Our Latest Care Quality Commission Inspection

We are incredibly proud to be rated outstanding in call five categories by the Care Quality Commission. Read on for full details of our latest inspection report and to see what the inspectors had to say about our tailor-made home care services.

Find yourself wondering what care from Home Instead - Exeter & East Devon is really like?  Why not read an independent review by the industry regulator, the Care Quality Commission.  The Company is the first home care provider in the South West to be found overall Outstanding in all 5 areas of inspection, a rating shared by less than 0.1% of care providers in the country - the full report is available at https://goo.gl/4JkGa5

Commenting upon the Company's impressive quality rating Debbie Westhead, CQC Interim Chief Inspector, Adult Social Care, said:“The quality of care which our inspectors found here was exceptional and I am very pleased that we can celebrate the service’s achievements.

Deborah Ivanova, Deputy Chief Inspector, Adult Social Care, said;“It is great to hear that this service has been rated Outstanding for the second time.“People received exceptional care with services being developed and tailored to their needs.“Staff spent time getting to know people to build meaningful and valued relationships with them. People were treated with compassion and kindness.“It was clear throughout the inspection, that the staff took pride in their work and went the extra mile for the people they supported. I would like to congratulate the service on attaining an overall rating of Outstanding again.”

Within the Report healthcare professionals commented; "They are amazing. The service they provide is second to none for clients and staff.""The service is well led. There is clearly a lot of attention focused on trying to improve their client's quality of life.""We have found them to be highly professional, caring and responsive to their client's needs. They go over and above in the care of their clients and excel in providing quality care.”

