Home Instead

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

Care and treatment was planned and delivered in a way which was intended to ensure people's safety and welfare. Risks were assessed and people were supported to make choices that balanced risks of harm with positive choices about their lives. Staff had been supported to complete training and develop the skills they needed to support people safely. There were enough staff to meet people’s needs. Staff were employed after the appropriate recruitment checks were completed.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported to access services to enable them to live at home. This included admissions and discharge from hospital, and referrals to professionals, where people needed specific support. A family member told us, “Staff go through a series of exercises with my [relative] to improve mobility. My [relative] was bedbound straight out of hospital but can carefully walk with a walking stick and is slowly improving.”

We saw examples of enabling people to leave hospital and dealing with issues such as ensuring they have the right medicines and the right equipment. The provider said, “When people return home from hospital on a 6-week reablement package, we are ready to take back over their care and get their regular staff in place to support them. For example, a person was unhappy with the support offered when they came out of hospital. At the request of a relative, the manager went out, completed a new assessment, put services in place quickly and the relative cancelled the existing service.”

We saw evidence of liaison with hospital discharge teams, and GP services when people were coming out of hospital. A professional said, “I feel Home Instead manage situations well and I got good feedback from the people I have spoken with.”

The registered manager told us they worked with other services such as the GP, community nursing service, pharmacist, occupational therapy service and the hospice. Referrals to health services were made in a very timely way. The registered manager gave an example of where a staff member had noticed a mark on a person’s leg and let the GP know. They were referred to a dermatologist and quick action prevented further deterioration in the skin.

People were protected from the risk of abuse and told us they felt safe using the service. Comments included, “My [relative] doesn’t like large numbers of new people, but once they are well recognised, they feel a lot safer”, “We feel safe no problem, absolutely wonderful staff” and “Having staff there for most of the time my [relative] has a sense of safety.”

Staff had received training in how to safeguard people and knew how to raise any concerns with management or external agencies. One member of staff said, “I have had training in safeguarding people. I have learnt how to recognise abuse, the different types as well as neglect. I would always contact my manager and if no response contact CQC and the local authority.”

The provider had up to date safeguarding policies and procedures in place to support staff in their work. The registered manager was confident that staff knew how to report abuse or to whistle blow to protect people. Safeguarding concerns and notifications had been sent to the relevant authorities appropriately and investigations completed to ensure people were being safeguarded from the risk of harm.

People were involved in planning their care and managing risks. An initial assessment of their needs was completed and reviewed with them regularly. We saw evidence that people were contacted by the office team and their discussion and views listened to and recorded. One family member said, “I attend care plan meetings, and staff email me on a regular basis.” Another told us, “We have had a review which went fine. A manager came to the house, chatted to [relative] and me and dealt with queries appropriately and effectively.”

Risk assessments and care plans provided guidance to staff to mitigate risks to people. Care plan and risk assessments were person centred and aimed to provide positive outcomes for people whilst maintaining their choice and independence. Staff were aware of the risks to people’s health and wellbeing. The staff and management team worked well together to identify risk and to mitigate it. They demonstrated the ethos and values of Home Instead through proactive engagement, compassion, and the provision of good quality care. The management team monitored people’s satisfaction with the service with regular phone calls made to them to ensure their arrangements were running smoothly.

When people first started using the service, they were assessed by a manager and a discussion on risks was documented in people’s care plans. Risk assessments regarding people’s capacity to make informed decisions were not always completed to ensure any risks were identified so that people were kept safe. The provider and registered manager had identified this prior to our visit, and we saw they had put a plan in place to rectify this. Family members were involved in discussions and decisions about risks and their relative’s ability to make choices and decisions. Details of people’s legal representatives were recorded including their Lasting Power of Attorney (LPA) who had the authority to make decisions in their best interests.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were satisfied with the times they received their calls and the consistency of staff involved in delivering their care calls. A person told us, “We have two regular staff and always another one on standby. It’s always the same staff we like. The consistency of staff is good.” A family member said, “They do everything from A to Z. [Relative] likes them, never feels rushed which makes a big difference. Haven’t missed a visit either which is great, 10 out of 10 for the support.” Another told us, “We have had no missed calls and staff usually tell us if they are stuck in traffic or running late. They still stay an hour regardless of what time they arrive.”

Staff told us there was enough staff with the right skills and experience to care for people. They received support, supervision, and training in their role. They worked together effectively to provide safe care that met people’s individual needs. A staff member told us, “We are kept updated on any changes to people’s needs. We also get 15 minutes between calls for travelling, which I find is great.” Another said, “Home Instead are the best company I have worked for. The training is up to date, and we must be signed off before going into people’s homes. Managers are always at the end of the phone if I have any problems or questions.”

There were appropriate staffing levels, and a consistent staff team who worked well together. The times and duration of people’s calls was monitored and processes in place to manage this through the electronic monitoring system and staff supervision. There was an induction programme for new staff including face to face training, shadowing more experienced staff and competency checks. Staff were supported to complete nationally recognized training such as the care certificate or a diploma in social care. Staff had support and supervision and staff meetings to share learning and review performance. Appropriate checks were in place before staff started work including taking up references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. There were some gaps in people’s employment history which were unaccounted for. We made the registered manager aware of this and action was taken to remedy this quickly.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported with their medicines. A family member told us, “The staff give [relative’s] medicines in the morning and keep an eye when things are running out, so they don’t leave it to the last minute. Staff are very proactive.” Another said, “The staff ensure [relative] has their pills and apply eyedrops and skin care creams. This is essential.”

Staff told us they had received training in medicine management and had their competency checked to support with medicines. A staff member said, “We have training and support when needed, managers come on site visit to watch this being administered and sign us off if competent. You can’t take on a person that needs their medicines given until you are checked.” Another told us, “All the medicines are on the App on our phones. It states in big letters about medicines which people need, say for pain. You complete the medicine record when you give medicines. Everyone is different, I always read the notes from the previous staff member, so I know if there have been any changes, say for example they needed antibiotics or pain medicines.”

Staff had clear instructions on how to support people with medicines and the level of support they required. Ongoing management and monitoring ensured people had their medicines as prescribed, records were completed, and any issues picked up and resolved quickly. Medicine administration records were clear with appropriate information, the dose, time, and how given. Medicines given as and when needed lacked some details of when to give and why. Medicines errors were recorded and investigated; however not all had been raised as a safeguarding incident. This was discussed with the registered manager who acknowledged both issues and took action to rectify this to ensure staff had the relevant information and due processes were followed.