One to One Support Services

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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 81 (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 embedded 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 and strengthen good practice.

Robust and well-established systems were in place to report, review and analyse key safety areas, including accidents and incidents. Leaders were proactive in overseeing safety events, reviewing the severity, contributory factors, trends and steps to reduce the risk. All staff told us the provider had a ‘no blame culture’ and there was a positive learning environment where everyone felt responsible for maintaining high standards of safety.

Events were consistently viewed as an opportunity 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 constant, safe practice. We saw evidence on how this was embedded in staff practice during supervisions and team meetings with a focus on reflective practice. Partner agencies confirmed that appropriate actions were taken as required.

Staff confirmed they felt confident in reporting incidents and near misses and leaders were clear in their responsibility to report and record such events. We saw examples where records were fully completed, demonstrating what action staff had taken, including any immediate outcomes, how this had been reported, and any subsequent healthcare or partner agency involvement. The majority of people and relatives, we spoke with all were satisfied with how any safety events were handled and responded to.

Staff confirmed they were encouraged to participate in learning, to improve outcomes for people as much as possible, including participating in safety training and local reviews of incidents. The whole staff team was actively engaged in reflecting and improving on safety and safeguarding systems, by completing regular ‘cluster meetings’ to review actual or perceived risk.

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.

Robust arrangements were in place, from first contact, so that care was fully discussed and planned with the involvement of people, their relatives and any involved professionals.

People told us there were introductory meetings and information shared about the service itself via the service user guide and about the staff who would be supporting them. Staff teams were built around each person, and specific training was designed to enable staff to have all the skills and knowledge they needed.

Comprehensive individual transition plans were completed, to establish what was important to people and ensure any risk was eliminated as care continued. For example, where people required any required specialist communication or specific procedure processes to be in place. Staff confirmed when new packages were commenced, people’s needs were effectively communicated to them.

The provider demonstrated a close working relationship with partner agencies which was confirmed, with those who responded to our requests for feedback. One spoke highly of the provider sharing, “[They] are working openly with another care agency (who also support the person) and lines of communication and joint working are very open and positive”.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives whilst 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 with the relevant agencies.

Pople’s safety and rights were central to how care was delivered. They had effective, clearly defined and embedded safeguarding systems and processes in place and staff at every level, demonstrated a clear understanding of their responsibilities and were confident in recognising and responding to concerns.

People were supported to understand what ‘keeping safe’ meant, including in relation to their protected characteristics under the Equality Act 2010. Staff took time to explain people’s rights in accessible ways, ensuring they felt empowered to speak up, People were encouraged to raise any concerns and were appropriately supported when they felt unsafe or experienced abuse or neglect. People and relatives told us they felt safe with staff in their homes, and most feedback reflected confidence, reassurance and trust in the care they received.

Staff and managers demonstrated a strong and embedded understanding of safeguarding, reinforced through regular, high‑quality training. They were confident in the steps to take when concerns arose and acted swiftly to ensure people’s safety.

Learning from safeguarding events was shared openly across teams, strengthening practice and preventing recurrence. Risks were consistently well managed, and the provider acted quickly when concerns arose and worked with other professionals to help keep people safe. External partners told us, “Where issues or concerns have arisen, the service has been responsive and willing to work collaboratively to address matters, including contributing to investigations where appropriate.” This demonstrated a strong commitment to partnership working and continuous improvement.

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.

People confirmed they were involved in creating and developing their own risk assessments and care plans. 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 physical health conditions, mental health and emotional needs. The plans were updated and regularly reviewed. This approach was embedded and recognised as being the responsibility of all staff to share information.

Staff received accredited training to ensure they were able to support people safely, including when they were very distressed. This minimised the risk of people hurting themselves or staff. Staff told us they felt well trained and confident because of the support they received. However, others had concerns that some specific training, including restraint techniques, was not always consistently reinforced in practice. We found evidence the provider completed reviews and reflections (including debriefs) with staff following any restraint, in order to assure staff were following best practice and they had acted swiftly when any concerns were raised.

