Home Instead – Eastbourne and Hailsham

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 safe and protected from avoidable harm, 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.

The provider had an exceptionally strong, proactive and person-centred approach to safety of people. Leaders took every possible opportunity to learn and actively questioned practices when analysing information.They had robust systems in place to ensure lessons were consistently identified, shared, and acted upon to reduce further incidents. For example, one person was living with dementia and had a history of getting lost in the community. Leaders analysed patterns of the incidents and ensured additional protocols and safety measures were put in place. This had helped to significantly reduce incidents of the person going missing. Where accidents had occurred, the provider worked with people and relatives to empower them to take charge of their safety and teach others who may support them. For example, one person had a fall while out in the community with staff. The provider conducted a thorough and objective review, clearly documenting the actions taken to address the issues identified, and what could be done differently to prevent recurrence. The person’s relative told us, “I had a phone call, and I was told about how [person] had a fall. When I next visited [person] and took them out, I went to hold their arm to steady them. [Person] said to me ‘not like that, this is how you have to hold me to support me.’ [Staff] had trained [person] on how they needed to be supported when they were out. So, if I fell, I wouldn't take [person] down with me.” This demonstrated the provider had a strong commitment to accountability and improvement and an exceptional culture of empowering people to take control of their own safety.

The provider had nurtured an excellent learning culture. All staff told us the provider had a ‘no blame culture’ and a positive learning environment. Events were consistently viewed as an opportunity to put things right, to learn and improve. This highly positive culture ensured staff consistently reported all concerns. Learning was shared across the staff team to ensure constant, safe practice. We saw evidence on how this was embedded in staff practice.

The provider clearly understood their responsibilities in relation to Duty of Candour.We saw evidence on how people participated in learning to ensure consistently positive outcomes, empowering them to be in control of their lives. All people and relatives gave consistently exceptional feedback about the provider’s positive culture of being highly approachable, open and transparent no matter how small their concern was. Comments included, “They are very responsive if I have an issue or if something has not gone according to plan”, “My [relative] and I are both so impressed with the level of care and leadership. If we have any concerns, [registered manager] is so open and easy to talk to and wants to do everything they can to remedy any issues. They are very responsive and understanding of our circumstances” and “We've found them to be totally transparent.” Leaders held ‘daily huddles’ to continually identify and share learning to embed exceptional practice. The provider’s commitment to learning and improvement was evident in both oversight and day-to-day practice.

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.

From the moment people first contacted the service, the provider demonstrated their continual passion to ensure people were at the centre of their care. Robust arrangements were in place so that care was discussed and planned with the involvement of people, their relatives and professionals. We viewed records which demonstrated the providers consistent and highly effective approach ensured people had excellent continuity of care. All people and relatives told us they had exceptionally positive experiences with Home Instead right from the beginning. This included how “the communication is amazing” and how transitions between services had been greatly eased by the “excellent care team who took the time to get to know me and my needs well.” The provider continually demonstrated exceptional practice in their holistic and proactive approach for people transitioning into their service ensuring they had highly positive experiences.

The provider prioritised safety and continuity of care throughout people’s care journeys. For example, when people had been admitted into hospital, the provider went above and beyond in their ways of collaborating with various clinical teams in other settings to ensure people had effective continuity of care. This had a significant positive impact on the support people received. It ensured they had safe and appropriate care which met their needs and preferences to an extremely high standard.

Staff and leaders knew people exceptionally well and recognised when their health and wellbeing needs changed. They were highly responsive in seeking advice and support from healthcare professionals which reduced hospital admissions for people. Leaders held daily team meetings to discuss any issues and collaborate on finding solutions to people’s individual and changing needs. For example, one person’s health had declined, and clinical professionals had not identified what had caused this. During the providers daily meeting, leaders discussed the persons health deterioration and recognised their symptoms were the same as another person’s which had resulted in hospitalisation. They spoke to the person concerned about their symptoms and what their condition could be; then they contacted a clinician, and tests were conducted. The suspected condition was confirmed, and the person began immediate treatment. This ensured they received the right support at the right time and avoided unnecessary distress or hospital admissions. This had an extremely positive impact on people's emotional wellbeing and supported their personal goals to remain at home. Where referrals to other services were needed, this was carried out quickly, and staff followed their advice. Professionals spoke highly of the provider. Comments included, “They have a strong proactive and preventative ethos. This is demonstrated regularly in my interactions with them” and “They are good at identifying changing needs and acting promptly.”

