remain actively involved in their care, with staff providing supervision and reassurance rather than taking over. This enabled the person to maintain independence and continue living in their own home.

The management team was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The management team ensured people lived in a safe environment that met their current needs and promoted their independence. One person remained in their long-term family home, where they felt comfortable, secure and familiar with their surroundings. Following hip surgery and a period of hospital rehabilitation, adaptations had been made in partnership with healthcare professionals and relatives to reduce risks and support their mobility. The person's bedroom had been relocated to the ground floor, adjacent to the lounge, and a commode was available to minimise the need to access stairs. Grab rails had been installed throughout the property to support safe movement and reduce the risk of falls. These adjustments demonstrated a proactive approach to environmental safety and helped ensure the person could move around their home safely while maintaining their comfort and wellbeing.

The management team demonstrated a proactive and person-centred approach to maintaining safe environments, identifying and responding to fire risks associated with people living with dementia before serious incidents occurred. Staff recognised changes in people's abilities and escalated concerns promptly, resulting in timely referrals to West Sussex and Fire Rescue Service, environmental risk reviews and enhanced support. For example, staff observed unsafe cooking practices and fire incidents which prompted the removal of a significant fire risk, the introduction of additional care visits and consideration of longer-term support options, while maximising the person’s autonomy and independence. For another person, staff recognised that standard fire safety measures may not adequately protect someone with cognitive impairment and secured a specialist assessment, which led to a tailored recommendation for a linked smoke detection system capable of triggering an emergency response without relying on the person to act. Records also showed a well-established pathway for specialist fire safety referrals, with coordinated involvement of families, representatives and care professionals. These examples demonstrated strong risk awareness, effective partnership working and a commitment to adapting environments and support arrangements to keep people safe while promoting their independence and wellbeing.

The service identified and responded proactively to ongoing environmental risks within a person's home associated with a wastewater holding tank that required regular emptying. Staff remained vigilant and promptly reported concerns when the tank overflowed, recognising the potential risks to health, safety and infection prevention. When those responsible for arranging maintenance did not respond effectively, the service escalated concerns, maintained oversight of the issue and followed up persistently to ensure action was taken. This included liaising with relevant parties, monitoring progress and coordinating practical arrangements with contractors where required. This enabled the person to stay safe and live where they wanted without fear of harm.

Staff also identified and acted on additional environmental hazards, including a damaged drain cover that presented risks to people, visitors and staff accessing the property. Rather than allowing the risks to remain unmanaged, leaders and staff took a proactive approach to monitoring, communication and problem-solving. This demonstrated a strong commitment to maintaining a safe environment. Staff acted quickly on concerns, showed effective management oversight and advocated on behalf of the person to ensure environmental hazards were addressed promptly, supporting their ability to continue receiving safe care at home.

The provider said, “Environmental safety is an active process. Front line concerns lead to referrals, specialist input and practical action; cognitive risks are considered rather than assuming an alarm is sufficient; and safety is balanced with autonomy, dignity and the meaning a person attaches to their home.” This was evident through the records viewed which demonstrated that innovative approaches were used to mitigate risk creatively whilst ensuring that safety did not unnecessarily remove choice or make a person’s home feel institutional.
 

The management team 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. People told us and relatives confirmed they were supported by a consistent, well-trained staff team. A person said, “We have no complaints at all with the carers. They go over and above what is needed, they will even empty our bins for us.” A relative when speaking about the staff said, “They are all well trained and particularly with dealing with Parkinsons which is one of the reasons why we opted for this agency. Every carer is well trained in dealing with Parkinsons.”

There was a strong emphasis to match people with staff who had similar likes and interests. The provider said, “Our matching begins during the initial consultation, where we gather detailed information about the person’s life history, personality, interests, routines, values and what matters most to them. This is discussed during our client handover meeting alongside the care professional (staff) team.” Care staff completed a ‘this is me’ profile which included their interests, hobbies and likes, this information was used following an assessment to match staff with people.

Management recognised that effective staffing was about more than having enough staff available and used detailed information from application forms, ‘this is me’ profiles and individual assessments to build compatible care teams. For example, one person was supported by staff who shared his interests in sport, music and puzzles, while another person was matched with care professionals who enjoyed sport, television and reading. Similarly, a third person was supported by staff with shared interests in gardening and music, and a fourth person was matched with a calm and patient care professional who enjoyed conversation. The provider continually reviewed the effectiveness of these matches through visit notes, reviews, feedback from people, relatives and staff, making changes where required to ensure positive outcomes were achieved. This person-centred approach promoted strong, trusting relationships, enhanced continuity of care and helped people receive support from staff who understood their interests, preferences and wellbeing needs.

