Home Instead Rochdale

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

Staff demonstrated exceptionally strong knowledge and confidence in safety procedures, escalation pathways, and risk management processes. Care workers were empowered to raise concerns, act quickly when risks were identified and seek timely support from managers. Lone working systems, including regular welfare checks and escalation procedures, were well managed, ensuring staff and people were protected. One staff member told us, “There is a good structure in place for reporting concerns, and office staff are always available.”

The provider had effective systems and processes in place to ensure safety events were reported, investigated, and used as learning opportunities. There was a clear and shared vision to provide high‑quality, safe care, which staff understood and followed in practice. Lessons learned from incidents and errors were shared appropriately to drive continuous improvement and reduce the risk of recurrence.

People and their relatives were reassured by the safe approach to care delivery. A family member described how staff identified a medication error supplied by the pharmacy and took prompt action. They told us, “It is a weight off my mind when mistakes like this are picked up, so I know Home Instead provide a very safe service.”

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.

The provider maintained excellent oversight of safety systems, using audits, spot checks, accident and incident monitoring, safeguarding reviews, and feedback to identify themes and trends. Robust systems were in place to identify, assess, manage, and review risks associated with people’s care, including risks linked to medication, mobility, safeguarding, health deterioration, and changes in people’s circumstances.

Care pathways were clearly defined, person‑centred and flexible, ensuring support was adjusted quickly in response to people’s changing needs. The provider worked collectively with external professionals, including GPs, district nurses, pharmacists, occupational therapists, hospitals, and local authority teams, to ensure people received safe, coordinated care.

Transitions such as hospital admissions, discharges, start of care packages, transfers between care teams or changes in support requirements were exceptionally well managed. Comprehensive pre‑admission assessments and discharge planning ensured people could return home safely with the right level of support in place.

People, and where appropriate their families and representatives, were actively involved in planning transitions, for example one person was reluctant to accept care and felt they were still able to manage most aspects of their daily life independently. They had stopped engaging with other professionals who raised concerns that it was no longer safe for them to remain at home. To address conflicting information, the provider met with all professionals involved while the person was in hospital to discuss their needs. This was followed up directly with the individual, who clearly expressed the support they wished to receive. We saw evidence of a growing relationship of trust between the provider and the person, with the provider attending meetings on the[KL1] persons behalf to ensure their preferences and wishes were represented. This support enabled the individual to feel heard and reassured, helping them maintain a sense of control over their life, they also became more trusting with other healthcare professionals and through working together, they managed to stay in their own home.

The service showed a strong commitment to continuity of care. Staff provided consistent support, with the same carers visiting people over time, which helped to maintain familiarity and trust. We received numerous comments from relatives confirming this continuity, including: “(Relative) has a core team of carers,” “(Relative) is safe with them as they provide continuity of care,” and “(Relative) has regular carers, which is helpful as (relative) becomes very anxious.”

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.

The registered manager demonstrated a clear understanding of their safeguarding responsibilities. Appropriate safeguarding referrals had been made when required, and there was an up‑to‑date safeguarding policy in place which staff consistently followed.

Staff had received safeguarding training, and their knowledge and competence in managing safeguarding concerns were regularly assessed by the provider and qualified trainers. Staff were confident in their understanding of safeguarding procedures and knew how to recognise concerns and report them promptly if they believed a person was at risk.

We saw evidence of this in practice, where a member of staff raised an immediate concern regarding a person’s welfare. An investigation was undertaken, and although it identified that procedures had not been fully followed, appropriate action was taken, and learning was identified to reduce the risk of reoccurrence.

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

Risk assessments were completed collaboratively with people, their families and, where appropriate, relevant health and social care professionals. These assessments were reviewed regularly and updated promptly to reflect changes in people’s circumstances, needs, or preferences, demonstrating a proactive approach to safety. This ensured a comprehensive understanding of peoples’ unique risks, strengths, and preferences.

Clear guidance on how people wanted to be supported during their visit was embedded within support plans, for example within medication care plans there was direct reference to relevant policies, procedures, and best‑practice guidance, including where these could be accessed. This enabled staff to manage risks and integrate safe practice seamlessly into everyday care confidently and consistently. A staff member told us, “The risk assessments are very detailed; I can go to support someone and manage their risk safely.”

Risks across all aspects of people’s lives were explored positively, promoting choice rather than restriction. Where necessary, specialist advice from health professionals was actively sought to ensure well‑informed and proportionate risk management. Risks and agreed control measures were clearly explained to people and accurately documented, supporting transparency and shared decision‑making.

The registered manager emphasised the importance of balancing safety with people’s comfort, wellbeing, and personal preferences. Evidence showed that all reasonable avenues were explored to enable people to live as independently as possible while maintaining safety.

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

People were supported in their own home, and risk assessments were undertaken of each person’s environment, including a fire safety risk assessment. Staff received fire safety training whilst on induction and completed annual refresher training. One staff member told us, “We have fire care plans in clients houses so we know where the evacuation route is.”

