Hegarty Care

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 outstanding. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 84 (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 consistently listened to concerns, responded promptly to incidents and safeguarding matters, and engaged in reflective discussions to understand what had happened and how practice could improve. Lessons learned were routinely identified, shared and embedded to prevent recurrence and strengthen the quality of care.

Robust systems were in place to identify trends and patterns across incidents, daily notes and safeguarding concerns. Staff understood the value of analysing this information and were able to describe how learning informed their day‑to‑day practice. There was a strong focus on using incidents as an opportunity to identify where people may have support needs that were not being met, and how the service could respond to them. This ensured that improvements were meaningful, consistent and sustained.

A balanced approach to risk enabled positive risk‑taking and person‑centred decision‑making. For example, staff at Hegarty Care had gone over and above, to share knowledge and risk management strategies to enable people to carry out their hobbies in the community. Staff explained that people were not restricted unnecessarily and that risk assessments supported independence while maintaining safety.

There was detailed analysis of incidents to identify themes areas to learn from which were used to work closely with people through focused monthly sessions, for example following on from incidents, thorough root cause analysis was completed.

The service had effective mechanisms for sharing learning, including team meetings, debriefs, reflective sessions and supervision. The registered manager ensured that all learning actions were followed through, including immediate risk assessment, clear communication with people and staff, review of relevant documents and targeted support such as competency checks or retraining where needed.

Staff told us they felt supported and valued. They described a culture where continuous improvement was encouraged and where they were able to develop their skills confidently and safely. This contributed to improved outcomes for people and a consistent, high‑quality standard of care.

The provider had well‑established systems that supported safe, consistent and coordinated care. They worked closely with people, their representatives and healthcare partners to ensure safety was consistently monitored and that any transitions between services were well managed. This contributed to continuity of care and reduced the risk of avoidable harm.

Clear and structured processes were in place for welcoming new people into the service. Following a referral, the registered manager liaised directly with individuals and professionals to understand their preferences, needs and goals. An introductory meeting ensured the service could assess whether staffing levels, skills and the environment could meet each person’s needs safely. Robust plans were established for the safe transfer of medicines, finances and any other individual requirements.

The provider completed thorough pre‑admission assessments and supplied people with a service user guide and consent documents, available in easy‑read formats when needed. Before individuals moved in, the service proactively engaged with relevant healthcare teams, such as GPs, physiotherapists, continence specialists and speech and language professionals, ensuring that the right support was organised from the outset.

People had key documents in place, such as communication passports, containing essential personalised information about their health needs, communication preferences and how they wished to be supported. This meant that when individuals accessed other services, professionals had immediate access to accurate information, helping to prevent unsafe or inconsistent care during transitions.

Comprehensive care plans and risk assessments were in place and clearly identified individual risks. Staff had detailed guidance on how to support people safely, including those who may experience periods of distress. When specialist input was required, advice was sought promptly to ensure people received the right support at the right time.

These systems ensured that people experienced safe pathways of care and effective, well‑coordinated transitions, both into and within the service.

The service promoted a strong safeguarding culture where people’s rights, safety and wellbeing were central to everyday practice. The provider worked proactively with individuals and healthcare partners to understand what feeling safe meant to each person and the best ways to achieve this. Staff focused on improving people’s lives while ensuring they were protected from bullying, harassment, abuse, discrimination, neglect and avoidable harm. Concerns were shared promptly and appropriately to maintain people’s safety.

Staff clearly understood their safeguarding roles and responsibilities. Information about safeguarding was easily accessible for both staff and residents, and discussions with people helped raise awareness and empower them to speak up. Staff received training that equipped them to recognise signs of abuse or neglect and respond quickly. The registered manager consistently reported concerns without delay to the local authority, ensuring timely reviews and actions to prevent future risks. This reflected a consistent safeguarding process that respected people’s human rights.

Staff had a strong understanding of each person’s individual vulnerabilities, including risks linked to communication, health needs, behaviour and social situations. This meant they were confident in noticing subtle changes that might indicate increased risk. Incidents and accidents were reported and investigated quickly, with appropriate agencies informed. Outcomes, actions and learning were clearly recorded and shared with staff to strengthen safeguarding practices across the service.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service and found where needed people had DoLS authorisations in place.

Lessons learned from safeguarding concerns, incidents and near‑misses were routinely shared with staff. This supported continual improvement and reinforced a culture where protecting people from harm was understood as everyone’s responsibility.

The provider consistently demonstrated an outstanding commitment to involving people in understanding and managing risks in a way that was holistic, person‑centred and empowering. Staff knew people exceptionally well and worked collaboratively with them to identify what mattered most in their lives, ensuring any risk management approaches supported, not restricted, their independence, wellbeing and aspirations.

Risk assessments were comprehensive, personalised and reviewed regularly. They promoted positive risk‑taking and encouraged people to live fulfilled lives. Care and support plans contained detailed and clear guidance for staff, including personalised positive behaviour support (PBS) plans. These plans thoroughly outlined each person’s needs, preferences and early signs of distress, as well as specific techniques for staff to use. This ensured staff had accurate, consistent information to minimise distress and support people safely and respectfully.

Where people had a history of behaviours that might place themselves or others at risk, the provider had developed highly robust, person‑centred plans. These clearly described how each individual’s distress might present, their triggers and antecedents, and how staff should respond in the least restrictive and most effective way. Staff implemented these plans with skill and compassion.

We observed excellent practice during the assessment when a person became distressed. Staff immediately recognised subtle early warning signs and offered reassurance with warmth and sensitivity. They provided the person with meaningful choice about whether to take ‘as required’ medicine, ensuring consent was central to the interaction. This demonstrated how closely and proactively staff monitored people’s wellbeing, enabling early intervention before distress escalated.