Staff were proactively encouraged to acquire new skills and become a champion in a particular field such as dementia or infection control. The champion roles had a positive impact on both people using the service and staff. A member of staff was a dementia champion. They provided additional support and continuity of care for a person with complex needs, helping to maintain their wellbeing during their family members' absence and reducing the risk of carer breakdown. The staff member also strengthened staff practice by offering advice, shadowing visits and supporting colleagues to adapt care plans to better meet people's changing needs. The provider told us that the champion role promoted the sharing of best practice and provided ongoing peer support, helping staff to continuously develop their knowledge and skills beyond formal training.

Staff consistently described Home Instead as a supportive and values-led employer that invested in its workforce. Robust values-based recruitment, induction and training processes ensured staff were matched to people whose needs they had the skills and knowledge to meet, while consideration was also given to shared interests and preferences to promote positive relationships. Staff received comprehensive mandatory and specialist training, regular competency assessments, supervision and ongoing support from approachable managers. There were clear opportunities for professional development, with staff reporting access to additional training and career progression. Staff spoke positively about the support available from both management and office teams, describing a culture where they felt valued, listened to and empowered to deliver high-quality, person-centred care. These arrangements helped ensure people received care from a skilled, competent and well-supported workforce.

Healthcare professionals spoke highly of the quality, responsiveness and professionalism of staff, describing them as knowledgeable, caring and committed to delivering person-centred care. One healthcare professional told us staff worked collaboratively with them and "went above and beyond their job description in healthcare every time", ensuring people received both practical support and meaningful social interaction. Professionals consistently reported that communication was clear, timely and proactive, with staff responding promptly to concerns and following up on healthcare advice. The provider's commitment to developing staff and maintaining high standards was reflected in the consistently positive feedback received from external professionals, who described the service as an excellent care provider with a strong reputation for delivering high-quality, person-centred care and driving improvements across the local health and social care system.

The management team assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Clear guidance was provided to staff to ensure a consistent approach. This included the use of appropriate personal protective equipment (PPE), effective handwashing practices, enhanced environmental cleaning, safe handling of laundry and appropriate waste disposal. Systems were in place to prevent and control infection (IPC). Staff received infection prevention and control training and managers monitored practice through observations and support visits. PPE supplies were readily available and staff demonstrated an understanding of infection control procedures.

The service demonstrated a proactive and effective approach to IPC when a person developed symptoms consistent with a potentially infectious condition. Staff recognised the risk promptly, escalated concerns without delay and implemented enhanced IPC measures to protect the person, staff and others receiving care. Staff maintained regular communication, ensuring all team members were aware of the precautions required and any changes to the person's condition. The service also took additional steps to minimise the risk of cross-infection by carefully planning staff rotas and allocating care staff in a way that reduced potential exposure risks across the wider service. IPC measures were regularly reviewed and maintained in response to the person's ongoing symptoms and the preferences of those involved in their care.

The management team consistently made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff worked creatively with people empowering them to be involved in managing and administering their medicines.

Staff used a proactive approach to supporting people with their medicines ensuring people were involved in any way they could be with managing and administering their medicines. The aim of the service was always to maximise people’s independence, reviewing people’s abilities regularly and reducing support whenever it is safe and appropriate to do so. Risks associated with medicines were monitored and concerns escalated appropriately. For example, repeated refusals of pain medication resulted in communication with health care professionals and requests for medication reviews, reflecting the person's preferences and current use of the medicine. This supported a person-centred approach to medicines management while maintaining people’s safety and wellbeing.

Staff worked creatively supporting people to maintain independence with medicines wherever possible through prompts, the use of automatic medication dispensers or technology as reminders. Personalised approaches were adopted such as, using pill pouches or monitored dosage systems where appropriate to simplify medicine processes whilst maintaining independence. Staff noticed a person was having difficulty swallowing tablets, with the person’s consent staff worked with the person’s GP and the local pharmacists to obtain alternative formulations, such as liquid medication. Staff had been empowered to observe, report, and question medication effectiveness, ensuring holistic and individualised care for people.

Staff supported another person whose advanced dementia had increased the risk of medication over or under dosing whilst self-administering. Staff worked alongside the person’s GP and family to identify new ways to prevent self-administration risks whilst maintaining the person’s independence with their medicines. A supervised administration call was implemented to maintain the person’s skill and independence whilst removing any potential risks.

The management team ensured people received their medicines safely and as prescribed. There were effective systems in place for the administration, recording and monitoring of medicines, which supported good outcomes and reduced the risk of medicine-related harm. Staff had been trained, followed comprehensive guidance, had their competency assessed and were observed administering medicines by a member of the management team during spot checks. These actions helped to promote the safe administration of medicines whilst giving staff the autonomy to support people in innovative ways to promote their independence in relation to medicines management.