Risk assessments were in place for equipment that was used by people and staff had constant access to senior staff members for advice and guidance.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The service demonstrated a comprehensive and well-structured approach to the induction, training, and onboarding of new staff. Training covered mandatory requirements alongside online and practical elements, including a scenario-based programme entitled “A Day in the Life of a Carer.” This training placed staff in realistic situations they may encounter when visiting clients in their homes, helping them prepare for a range of potential scenarios.

Protected time was also scheduled into the process to meet new clients and shadow experienced colleagues, ensuring staff were fully supported as they developed confidence and competence in their roles. All new staff completed a “This Is Me” profile on joining the service, which was actively used to match clients with carers who shared similar interests and backgrounds, promoting strong, person‑centred relationships.

Competency-based training was effectively managed, with ongoing assessments conducted throughout staff members’ employment. New staff were accompanied by trainers to clients’ homes, where practice was directly observed and competencies assessed before staff were formally signed off from training. Where additional development was identified, further training sessions were promptly arranged to ensure staff consistently delivered safe, effective, and high-quality care.

There was a clear and effective strategy in place to continuously develop staff competence and capability. Regular knowledge checks, competency assessments, and refresher training were embedded into practice. Recordsdemonstratedthat any gaps in knowledge wereidentifiedand addressed, ensuring staff consistently delivered safe, effective, and high-quality care. This approach supported a knowledgeable workforce who continuously enhanced their skills, resulting in positive outcomes for people.

Clients were supported by a consistent team of carers who received bespoke training tailored to their individual needs. This included specialist training for a wide range of scenarios, such as Percutaneous Endoscopic Gastrostomy (PEG) feeding, medication administration, and the correct application of support stockings to ensure maximum therapeutic benefit. A comprehensive training matrix was maintained, with refresher training scheduled in line with Skills for Care guidance.

Analysis of call monitoring data showed that 97% of visits were delivered within 15 minutes of the scheduled time. This reflected feedback from people using the service and their relatives. They told us carers arrived on time and did not rush visits.

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.

Appropriate infection prevention and control policies and procedures were in place. Staff received infection prevention and control training from the start of their employment. Mandatory e‑learning was completed prior to face‑to‑face training and included a module on food safety. Trainers assessed and verified staff competencies. Staff reported that there was always sufficient personal protective equipment (PPE) available, and they demonstrated a good understanding of how to use it correctly.

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.

Policies and procedures were in place to govern medication management, and peoples’ medication support needs were identified during the initial assessment, prior to the commencement of care. This included prescribed PRN (“as required”) medication, such as pain relief.

All care plans contained comprehensive, clearly written instructions to support the safe administration of medicines, including oral medications, transdermal pain patches, and topical treatments. Detailed, step-by-step guidance supported staff throughout the entire process, from obtaining informed consent at the beginning of the task to securely returning medicines to the designated storage area.

Staff demonstrated a strong understanding of how to support people safely with their medication. One staff member explained: “Medication training is detailed and thorough, and our competencies are regularly checked. This includes trainers observing us in people’s homes. We can contact the pharmacy if we need to order medication or check any issues. We always record this in our care notes and inform the office.”

The provider completed regular medication audits to ensure administration aligned with the support outlined in care plans, enabling any discrepancies to be identified and investigated. One such audit was a weekly ‘not taken’ audit, which recorded medications that had not been taken and the reasons why. Monthly reviews of these audits helped identify patterns and emerging themes.

A recent issue identified was inconsistency in how staff recorded medication refusals. Some refusals were incorrectly coded as “Not required PRN” or “Other reason not taken” rather than “Refused.” The registered manager explained that, as this was a wider team issue, a proactive approach was taken. Guidance on correct medication recording processes was shared with all staff and included in the monthly newsletter. Additionally, a small medication coding reference card was produced and distributed to staff to keep in their identification lanyards for quick and easy reference.

We also saw evidence that when medication refusals were identified through audits, appropriate actions were taken. This included seeking advice from healthcare professionals, agreeing on suitable resolutions, and ensuring all relevant documentation was updated. Families were also kept informed throughout. The result from this approach made people more acceptable to medications while still having control over decisions involving them, and side effects from missing medication reduced.

Medication support was routinely discussed during clients’ service reviews, even when audits indicated no changes were required. This ensured that clients and their families remained satisfied with the support provided. The registered manager explained that these discussions had been instrumental in identifying changes among individuals who were managing their own medication. For example, families had reported instances where their relatives were missing doses. This allowed the service to explore whether additional support was needed and to agree on an appropriate level of involvement, in one example involvement needed pharmacy and GP intervention due to medications being taken more than expected posing a risk to the person. After discussion about the risk of over medicating the person asked for the provider to take full control over their medications to avoid this continuing.