Home Instead Mid Norfolk

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. This key question has been rated 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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Strong and well-established systems were in place to monitor, report, review and analyse key safety areas, including accidents and incidents. Artificial intelligence was used to monitor records on a daily real-time oversight, weekly, monthly and annual basis to identify any areas of concern or incidents, starting with real-time oversight to take any immediate action needed, escalate to others and any initial learning identified. An example was given of a person who slide off the edge of their bed. It was identified this was due to them picking items off the floor, so a ‘grabber’ stick was provided to stop this happening. The management team were confident the systems were extremely robust at identifying themes, patterns, trends and potential risks at the earliest stage, and gave strong oversight of safety events. These events were then reviewed at different levels, eg, for the person, the staff team, within the office or across the group of services, enabling identification of recurring themes, isolated issues or wider process. This gave strong oversight of safety events, ensuring steps were taken to reduce the risk across the service. These exceptional systems worked alongside staff reporting issues, meant no event, however small, were ever missed.

Events were consistently viewed as opportunities to put things right, to learn and improve. This ensured staff consistently reported all concerns. Any learning was shared across the staff team to ensure consistent, safe practices. We saw evidence of how lessons learnt were automatically embedded in staff practice through supervision and team meetings where changes and improvements were discussed, with open dialogue being encouraged to ensure staff understood why they were being put into practice. Staff also reflected on their practice to improve on safety and safeguarding systems through regular staff meetings. Examples shown including for medication management and capturing information post hospital admission. Partner agencies confirmed appropriate actions were taken as required. This meant any risks were identified early and steps put in place to mitigate to help ensure people received consistently safe and consistent care.

Staff confirmed they felt confident in reporting incidents and near misses. They confirmed lessons were learnt and meaningful changes made from this to keep people safe and provide consistent high quality care. One staff member told us lessons learnt were identified and feedback given to staff where appropriate. They said this was done, “Through team communication, updates and discussions so that improvements can be understood and put into practice. There is a clear focus on making sure changes are embedded into day-to-day care, rather than just being acknowledged once. This helps support safer and more consistent practice going forward.”

The provider always worked with people and healthcare 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.

Robust arrangements were in place from first contact with a person, and/or their family, to ensure care was fully discussed, assessed and planned with the involvement of the person, their relatives and any professionals involved. Artificial intelligence was used to capture this initial meeting, so no information was missed regarding their aims and goals for the care and support they needed, and this formed the basis of their care package. Staff were then carefully matched considering their personalities, interests and likes, to build a small highly skilled team of staff who could relate to with the person, to provide totally person-centred care and support. This meant trusting relationships were built quickly and efficiently to ensure people received safe, consistent care from the start. A relative told us, “Care planning was completed prior to [person] leaving respite care and this was a very smooth transition, having the care in place and agreed before [person] came home.”

People and staff consistently told us that care was only introduced following an initial visit where people and their relatives were given the opportunity to meet with staff and confirm they were comfortable with them. One person said, “Home Instead introduce me to the 2 carers that would support me. The carers are lovely and well trained so I am more than happy with the care I receive.” Another person said, “The new carers will shadow regular carers so they get to know me and my routine which I think is excellent.” This showed the provider took time to get to know a person and identify who would be most suitable to provide care. This ensured they mitigated against risks the care package would fail due to incompatibility of staff with the person and showed the importance they gave to this at the start of care packages.

After the care package had begun, regular reviews were undertaken to monitor the care being provided and to make any required amendments, with calls being put in after 24 hours and then review of the care package provided after the first two weeks.

We saw many examples where the provider had worked exceptionally well with health care professionals to ensure consistent, joined up care. A health care professional told us they had worked with the provider to problem solve and train staff to meet a person’s complex mobility needs. They said they found staff very engaged and wanting to work together for the best interests of the person. The training was an interactive session where different techniques were discussed and learnt and this ensured specific training was designed to enable staff to have all the skills and knowledge they needed to meet that individual person’s needs. This meant people received exceptional, person centred care to meet their individual needs to ensure they became as independent and lead a full a life as possible.

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 always shared concerns quickly and appropriately.

There were robust systems in place to protect people from abuse and improper treatment which included policies, staff training and monitoring systems. The monitoring systems included the use of artificial intelligence which reviewed events to highlight any which needed investigating and reporting.

Staff had a good understanding of different types of abuse and where to report both inside and outside of the organisation. They had regular training and this topic was discussed at team meetings. Staff told us they had raised concerns to the registered manager when they were worried about a person. On all occasions the registered manager had responded, and appropriate actions, taken including making referrals to the local authority if needed. This meant, with staff’s knowledge and the use of artificial intelligence, the systems in place identified any concerns at early stages which helped protect people and ensure measures were put in place to keep them safe.

The provider raised safeguarding referrals when required and engaged with the local authority teams to ensure they were resolved. Health care professionals said they found the manager to be proactive and responsive, being open and transparent with their communication of reporting concerns and risks.

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.

The provider fostered a culture that embraced positive risk-taking, ensuring that risk was not viewed as an obstacle. They collaborated closely with people and health care professionals to address and resolve any safety concerns, which helped preserve people’s independence and fulfil their preferences. Risks were systematically identified, assessed, comprehensively documented, mitigated and subject to regular review to ensure people’s safety was upheld

People confirmed they were involved in developing and reviewing their own care plans and risk assessments. There was a balanced and proportionate approach to risk for people who made choices about their own care. Staff were guided on how to manage and mitigate risks in relation to people’s health conditions, mental health and emotional needs via care records, knowing people well and training. This approach was embedded within the service and staff team.