Other external organisations were contacted as required and actively engaged in managing anticipated future risks. A professional who worked with the service confirmed, “Staff appear able to recognise risks to individuals’ health and wellbeing and communicate concerns effectively. One to One Support Services escalate concerns where required, adjust support in response to changes, share concerns appropriately, and request reviews and professional meetings when necessary”.

In people’s own homes, CQC does not regulate the environment in which people live. However, we do ensure people’s safety is still assessed and monitored. The provider identified and managed environmental risks well, ensuring people received care in safe, well‑maintained surroundings. The service made sure equipment and technology were appropriate and supported the safe delivery of care.

The provider maintained safe environments through consistent monitoring, prompt responses to emerging risks and a caring, hands‑on approach supported people to feel secure and well looked after. Equipment checks and audits were completed consistently, helping the provider detect issues early and take action to prevent harm. Staff responded quickly when environmental problems arose, ensuring risks were controlled without delay.

People were supported by staff who had access to technology which enabled quick access to care documentation, guidance and records. This ensured staff had access to the most up to date information to support people. There were effective arrangements for staff to manage risks and escalate concerns. The provider confirmed there were managers with different areas and levels of expertise whom staff could approach for advice and support. Information was shared as required with families, relevant professionals, and external services involved in people’s lives.

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.

New staff completed a comprehensive and structured induction programme, which included knowledge checks, direct observations and competency assessments. They undertook shadowing and a trial period before working independently, ensuring they were fully prepared for their roles and confident in the provider’s expectations around safe practice.

Training was a blend of classroom‑based and online learning. Training was responsive to people’s changing needs and included specialist courses such as British Sign Language (BSL), mental health awareness, and management qualifications. Staff also completed regular knowledge checks to ensure their understanding remained current. Many staff spoke positively about opportunities for progression, saying they felt, “Encouraged to grow” and “Supported at every step”. However, other staff were concerned around workforce capacity and consistency, particularly within complex care packages, where some staff reported they felt colleagues lacked the necessary experience or confidence to safely support complex behavioural needs.

Senior care worker roles had been developed to strengthen oversight and continuity. These supported and supervised care delivery but also covered any staff absences. This ensured people experienced consistent care from familiar staff. One staff member’s example described ‘shadow shifts’ created to prevent any disruption should a planned respite care arrangement failed, demonstrating proactive and person-centred planning.

The provider had effective systems in place to assess, monitor, and manage the risk of infection. Staff were proactive in identifying potential infection risks and took timely action to prevent the spread of infection. Regular cluster and staff meetings ensured information and updated guidance was shared. Any concerns identified were shared with the appropriate external agencies to ensure coordinated responses.

People told us that staff were respectful of their homes and surroundings and consistently supported them to maintain clean, tidy and hygienic environments.

Staff confirmed they received infection prevention and control (IPC) training, alongside individual discussions to identify and address any gaps in their knowledge or skills. Leaders carried out regular spot checks to ensure staff demonstrated consistently safe and compliant IPC practices. Staff had access to appropriate personal protective equipment (PPE) and followed practices such as safe hand hygiene and adherence to policies to support good hygiene standards.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People or their representatives were appropriately involved in decisions and reviews about their medicines and the level of support (including self-medication) they needed to manage their medicines safely.

Staff had received appropriate medicines training, and leaders completed regular competency assessments to ensure staff were competent in their roles. Staff worked closely with healthcare professionals to maintain safe and accurate medicines and any other medical support in line with current guidance. Regular medication audits were carried out and checked by leaders. The audits included a "medication concern" column, which helped identify actions needed, who was responsible, this meant any issues could be reflected upon and further actions taken to improve practice.

Medicine records were personalised, clearly detailing how each person wished to be supported, any known allergies, or specific methods of preparation or administration. Clear guidance was in place to support the safe administration of when required (PRN) medicines. People who were receiving their medicines covertly, were safely supported in line with the Mental Capacity Act 2005 and with the provider’s policies and procedures. There were effective systems to ensure changes to people’s prescribed medicines were communicated, documented, and implemented without delay.

Care plans included links to information guides so staff could look up information about medicines and described how possible side effects or how a medicine might impact an existing health condition for each person. The provider used nationally recognised resources to benchmark their policies and practice against sector guidance.