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.

The provider always worked with people to understand what feeling safe meant to them and the best way to achieve that.The provider encouraged and empowered people to raise any concerns they may have. People and relatives consistently told us they felt safe with staff in their homes. Comments included, “Nothing has ever caused us concern. We can always phone them. They are easy to talk to and resolve things quickly” and “They are very responsive if I have an issue or if something has not gone according to plan.”

The provider demonstrated learning from safety events, and this was embedded into staff practice. They ensured safety incidents were investigated, and risks were dealt with and not left. People were supported to have maximum choice and control of their lives. Staff supported people in the least restrictive way to ensure people and their families felt in control of their journey. One professional said, “[Registered manager] is quick to seek further advice from us. The provider has a strong understanding of person-centred care as well as legal duties such as Mental Capacity Act and Safeguarding.”

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 consistently demonstrated they had an exceptional culture of improving people’s lives while protecting their right to live in safety. For example, a person had an indoor pet which was really important to them. The person regularly had skin infections. Staff worked with them to ensure regular touch points in their home were consistently clean and taught them how to effectively wash their hands after stroking their pet. As a result, the person’s skin infections significantly reduced. Staff and leaders continually ensured people’s personal goals and ambitions were achieved by taking positive risks. For example, a person resided in a flat managed by a different service. The person had limited mobility and described feeling trapped in their home due to management from the other service deeming the risks too great to leave their home. Staff worked with the person to understand their rights and advocated on their behalf, working with the other service to share learning on the benefits of positive risk taking. They created a plan with achievable mini goals. The highly effective support enabled the person to build up their physical strength and confidence to achieve their ultimate goal. This had an exceptional impact to their health and wellbeing.

The provider actively supported people to take positive risks to revitalise their emotional wellbeing and reduce social isolation. They created a ‘moments of joy’ scheme which was a free service which enabled people to access the community outside of their care calls. We saw evidence on how people were actively supported to take positive risks. This had worked exceptionally well for people who lived with physical disabilities, sight impairment, social or communication difficulties. Opportunities included people attending special community events, going to a cinema to see a film, visiting a garden centre for sensory engagement, or attending a place they used to work at years ago. For example, one person’s mobility had significantly declined which resulted in them losing their confidence and ability to go out into the community. Staff knew the person loved going to a specific theatre to watch shows. They worked with the person to plan how they could safely support them to see a show. This had a significantly positive outcome for them. The person said, “I don't get to go to the theatre, but one of the [staff] did take me to a pantomime. I had such a great time, and it was so lovely to be back at the [theatre] where I used to know everybody!” The provider consistently demonstrated how they actively supported people to take risks to enhance their quality of life and reduce their social isolation.

Care plans had personalised guidance for staff on how best to support people to minimise risks to their safety and emotional distress. People and relatives consistently told us that staff knew them exceptionally well. They were regularly involved in reviews of their care and had confidence in staff’s skills to support them safely. Staff understood their responsibilities to keep people safe and told us how they involved people in their care. The registered manager told us that people have the right to make unwise decisions, “If people are aware of the risks and have capacity, we should support them.”

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 to keep their environment safe. The provider would signpost them to services where they could get support to repair or replace equipment. Care plans contained environmental and fire risk assessments. They included vital information such as where to shut off potential hazards such as gas, electric or water. As part of the providers pre-assessment process, they would discuss any environmental concerns with people and if needed, make referrals to external services. The provider told us, “Our referrals to [local fire services] have also promoted the installation of additional fire safety equipment such as smoke or carbon monoxide detectors. This ensures people’s safety when we are not there.”