Further Summary Highlights included:People praised staff and said they were exceptionally caring and compassionate. Comments included, “Each carer provided warmth and loving care along with great attention to mums needs and interests,” “Nothing is too much trouble for them, they are so kind to her, explaining what they are doing.” Staff were matched with people based on their life, experiences, interests and hobbies.This helped them develop positive, meaningful relationships with people. They knew each person as an individual, and what mattered to them and treated people with the utmost dignity and respect.Staff went that extra mile to promote each person’s wellbeing and improve their quality of life. For example, taking one person to visit their old home and helping another person reconnect with old friends. The service had a strong, visible, person centred culture which people and staff described as “like an extended family.” Staff said, “The hour minimum visit gives us a chance to really connect with clients,” “I am proud to work with this friendly professional caring team that always puts the clients first.” People were safe because there was an exceptionally strong emphasis on safety. Staff were skilled and proactive in recognising and reducing risk. They used innovative ways to support people to stay safe in their own homes, lead fulfilling lives and minimise restrictions on their freedom. Staff proactively helped people improve their health and reduce their risk of falling.People and families praised the exceptional skills of staff who supported them. Their comments included: “We are so grateful for the high quality, efficient and reliable care you provide.” Staff were well trained using best practice evidence and felt supported in their role. The service used innovative training methods to help staff understand people’s experience of becoming frailer, and experiencing visual impairment. They were proactive in ensuring people newly discharged from hospital had increased support. People living with dementia received best practice care and the agency participated in dementia research. They promoted and encouraged people with dementia to live well. The service worked in partnership with local health and social care organisations to improve people's health. Staff taught people, relatives, staff and local people about the various types of dementia, and how it affected people. They signposted people to other local services and trained local volunteers in first aid and moving and handling.People received an exceptionally personalised service that promoted their independence and enhanced their quality of life. People were at the heart of everything the service did, they felt valued and that they mattered.People were partners in their care. Their views, experience and contributions were sought and valued and used to make continuous improvements. The agency worked in partnership with local professionals and other organisations to develop joined up, innovative, flexible services and sustainable models of care that improved the health and wellbeing of local people. For example, they contributed to a successful campaign to reopen a closed community hospital as a “community hub,” which offered a range of services to local people. They supported a person, newly diagnosed with dementia, to influence policy by helping them to attend their local dementia alliance group.Safe – HighlightsPeople were safe because there was a strong emphasis on safety, and staff were exceptionally skilled and proactive in recognising and reducing risks. The service used innovative ways to support people to stay safe and minimise their risk of injury. Staff supported people to lead fulfilling lives and minimise restrictions on their freedom. They promoted people and families to be proactive and take preventative measures to reduce risks.People and relatives consistently said care staff made them feel safe.Staff proactively reduced people’s risk of falls, they were trained to recognise falls risks and prevented unnecessary admissions to hospital due to falls. As part of the agency’s ongoing ‘Falls Prevention’ programme, care staff were trained in assisting and promoting people to exercise and develop core body strength.In 2018, the provider identified a further innovative way to further reduce risks following falls, when staff attended a local NHS ambulance trust falls prevention training event. They were made aware of and purchased a battery operated mobile lifting chair used to get people who had fallen up off the floor. They arrangedfor ambulance service staff to train the registered manager, care supervisors, and office staff to use it. A falls risk assessment tool was used to confirm the person who fell was unhurt before moving them using the chair. This meant people’s health didn’t deteriorate by lying on the floor for hours waiting for an ambulance. This significantly reduced risk of people being admitted to hospital following falls, because agency staff could respond quickly to such emergencies.For example, the day before the inspection, care staff contacted the office to say when they arrived for their visit they found a person who had fallen when their legs had given way. The person was unable to get up, so two staff were sent from the office with the lifting chair. They had the person up from the floor and in bed within 15 minutes. Prior to using the chair, they had carried out an assessment to confirm the person was unhurt and could be safely moved. The ambulance trainer said, “Staff were really involved and engaged. They implemented the risk assessment tool, and bought the chair, which was a big investment. It was innovative for a domiciliary care agency to take on that.”The agency was proactive in preventing risks associated with unplanned hospital discharges. When a person was admitted to hospital, they rang the hospital each day to check on the person and ask about discharge plans.Care staff continued to visit the person while they were in hospital to maintain continuity and reassessment of their needs. They provided ongoing practical support such as bringing them clean clothes and toiletries from home, and kept in contact with family members, where needed. Staff made sure they knew when the person was coming home, and put extra practical help and staff support in place, including overnight care, if needed. This helped the person readjust to being at home and continue their recovery. Monitoring data from accidents/incidents showed these steps had reduced the risks of people having to be readmitted to hospital.On one occasion, care staff visiting a person in hospital highlighted a hospital prescribing error. A care worker visiting the person in hospital thought the person was unusually sleepy. They were familiar with person’s medicines and questioned hospital staff when the person was being given twice the dosage of the medication they gave them at home. This prompted hospital staff to get the doctor to review the persons medicine and reduce it to their normal dose.The provider promoted a ‘no blame’ culture, whereby staff were encouraged to speak up if they made mistakes or did not get things right. This was so wider lessons could be learned and safety improved. People received their medicines safely and on time. Staff who administered medicines were skilled so ensured people gained the maximum benefit from their medicine. A health professional said; “Their staff are proactive with medicine management, and raise any concerns with GP’s.” For example, a staff member contacted a person’s GP because they were taking a lot of medication, was sleepy and having a lot of falls. The GP reduced their prescription, which dramatically reduced their falls and their risk of injury. Effective – HighlightsThe provider was passionate about supporting people with dementia to live well.  