Local Homecare

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 requires improvement. At this assessment, the rating has remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment including medicines.

This service scored 53 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learned to continually identify and embed good practice.

Not all gaps in required documentation had been recognised. For instance, records relating to repositioning, food, and fluid intake were not consistently completed. This limited the service’s ability to identify emerging themes and take timely action. Additionally, care plans did not consistently contain clear, person-centred information about how people needed and preferred to be supported.

Some lessons learnt had been identified and recorded on action plans, with next steps outlined and communicated to staff.

While the service was starting to evidence improvement, further work is needed to ensure that documentation and risk assessments are comprehensive and person-centred. Addressing these gaps will support the service in maintaining high standards of care and ensuring that risks are managed effectively.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people's safety. They did not always make sure there was continuity of care, including when people were supported by different services.

During the inspection, we identified an instance where care was being delivered jointly by two providers, but no clear care plan was in place to outline the responsibilities of each party. This lack of clarity posed a risk of tasks being either duplicated or missed entirely. This concern was raised with the registered manager, who acknowledged the issue and agreed that responsibilities between providers needed to be clearly defined and documented.

Positive examples of partnership working were also evidenced. The registered manager told us of examples of staff engaging with colleagues at day services to build stronger relationships and gain a deeper understanding of the people they supported. Communication between staff, management, and the people receiving care was timely and effective, contributing to a more coordinated approach to care delivery.

Staff demonstrated a strong understanding of the importance of confidentiality. One staff member explained that they were careful not to share personal information inappropriately, stating, “Do not discuss matters with others. We sometimes open people's letters for them but mustn't inform others about them.” This reflected a respectful and professional approach to handling sensitive information.

Safeguarding practices were not always safe to protect people from avoidable harm. Although concerns were shared promptly and appropriately, the lack of detail in documentation meant that safeguarding practices had not been fully embedded. As a result, we could not be assured that all safeguarding issues would be consistently identified, reported, and addressed.

Staff were knowledgeable about safeguarding procedures and understood their responsibilities in protecting people from abuse. Clear and accessible guidance was available to support staff in recognising and reporting concerns. During our visit, staff described various indicators they would monitor, such as changes in behaviour or unexplained injuries. They expressed confidence in escalating concerns to managers, the provider, the Care Quality Commission (CQC), or local authority safeguarding teams. One staff member stated, “People have the right to ensure they are not abused and feel safe,” reflecting the shared ethos of safety and respect within the service.

The provider did not consistently engage with people to understand and manage risks in a way that was both safe and person-centred. In some instances, staff failed to deliver care that fully met people’s needs or supported them in doing the things that mattered most to them. This impacted the overall quality and responsiveness of care.

Care records lacked clarity and did not consistently demonstrate people’s involvement in risk management. Lack of detail in care records meant that care was not always tailored to people's individual needs. A behaviour support plan had been in place since 2023, this documents the appropriate way to interact with a person to minimise any behaviours of anxiety that may be displayed. Although the manager had spoken with the person’s relatives to suggest a review, no formal referral had been made to a relevant health professional to assess whether the plan remained appropriate. This raised concerns about the provider’s oversight and responsiveness in ensuring care plans were regularly reviewed and aligned with people’ evolving needs.

Risk assessments were also found to be lacking in several key areas. While environmental risk assessments were in place, there was no evidence of risk assessments addressing specific clinical or personal care needs. For example, there were no documented risk assessments outlining the actions to take in the event of issues with a person’s catheter or stoma. Furthermore, one individual with an implantable cardioverter-defibrillator (ICD) did not have a corresponding care plan or risk assessment in place.

Feedback from people and relatives was mixed. One relative commented positively, stating that staff provided a good service and listened to the person’s preferences. In contrast, a person using the service expressed frustration about the timing of care visits, explaining that staff were sometimes scheduled too closely together, leaving inadequate time between calls to be supported out of bed.