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 had an excellent induction and training programme for staff which included training on learning disabilities and autism. The provider prided themselves on specialising in supporting older people living with dementia. We viewed evidence of their collaboration with external services and charities in the local community to share learning and develop expertise. The provider had an extremely positive culture where staff were actively encouraged to share any concerns around their skills and development, and they worked together to find solutions. For example, a staff member did not feel confident in supporting people living with dementia. The provider encouraged them to work at their dementia café to develop their skills and confidence in a fun and supportive environment. The staff member “loved it” and felt it was extremely beneficial. This had been highly effective to support their development and confidence. Staff told us training and shadowing visits were personalised and tailored to each individual staff members skills, experience and confidence. They consistently described the entire process as highly effective and felt leaders constantly personalised support to bring out their individual strengths and made them feel respected and motivated. Their comments included, “I was impressed by their induction. Previous inductions at other services were very speedy. The depths Home Instead go into your character; they want someone who is trustworthy. They want the right people”, “The training is really good. The minute you are going to someone with a specific condition, that pops up on your electronic app” and “I always get phone calls from leaders to ask how I am or if I’m having any struggles or need any extra support.” The provider’s commitment to deliver excellent support and training to staff meant people received consistently positive outcomes in their care.

The provider consistently ensured staff were recruited based on their values of putting people first; They had a highly supportive culture which enabled good staff retention. This meant people had continuity of staff and built excellent working relationships. People and relatives consistently told us this was vital to meet people’s needs. For example, a person lived with memory loss and was highly anxious around people they did not know. Their relative said, “What I really like about Home Instead is that they send the same staff so [person] builds up a relationship with them which is really important.” By having a carefully selected team of exceptionally well trained and competent staff, this had a significantly positive impact on the person in reducing their anxiety and distress.

The provider ensured staff had the right balance of skills to consistently meet people’s needs. This included how staff had the same meaningful values to enhance people’s quality of life. For example, staff were matched to support people based on common interests, work or life experiences. We viewed evidence on how this had worked exceptionally well with people and staff building excellent working relationships. People and relatives told us how this matching process worked exceptionally well. All people told us they consistently had extremely positive experiences with staff. A relative said, “I can't praise them enough for how they just put care in and matched [person] well to staff they can get on well with. [Person] is such a character and can be challenging at times. They love to tell stories and staff take that time to listen to them. It's taken a lot of stress off us because they are very happy with everybody.” All people and relatives told us if there were any issues with the matching process, the provider would change that staff member. This process ensured people were always in control of their care and any changes were consistently in line with the person’s wishes.

The provider had excellent monitoring procedures to oversee staff daily attendance and timekeeping. People and relatives told us their calls were on time, but if there had been any minor delays, someone always called them to let them know. Records demonstrated this had worked remarkably well as punctuality was exceptional. People and relatives told us staff did not cut calls short and often stayed “a bit longer”. The provider ensured there were realistic call durations which allowed staff to consistently provide person-centred care without rushing.

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 and relatives told us staff used personal protective equipment (PPE) to keep them safe and help keep their home hygienic. A staff member said, “We have been given PPE to wear, and we have shoe caps so we can keep the clients’ homes clean.” Leaders completed spot checks to ensure staff demonstrated consistently good practice.Staff had training in infection control. They demonstrated the providers values of putting people’s health and wellbeing first. Staff told us, “If I go into a person’s home and I have the slightest sniffle, I will put on a mask. Especially for one person who is at high risk of getting infections. I always say to them ‘Do you mind if I wear this mask as I don't want to put you at risk?’ The person agrees as they want that too. I always share this with new staff” and “Should we be ill ourselves, then we are encouraged to take time off to avoid any spreading of germs.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People and relatives told us medicines were given safely.Comments included, “No issues. They are on the ball, and diligent in noting and acting on any changes to the norm” and “They provide effective support in the administration of the required medications.” Staff had received training, and competency checks were completed to ensure staff were suitably skilled to do their roles. A staff member told us, “I had to do training online and face to face. Then someone came out to see me doing medication. I had to do all of that before I was able to do medication on my own.”

Medicine records were personalised to detail how people liked to be supported to take their medicines, if they had any allergies or required medicines in a specific format. Where one person had fluctuating capacity around medicines, we saw records that demonstrated a best interest decision meeting was held to discuss how to support the person to have their medicines safely. This meeting included the person, their loved ones, staff and external professionals.