They were participating in research by using techniques thought to help people with dementia better manage daily living tasks.Staff were exceptionally well trained and knowledgeable and felt supported in their role.People, relatives and healthcare professionals consistently praised the skills, knowledge and understanding of staff, who supported them to experience care that promoted their health and wellbeing. One person who had a life-threatening emergency said, “I wouldn’t be alive today if the carer had not been there.” Other people commented, “I can’t believe the support I’m getting,” “they anticipate what I need,” and “they got me back on my feet when I was very unwell.” Relatives said,“The carers are all patient, professional and knowledgeable about my parents’ health conditions,” and “He is becoming much more confident with his movements and general health.” A health professional said, “The staff are well trained and communicate well with us.”The service was participating in pioneering research with the Exeter University and the Alzheimer’s Society to contribute to best practice by trying out techniques thought to help people living with dementia. The research, known as the ‘GREAT into Practice’ project used cognitive rehabilitation (CR) to benefit people living with dementia. The provider and another member of staff had been trained to use cognitive rehabilitation techniques. These were working with several people the agency supported to achieve personal goals to manage and improve daily living activities which were important to them. For example, to call people by their right name, to cook themselves a meal, and to learn how to make calls using a mobile phone to seek help if they became lost or confused. The service had a dedicated training facility which they also made available for use by local community groups. They provided a comprehensive staff training programme based on best practice evidence and staff had access to learning materials online and from a library.The service worked in partnership with local health and social care organisations to improve people's health.  The provider was passionate about sharing their knowledge and said, “I feel privileged to be in a position to influence.” They shared good practice information through giving talks in local care homes and to pastoral care teams in local church groups. The provider set up and chaired the East Devon Coastal Towns Dementia Action Alliance across Exmouth, Budleigh Salterton, Sidmouth and Seaton, helping to make these communities dementia friendly. They worked with Age Concern as part of a community outreach programme at the local hub (which used to be the community hospital) by providing additional training for volunteers working there on first aid, dementia awareness, and moving and handling.Staff had developed close working relationships with local occupational therapists and physiotherapists. This meant they worked together to support people with any exercise, moving and handling or equipment needs. A health professional praised foot care given by staff. They said, “It is lovely to see well cared for clean feet. Staff will let me know if there is or has been a problem, they are happy to follow any advice I give them regarding people’s foot care.” The agency was a member of the Parkinson’s Excellence network (Parkinson’s is a neurological condition). They liaised with the person’s specialist nurse and consultant and incorporated their advice into people’s care records. For example, about the importance of timing for the persons’ medicines to maximise their mobility.Caring – HighlightsCare exceeded people's expectations, because staff went that extra mile for people they supported.The service had a strong, visible, person centred culture.  People and relatives praised staff and described them as exceptionally caring and compassionate.The service was inclusive and care was culturally sensitive. People were treated as individuals and with the utmost dignity and respect.One relative said, “The carers have made the most wonderful difference to my mums’ quality of life. Nothing is too much trouble …they are kind, compassionate and genuinely care about mum and treat her with utmost dignity." Other relatives commented, “All of the carers dad has are fantastic and will go above and beyond, carers are kind, super girls. They know about his life,”A member of staff said, “Its brilliant, I feel I've been personality matched with my clients very well and the time we have with them is great.” For example, a staff member was keen on ballet and was matched with a person who loved ballet. The staff member practised with the person who gave them constructive feedback. The person and staff member had developed a close personal relationship based on their shared passion.Staff went that extra mile for people they supported.People and relatives praised how staff promoted and respected people’s independence.Each person's care plan included information about their individual communication needs. For example, for people with a hearing impairment, care records included the persons preference of whether staff should talk to them from the front, or lean towards their right or left ear. To support people with hearing aids, staff had received training from a hearing aid company. For example, checking and replacing batteries regularly to make sure they were working effectively. Where a person’s speech had declined, their speech was slower and more slurred and they found words hard. Their care plan said, “Person would like you to listen actively and take time to understand what he is discussing and communicate clearly.”Responsive – HighlightsPeople received an exceptionally personalised and responsive service that exceeded their expectations. People’s comments included; “I couldn’t find a better group of people to look after me,” “They are always happy, and want to do as much as they can, nothing is too much trouble.” A relative said, “I cannot praise and recommend them highly enough. Using their services is the best decision we could have made for my father after a long spell in hospital. They came to meet dad and the family to find out his needs and interests and created a bespoke care package for him.” Another relative said, “Without their care and attention, she most certainly would not have been able to remain in her own home for so as long and would probably in a home.” A professional said, “The family are very pleased, it is a personal service tailored to their mother’s needs, which makes a big difference to her quality of life.”Staff were responsive to changes in people’s needs. For example, a person said, “One day I was poorly, they got onto GP and phoned my daughter. The GP thought  I should go to hospital but I had a chat with agency. They arranged for a staff member to stay with me overnight and to visit me three times a day. It was organised in minutes, the manager was in charge of that. Everyone thought it went like clockwork. They looked after me very well, so quickly, my daughter was most impressed.”We looked at how the provider complied with the Accessible Information Standard (AIS). This is a framework put in place from August 2016 which made it a legal requirement for all providers to ensure people with a disability or sensory loss can access and understand information they are given. Information was made available in different formats according to need.  For example, in large print, on different colour paper, so that it was easier for a person with a visual impairment to see.Also, in easy read formats with picture symbols and by using whiteboards for people to write messages on. A member of care staff recognised a person was struggling to communicate because their speech was poor. They arranged to have printed cards of various items available, so the person could point to these to indicate which items they wanted. They took a number of photographs of their personal items to extend this collection. The registered manager said, “It made a massive difference to her.”The agency supported people nearing the end of their life with their wishes. For example, to see friends and family one last time. They arranged for them to visit over a two week period to coincide with the end of their care visit. That way, the person was refreshed and feeling their best to receive visitors. Another person wanted to go to church one last time but was unable to do so because of their failing health. So, staff arranged for the local vicar to make a house call and conduct a service for the person, which brought them great comfort. When a person died, all staff caring for the person were contacted to offer them support and sent a letter thanking them for their care. Staff also had access to an employee assistance programme for further emotional support. One staff grew a yellow rose to remember a person who had died, and each year brought the first rose into the office in memory of them.Well-Led Highlights