The provider took proactive steps to identify and manage potential risks within people’s homes, ensuring that equipment, facilities, and technology were aligned with the safe delivery of care. Environmental risk assessments were carried out in people’s homes to create a secure working space for staff. These assessments considered various factors including the layout of the home, utilities, potential hazards, and the presence of any equipment. For example, one person had a dog, and this was appropriately noted during the environmental checks to ensure staff safety. Although the equipment used was not owned by the service, staff received training to operate it safely and were instructed to verify its condition before use. In one case, an agreement was established with a person to maintain their home to a certain standard, allowing staff to carry out their duties in a safe and hygienic environment.

The provider ensured that staffing levels were sufficient to meet the needs of people using the service. However, there was limited evidence to demonstrate that staff had received adequate training to carry out their roles effectively. This meant they did not always have the necessary skills and competencies to deliver safe and appropriate care. For example, there were gaps in training related to the safe management of people's specific health needs, including stoma care, catheter management, PEG feeding, and the correct response should an implantable cardioverter-defibrillator be activated. These omissions posed a risk to people's health and wellbeing, and staff confirmed that they had not received training in these areas. Feedback from people and their relatives regarding staff competence was mixed. Whilst some felt that staff lacked the appropriate training to meet their needs, others expressed confidence in the staff's familiarity and understanding of their care requirements. Despite these concerns, people and their families confirmed that care visits were consistently delivered. Staff were mostly on time, with no missed calls, and staff remained for the full duration of each scheduled visit. Staff told us that regular supervisions and observations of their practice helped them to maintain expected standards, and these were said to be carried out consistently. When concerns or issues were identified, action plans were developed and completed. Lessons learned were clearly recorded, with next steps outlined and communicated to staff in a timely and effective manner. Staff recruitment was carried out in accordance with the provider's safe recruitment procedures, ensuring that people were appropriately vetted before commencing employment. Staff described their induction experiences, which included shadowing more experienced colleagues, and completing training in areas such as medication administration, moving and handling, food hygiene, personal protective equipment (PPE), and safeguarding. One staff member told us, "I undertook shadowing for two days, then acted as second person for people requiring 2 staff to support them. Even now we are learning." Another staff member told us, "[I] completed induction, [a] range of training including medication, moving and handling, caring about clients, food handling, PPE safeguarding and four or five days shadowing."

The provider demonstrated a clear commitment to assessing and managing the risk of infection within the service. Measures were in place to detect and control the spread of infection, and any concerns were shared promptly with the appropriate external agencies. Staff had completed training in infection prevention and control and showed a good understanding of how to minimise risks. One staff member told us, “We have gloves, aprons, and masks. We change them between tasks; you can get a new stock from the office; there is always plenty.” This was supported by feedback from people using the service, who confirmed that staff consistently used personal protective equipment (PPE) appropriately. Comments included, “They always change the PPE,” and “They wear gloves.”

During the inspection, we observed that PPE was readily available at the office. Daily care notes provided further evidence that staff were changing PPE between tasks, demonstrating adherence to safe working practices. The provider had taken effective steps to reduce the risk of infection and protect both staff and people receiving care.

The provider did not ensure that medicines and treatments were managed safely or in a way that met people’s individual needs, capacities, and preferences. People were not actively involved in planning their medication regimes, and documentation from general practitioners was minimal. Crucially, there was no evidence of pharmacist involvement in reviewing medicines administered covertly (those hidden in food or drink) which meant we could not be assured that these practices were authorised or safe. This lack of oversight posed a significant risk to people’s health and wellbeing.

Medication administration records (MARs) contained errors, including the use of incorrect codes to document missed doses. As a result, it was unclear whether doses had been refused or simply not given. Although the provider stated that missed doses were reviewed daily and reasons recorded retrospectively, we found that this process was inconsistently applied. Numerous entries lacked explanations, leaving gaps in the medication history. For people prescribed variable doses, such as 1.25–2.5ml, records did not specify the actual dose administered, making it difficult to assess the effectiveness of treatment or monitor responses.

Time-critical medications, including those prescribed for Parkinson’s disease and epilepsy, were routinely administered late. This delay had the potential to negatively affect symptoms and reduce quality of life. In some cases, records evidenced that one person may have gone for extended periods without receiving essential medicines, such as antibiotics and opioid pain relief. Escalation procedures were not followed promptly, further increasing the risk to people’s health. These shortfalls in medication management placed people at significant risk of harm and highlighted the need for urgent improvements in oversight, documentation, and professional input.