Home Instead - Bromley, Chislehurst & Orpington

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 positive culture of safety, based on openness and 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.

Leaders maintained systems that supported open and transparent information sharing about concerns, accidents and incidents, and used these systems to capture learning and drive service development. The registered manager reviewed incidents within 24 hours, completed root cause analysis and shared learning across the staff team.

Staff built trust with people by encouraging open communication and responding constructively to concerns. For example, staff challenged an unsafe medicines request from a health professional, escalated it appropriately, and the provider used the incident as a service-wide learning case that embedded safer medicines practice and a culture of open challenge.

The provider used information from external sources to improve practice. It used findings from coroners' reviews to refresh choking risk training and introduced a client-specific choking risk checklist, enabling staff to identify and monitor escalating risks and act on them. This promoted people's safety while not limiting their choices and empowering them to take acceptable risks.

People and families expressed confidence in the service's safety. A person told us, “I am safe with them, and the staff are well trained.” A relative said, “We are confident that they are safe due to the continuity of care and reliability of the staff.”

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 worked with people and healthcare partners to maintain safe, continuous systems of care. Managers completed a full assessment before each person started using the service, gathering all information needed to support smooth transitions, including hospital discharges. The provider used a digital care management system so staff had prompt access to up-to-date information about people’s needs and safety. Staff shared relevant information with healthcare professionals with people’s consent. A professional told us the provider took initiative and shared thorough, up-to-date information. Another said, “I was profoundly impressed. What stood out most was their holistic approach to care. They ensured that every need was met: practical, medical, emotional and spiritual.”

The provider worked with people and healthcare partners to understand what being safe meant to each person and how best to achieve it. Staff focused 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 and their relatives told us they felt safe using the service and explained that staff understood how to keep them safe. One person told us, “I feel safe. There have never been any incidents that have caused me to have any concern.” A relative said, “[Relative] is safe and cared for very well. I know how to make a complaint if we are not happy.”

The management team and staff recognised abuse and neglect in its different forms, understood how to protect people from it, and reported concerns appropriately. Staff followed the safeguarding pathway to keep people safe.

Staff reported safety concerns to the registered manager, who recorded and monitored them, raised them with external bodies in a timely way where appropriate, and investigated them fully. The provider involved people and those important to them throughout the process and kept them informed of the action taken.

A member of the care team raised concerns about a colleague’s conduct and their fitness to provide care. Although no one had made a specific allegation of abuse, the registered manager treated the matter as a potential safeguarding concern and acted immediately, so the person continued to receive safe, consistent care without disruption. Applying duty of candour, the registered manager explained to the person’s family why they had acted so quickly and carried out a full investigation. The family valued the openness and speed of the response. This showed that staff felt confident to raise concerns, that the registered manager treated them as potential safeguarding matters from the outset, and that the provider kept people safe while it investigated fairly.

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 staff understood the risks each person faced and supported them to manage those risks. Care records set out risks to safety and welfare clearly. Risk assessments covered people’s health, daily living and social activities, and the registered manager reviewed and updated them regularly. The provider identified risks at an early stage and developed care and risk management plans with people and their relatives, so that risks were managed proportionately while protecting people from avoidable harm.

The provider’s approach to positive risk-taking was demonstrated in their support for one person living with dementia who managed their own medicines as part of their daily routine. The person used a diary to record each dose, which gave them a sense of control and dignity. When a change in the formulation of one supplement meant the person inadvertently took a significantly increased amount in a single day, the provider sought guidance rather than removing the person’s responsibility for their medicines. The supplement was returned to its original formulation and the person remained capable of managing their own medicines safely. To balance the person’s continued independence with the safety lesson learned, the provider introduced a supervised medicines count at each visit. This kept the person at the centre of decisions about their own care while reducing the risk of recurrence. The family were kept fully informed throughout, and the new arrangement was reviewed to monitor whether it remained effective.

This approach helped to maintain people’s independence, reduced the risk of poor care and incidents, and improved people’s engagement and involvement in their own care and support.

The provider 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.

Staff recognised risks in people's homes that went beyond the delivery of care, and the provider acted decisively to resolve them. When staff identified that one person was living in conditions that had become unmanageable and unsafe, the provider worked alongside the person at their own pace to restore their home, respecting their choices throughout rather than imposing solutions. As a result, the person continued to live in their own home safely and with dignity.

Where risks required specialist intervention, the provider worked with the fire service to secure a home safety visit and specialist alarms tailored to a person's sensory needs, so risks were reduced without restricting the person's independence.

Staff assessed risks in people's homes on an ongoing basis and reported changes promptly. The provider used what it found to review the equipment and support people needed, covering people's health, daily living and social activities, and the risks staff faced in people's homes. People and relatives told us they felt safe with staff in their homes.

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 provider used an electronic scheduling system, rotas and managerial oversight to deploy staff safely. An on-call system meant staff and people had support outside office hours. Staff had enough time to carry out their roles and told us social interaction was an important part of the care they provided.

People told us staff arrived on time. One relative said, "You can almost set your watch as to when they will come." Another relative said, “[Relative] has the same carer, and they are always on time.” Continuity in the staff team was also cited as important by people and their relatives. Staff felt able to discuss any issues with management if there were challenges with time. Staff told us they could raise any concerns about timing or workload with management.

People experienced care from staff recruited through safe processes. New staff received a personalised induction based on their experience, with extended support for those new to care. Staff completed regular training and confirmed they received consistent supervision.

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 explained staff followed good hygiene practices. One person said, “[Staff] wash [their] hands. They have the gloves." Staff completed infection prevention and control training and followed the provider’s policies. They used personal protective equipment and maintained good hand hygiene to protect themselves and others.

The management team and staff were aware of the importance of keeping people’s homes and equipment clean, hygienic, and free of infection. They also confirmed they had received appropriate training that was regularly reviewed.

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.

The provider assessed risks relating to medicines management. However, we found risk assessments relating to the use of flammable emollient creams were not personalised for 3 people. We discussed this with the registered manager who agreed to review and update these to make them more person-centred.

The registered manager assessed each person’s ability to manage their own medicines and supported them to do so, where appropriate. Staff supported people who needed help with medicines in line with their assessed needs and preferences.

All staff completed medicines training. The registered manager assessed staff competencies at regular intervals, and more frequently where concerns were identified, to make sure staff remained safe to administer medicines. Medicines records such the MARs were completed accurately. The provider had clear protocols in pace for ‘when required’ (PRN) medicines, which set out when and why each medicine should be given so, staff administered consistently.

People told us they received their medicines when they were supposed to, and staff supported them to take them. One relative said, “[Staff] work alongside me. They know exactly what medicines to give. They know what [person] has morning and evening.”

The management team said appropriate training was provided and refreshed. This was confirmed by staff, who told us the medicine training provided was helpful. The registered manager audited medicine records to make sure people received their medicines as prescribed. Where the audits identified any issues, the provider acted on these promptly and use the learning to improve practice across the service.