People were supported daily to ensure any changes in behaviour, health or circumstances were promptly recognised. Staff engaged in ongoing conversations with people about how they were feeling and updated plans accordingly. This ensured risk management plans remained accurate, relevant and genuinely co‑produced.

Risk management extended beyond the service and into the community. People had personalised community safety plans that reflected both their goals and their potential vulnerabilities. As highlighted earlier in this report, where individuals engaged in activities that might be misunderstood by the public, the provider took exceptional steps to collaborate with local businesses and community partners. This proactive approach helped the wider community understand people’s needs and enabled individuals to participate in valued activities safely and confidently. As a result, people were able to take positive risks in the community, supported by both knowledgeable staff and informed community members.

To further promote autonomy and understanding, people had access to easy‑read guides that helped them make informed choices about keeping themselves safe. These accessible resources supported people to build confidence and independence in managing their own risks.

Throughout the assessment, we saw that staff consistently applied risk management plans in practice. They worked in partnership with people to review plans regularly, discuss any changes, and agree updates together. This collaborative approach ensured risk management was dynamic, transparent and firmly grounded in people’s own voices and lived experiences.

The provider ensured the environment was safe, well maintained and adapted to support the delivery of high‑quality care. Systems were in place to detect, manage and control potential risks within the service, and the premises were equipped with suitable facilities, equipment and technology to promote people’s safety and wellbeing.

The property was kept in good repair and had been thoughtfully designed to meet the needs of people living at Hegarty Care. Communal areas and personal spaces, including bedrooms, were regularly checked to ensure they remained safe, accessible and comfortable. Routine environmental checks helped staff identify and address any hazards promptly, supporting people to live in a secure and well‑managed environment.

People’s bedrooms were highly personalised, reflecting their interests, hobbies and individual identities. This not only created a welcoming and homely environment but also enabled people to feel safe, valued and settled in their own spaces. The service also celebrated diverse backgrounds and cultures. For example, Ramadan was recognised and supported during the assessment period. Photographs displayed in communal areas showed people participating in meaningful activities, helping to create an inclusive atmosphere where individuals felt encouraged to be themselves.

Fire safety was well managed throughout the service. Each person had a detailed Personal Emergency Evacuation Plan (PEEP) outlining the support they would require in an emergency. The registered manager ensured fire drills were carried out regularly, enabling both staff and people to practise evacuation procedures. This proactive approach helped reduce anxiety, increase familiarity with safety routines, and ensure everyone understood what to do in the event of a fire. People also had access to easy‑read or pictorial fire instructions, promoting understanding and independence.

Overall, the provider created and maintained a safe, supportive and responsive environment.

The provider demonstrated an exceptional commitment to ensuring there were always enough qualified, skilled and experienced staff available to meet people’s needs safely and effectively. Staffing arrangements were consistently responsive, enabling people to live safely, confidently and free from unnecessary restrictions. People were supported by staff they knew well and were given choice in who supported them, promoting comfort, trust and autonomy in their day‑to‑day lives.

Throughout the assessment, we observed warm, respectful and natural interactions between people and staff. Some people preferred not to speak with us or were unable to communicate verbally; however, their body language and engagement told us a great deal. People appeared relaxed, happy and at ease in the presence of staff. We saw laughter, companionship and quiet moments of shared understanding, all of which reflected strong, trusting relationships. Staff sensitively recognised when people wanted space or reassurance, adapting their approach with skill and empathy.

Staff were highly experienced and knowledgeable about the needs of the people they supported. The registered manager led by example and demonstrated excellence in their practice, establishing a culture where high standards were both expected and achieved. Staff told us they felt supported and valued, and this was reflected in their confidence and competence in their roles. Staff received thorough training relevant to people’s individual needs and were actively encouraged to pursue additional development opportunities. This commitment to continual learning ensured staff were always equipped to deliver outstanding care.

Professionals who regularly visited the service echoed these findings, describing the staff team in exceptionally positive terms. One professional shared that staff were, “super knowledgeable” and had “detailed knowledge regarding their residents.” Another told us, “I have observed staff interactions and can confirm that all staff are polite, calm, kind, human, friendly and really care for each of their residents achieving their best life and best outcomes.” Such feedback reflected a team that was not only skilled but also deeply committed to delivering compassionate, person‑centred support.

Recruitment processes were robust and consistently followed. The provider ensured only suitable staff were appointed, using thorough checks including interviews, references and Disclosure and Barring Service (DBS) checks before staff took up post. These procedures ensured all staff were safe and appropriate to work with people who may be vulnerable, supporting a culture of safety from the outset.

Staff understood each person deeply, championed their choices, and supported them to achieve the best possible outcomes.

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.

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. The home was clean and tidy; people were encouraged to increase their independence and were supported to maintain cleanliness in their own bedrooms. People’s bedrooms and bathrooms were clean, personalised and homely.

Staff had access to personal protective equipment, such as gloves and aprons for carrying out any appropriate personal care tasks.

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 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. Staff received training in medicines and had their competency assessed. People had detailed individual medicine care plans in place to guide staff what support each person required. There was documentation around mental capacity and understanding for medicines. Care plans contained clear information on how to administer medicines and how to support compliance. People had easy read guides in place explaining what they were for.

The service implemented best practice guidance to ensure people did not receive medicines unnecessarily. The STOMP (Stopping Over Medication of People with a Learning Disability, Autism or both) initiative was embedded at the service. The implementation of this initiative protects people from being over medicated and has improved the quality of life of people living at the service.

People gave positive feedback about the support they received with their medicines.