The trusting relationship, which was built early between staff and people, and fostered thereafter, was one of the cornerstones to the care and helped reassure and ensured people felt confident and safe when care was being provided. For one person maintaining their independence was key to their sense of self, but their needs fluctuated on a day-to-day basis increasing risks to their health and safety. Staff’s understanding of their condition, but more importantly, of them as a person, was key to ensuring the level of support was flexible to meet their changing needs and manage the risks this posed. The open communication ensured the support was adapted to their needs and the risks, helping ensure the person’s independence was maintained with the right level of support which gave them confidence, consistency and peace of mind.

Staff had undertaken training to promote people’s safety including in relation to moving and handling and basic life support. The training was of an exceptional high standard with role play used to investigate different ways to manage situations and to ensure people were kept safe whilst giving care. A health care professional told us how they had worked collaboratively with staff during specific training sessions on how to support the person’s rehabilitation, which then lead the person who had been cared for in bed gradually to mobilise and walk again, mitigating risks, supporting as a team in the best interest of the person. This meant the person returned to sleeping in their own bedroom which they had not done for a while and regain some of their independence they had lost. This showed the provider demonstrated an exceptional approach to involving people in managing risks, working with health care professionals, where safety and independence were equally prioritised, and lead to improved outcomes and enhanced quality of life.

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

People’s homes were risk assessed on the first assessment to ensure all safety measures were in place for both the person and staff. This covered utility shut off points in case of an emergency and environmental issues such as uneven floors, cluttered rooms and stairs. Detection equipment for fires such as smoke and carbon monoxide alarms were identified and other risks such as if people smoked and pets were assessed to ensure all steps were taken to mitigate any potential concerns.

The provider’s main office was assessed to ensure it provided a safe and well managed environment for staff for training and supervision.

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 was clear of the role staff played in achieving an outstanding service which consistently delivers high levels of person-centred care which impacts on peoples” lives positively. This started at the beginning with the recruitment of the right staff. Therefore, the recruitment processes had been developed to ensure they were robust and extensive ensuring staff were employed who had the required qualities, including integrity, trust, empathy and the right values and experiences, for the role. Staff then undertook a comprehensive and structured induction programme to prepare them for the role and for providing true person-centred care. This included bespoke training including role play in a specially designed room with equipment to facilitate learning, and practice for ‘a day in the life of a carer’ to ensure new staff had a full understanding and competency for the role and training for specialised care such as catheter care. This was alongside e-learning (training through digital technologies), direct observation, shadowing, reverse shadowing and specific training for people’s individual needs. Staff felt the training was very good and the induction had equipped and gave them confidence to take on their role. One staff member said, “For in-house training we were able to physically experience and practice certain aspects of care. We trained as a group so were also able to discuss each other’s previous experiences.” This meant when new staff were ready to start their role, they had a good understanding of what would be expected of them and their responsibilities to ensure people received high-quality person-centred care.

This was further advanced by staff being matched to people with similar personalities, interests and likes to form a small group of staff to look after each person. People told us they appreciated meeting staff prior to them providing care to them. This ensured people knew staff who were going to be coming into their homes prior to them giving care, which gave them reassurance and confidence, enabling therapeutic relationships to be developed early with a small, well trained and individually picked team.

Staff were also encouraged to complete additional qualifications. One staff member said, “Last year I had a client with mental health and alcohol problems. I was signposted to training and this helped me to enhance the care I could provide to this person.” People and their relatives agreed staff were trained to a high standard and had the required skills to meet their needs.

Staff said they felt supported within their role. This support was in many forms from formal supervision sessions, competency assessments, support observation visit to meetings and check in calls to check how they were. Debriefs were held if there had been difficult situations. A staff member told us, “Team at the Mid-Norfolk office are all amazing, they truly care about my welfare and are quick to praise. Their biggest strength is their checking in policy. If there has been an incident then they just check in with me, outside of working hours to see if I am ok. It honestly means so much.” Staff told us they were encouraged to contact the office team if they needed anything or had any questions. One staff member said, “The team are all friendly and approachable, no question is too big or too small. They offer support and professional knowledge. If I have a task which is challenging, I would feel comfortable to ask for help and a member of them team would meet me on a visit for support or extra training.” This meant the staff felt supported which then enabled them to raise concerns, ask for support leading to them providing high level person-centred care confidently. The impact to people was in the delivery of high-quality person-centred care, tailored to meet all their needs by exceptionally competent, well supported staff.

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.

People, their relatives and staff told us staff wore appropriate Personal Protective Equipment (PPE) when carrying out care tasks. All staff had completed up to date training in infection prevention and control. There were appropriate policies and procedures in place which were up to date for staff to follow. If people were particularly susceptible to infections, then there was a risk assessment completed to ensure extra mitigation was put in place to ensure they remained safe. This meant people were protected from the risk of becoming unwell.

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.

There were robust systems in place which ensured the provider had clear oversight of medication. Artificial intelligence was used to review medication administered, which was documented on an electronic Medicine Administration Record (MAR), at least twice daily. This ensured if medication had not been given as prescribed it was identified at the earliest opportunity. As well as ensuring medication was appropriately given any shortfalls were identified immediately and quickly rectified which helped protect people from the risk of harm and receive their medication as intended.

People had comprehensive medication records which detailed their medication, dosage, how it should be taken including their preferences, what it was for and any side effects.Staff raised any concerns they had with regards to people taking their medication and the regular oversight also assured issues or themes were identified so they could be investigated and, if necessary, health care professionals contacted for advice.

Staff received medicines administration training and competency checks. This meant people consistently received safe support with their medicines by trained and competent staff.