People, relatives and healthcare professionals consistently praised the exceptionally high standards of care provided by the agency. They spoke about the high quality of care provided by Home Instead. People’s commented; “The care is exemplary, and we are delighted that we made such an excellent choice of agency,” “They are the best thing that has happened to me.” Relatives comments included; “This fantastic agency provide care for my father four times a day every day of the week,”“The provider and his team are wonderful, nothing is too much trouble. It is obvious that the carers really enjoy their job and this shows in the care that they provide,” “We are so grateful for their high quality, efficient and reliable care.” Everybody we spoke with and surveyed said they would not hesitate to recommend the service to others.Professionals commented; “They are amazing. The service they provide is second to none for clients and staff,” “The service is well led. There is clearly a lot of attention focused on trying to improve their client’s quality of life,” and “We have found them to be highly professional, caring and responsive to their client’s needs. They go over and above in the care of their clients and excel in providing quality care.”Staff comments included; “This is a fantastic company to work for. We get great support, it’s like a big family,”The service was led by a dynamic and purposeful provider who promoted a positive culture that was person-centred, values based, open, inclusive and empowering. The directors and the registered manager were passionate about care and had a clear vision for the service. The statement of purpose showed their principle objective was, "To provide supportive care and companionship which both enables and encourages our clients to remain independent." Their ethos was, “To change the face of ageing and be the most trusted home care provider in the area.”Staff were highly motivated, enthusiastic and recent staff survey results showed staff felt proud to work for Home Instead. They consistently praised the good support, communication and teamwork. Staff comments included; “Recently my own parents have been unwell and I have received more support and kind words from the team at Home Instead than from some members of my own family. This is just one example of the fantastic support I have received since working for Home Instead,” “I am very happy with Home Instead, they are always there if I ever need them and help me in any way they can, they have made me so more confident with the support I give the clients.”The provider had an award scheme that recognised, re-enforced and rewarded positive staff values, attitudes and behaviours. Each Friday known as “Positive Friday”, the registered manager and a director reviewed people’s feedback to identify staff who had gone “above and beyond” that week for a person. On Monday morning, they rang those staff to recognise and thank them for their positivecontribution. For example, when a staff member took a person back to visit her old school, which meant a lot to them. Every two or three weeks, during an ‘Hour of love,’ office staff identified and made contact with staff having a difficult time. For example, recently bereaved, or experiencing personal difficulties. They took time to give that member of staff a special hug, or phoned them to check in and ask how they were.  A staff member said, “They care, little things make such a difference.”The service had a ‘Caregiver of the month’ and a ‘Caregiver of the year’ schemed with awards for staff who went that extra mile for people to make a difference for the people they supported. For example, for a quick response to a medical concern, for wonderful support when a staff member took a person to visit the croquet club, where they had spent many happy years. They also had long service awards which were presented to staff at celebratory events. These included details of how many care hours  the staff member had worked. The agency had high staff retention rates. To further improve retention and value staff, their exit interview with staff leaving was renamed a “thank you chat.” This valued the staff members contribution and left the door open for staff to return, which they often did. The service worked in partnership with other health and social care providers to develop services in response to the changing needs of local people. For example, they developed local links with local GP practices, Age Concern, and Devon Dementia Care Partnership. This meant people were signposted to local services available. They supported a person, newly diagnosed with dementia, to influence policy by helping them to attend their local dementia alliance group. The service demonstrated a commitment to developing joined up, innovative, flexible services and to developing sustainable models of care that improved the health and wellbeing of local people. For example, when Budleigh Salterton community hospital closed, they were involved with the Neighbourhood Plan and a successful campaign to reopen it as a “community hub.” They continued to support and champion improving lives of older people in their community it by giving talks to community groups to actively raise awareness of dementia, and risks to vulnerable adults. A professional said, “The directors are very involved in the community and helped Age Concern in the management of dementia. They arrange an annual information day relating to care in the community. They regularly engage in and support community projects.”The provider was a founder member of the South West “Proud to Care” group, a partnership of 16 local authorities and Health Education England working together at a regional level to raise theprofile of a career in care and health. As part of this group, they were currently working with Devon County Council to make a series of videos. Care staff interviewed were positive ambassadors about their experiences of care. This promoted careers in care positively, and helped overcome negative stereotyping. The provider said, “We want to professionalise care, make it a real career.”The service used a range of quality monitoring systems to continually review and improve the service. During 2018 the provider introduced a Total Quality Management (TQM) tool, which used key performance measures and analysed a range of monthly data, to identify and patterns and trends The service was committed to continuous learning from accidents, incidents, complaints and from training. At monthly meetings staff received praise for good work and feedback about any issues that had arisen. The agency monitored people’s feedback, the findings of staff ‘spot checks,’ audits of care records, medicines management, accidents/incidents, complaints and staffing levels. Where any gaps or areas for improvement were identified, these were identified and followed up. For example, following feedback from staff in 2017 about online update training, in 2018 this was improved to a face to face training day.People's feedback, views and suggestions were regularly sought through regular reviews and annual customer satisfaction surveys. For example, improvements were made in response to feedback about last minute changes to people’s rotas which caused some people anxiety. Last Christmas, to remind people of the agency’s “no gift” policy, the agency implemented an illuminated “Treasure Tree.” This was so people could write messages to staff which were hung on the tree for staff to read and enjoy. The registered manager said, “There were lots of tears at our Christmas meeting, staff loved reading people’s comments.”Staff spoke with pride about the service, and said they were consulted and involved in changes, day to day, through local team meetings, and via a staff newsletter. Staff comments included; “This is my first job within the care sector and I can't imagine a better company to work for,” “It is the best job I’ve ever had,”In a recent staff survey, staff were asked why they liked working for Home Instead. Their responses included; “They take care of their caregivers as much as their clients,” “The support and kindness make me feel proud,” “Always there for me,” and “Great care and training.”The provider supported leadership and management development within the staff team through education and training through the franchise and accessing external courses. Five staff had completed level five leadership and management, with other completing level four courses. Speaking about their leadership and coaching training, the registered manager said, “It’s made a massive difference, I’ve adopted a different approach, and changed my leadership style to delegate more responsibility.”


In addition we are delighted to share the results of Smith & Henderson's independent survey which was carried out to determine the Exeter and East Devon's Client and CAREGiver satisfaction.  Following annonymous feedback from both our Clients and staff we were thrilled to receive results such as:

Client Satisfaction

97% of our clients would recommend Home Instead to others

100% of clients said their CAREGiver takes an interest in them as a person

97% of clients rated the service as good or excellent

97% of clients said their CAREGiver was properly introduced to them before they started working

CAREGiver Satisfaction

100% of CAREGivers rate their initial training and support as good or excellent

98% of CAREGivers view the company's leadership and direction as good or excellent

100% of CAREGivers rate overall satisfaction with their job as good or excellent

100% of CAREGivers believe the Directors and Care Manager live Home Instead values

100% of CAREGivers would recommend Home Instead to a friend or family member as a place to work

Some of the Client comments made in the survey included:

'Communication is good.'

'Office staff are professional and kind.'

'The communication between the office staff, myself and my family has been excellent, always dealt with in a friendly and professional manner.'

'I can relax confident in the knowledge the CAREGivers and office staff will deal with situations as they arise.'

'CAREGivers receive very good training prior to commencing duties.  Each one has been most kind, patient and cheerful often in difficult circumstances.'

Some of the CAREGiver comments made in the survey included:

'Great training, very well explained, good support, good values, opportunity to ask questions, feel valued as a team member, company is professional, most efficiently run I have seen in over 20 years in care.'

'I really can't see how they can improve the way they work as they are excellent.'

'I feel that Home Instead have got everything running very well and 100% for support.'

'The training I have received from Home Instead has helped me to work well in the community and feel confident in my role as a CAREGiver.'

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