Visiting Angels - South Middlesex Also known as Murray Moments T/A Visiting Angels

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 78 (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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The manager told us there was a process for recording and investigation of incidents, accidents and complaints. The form completed with information on incidents and accidents included a section for the manager to identify if all actions have been taken. Referral to health and social care professionals and organisations were made if required. Lessons learned from the investigation were shared with staff. The manager said, as part of learning, scenarios of incidents and accidents were discussed during team meetings with staff being asked how they would respond.

The manager explained that they had identified that staff were not always recording concerns on the electronic records system. Additional training with support from senior staff was introduced to empower staff by explaining the importance of recording concerns and how it can improve the care being provided. There was an improvement in the recording of concerns.

The manager demonstrated they understood the duty of candour by ensuring the outcomes of investigations were shared with the people involved and the action for improvement were identified and implemented.

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.

People and relatives confirmed they had been involved in identifying care needs with a relative telling us, “We have a visit and go through it.”

The registered manager told us that before a new care package started the staff who would be working with them were introduced to the person before the first visit. People would be given background information about the staff who would be visiting them. The person was then asked for feedback to identify which staff members who had visited they preferred to support them. This meant the person was able to indicate which staff they felt most comfortable with.

The manager explained they encouraged the person to include anyone involved in their support to attend the initial needs assessment discussion. If the person was unclear about the level of support they required, the manager told us they worked with the person to identify their wishes and develop a care plan which reflected their needs.

The manager told us they worked to develop a link between the care needs relatives identified and the person’s preferences for their care with dignity in the forefront of the support provided. The person was contacted shortly after their care visits started to ensure their needs were being met and to review the care plan.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated 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.

The provider had a procedure for safeguarding adults and children which reflected the processes used by the local authorities the provider worked with. When a safeguarding concern was identified the manager carried out an investigation, identified actions taken and the outcomes implemented to reduce further risk. The outcomes from the investigation were shared with staff to improve practice.

The manager told us they completed audits of safeguarding concerns to ensure the procedure was followed and the outcomes were embedded in how care was provided.

Staff completed safeguarding adults and children training. Staff demonstrated a good understanding of the importance of ensuring people were safe when providing support. A staff member told us, “Safeguarding means working together with colleagues to both detect and prevent an individual experiencing abuse and neglect.” The manager explained that staff completed a safeguarding competency assessment following training to assess their skills and understanding.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Relatives confirmed they felt their family member was safe when they received support from staff. A relative said, “Perfectly safe. The ladies are all lovely. It’s been great from the start.”

Care plans included contingency plans which identified how risk could be managed in relation to staff shortages and adverse weather which could impact how care was provided. The contingency plans included what actions should be taken to reduce the risk of care not being provided as planned.

The provider had developed a range of risk assessments which provided detailed guidance for staff on how manage the identified risk when providing care.

Risk assessments relating to medical conditions a person was living with were developed. The risk assessments provided staff with guidance on possible impacts the person’s life and how they could provide appropriate support.

The manager told us, “We are guided by the person when developing risk assessments. We ask the person about possible risks and give options on how to manage them. For example, if the person wants to put their bins out but relatives want it done by staff. We would discuss possible compromises where the person either does the activity with the staff or supervised by staff. People were involved in finding an outcome which reduces the risk.

Staff completed training to develop their understanding of how to keep people safe. The training included courses covering moving and repositioning, first aid as well as health and safety. Competency assessments were carried out to assess staff members skills.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider undertook risk assessments on the person’s home environment to identify if there were possible risks and how these could be managed.

Personal evacuation plans (PEEPs) had been developed to indicate how staff could support the person in case of an emergency including how to evacuate the home in case of a fire.

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.

People and relatives explained they usually were visited by the same group of staff, but some people said that recently there had been some changes in the staff who visited them. Their comments included, “We have a little team of 3 excellent regulars”, “They are A1. They are a sound bunch. They do rotate, but they couldn’t be any better”, and “It varies. We have one regular carer who is excellent. It’s taken a couple of years to get some consistency on the rota.”

The manager confirmed that visits were monitored for late or missed visits through an electronic system at the end of each day. Staff told us they regularly received their rotas, and they were happy with them

People and relatives provided mixed feedback about the training of staff. Some relatives felt staff were well trained whist others felt there were issues with the knowledge of new staff. The areas included their ability to communicate, aspects of care such as putting out the rubbish bins and opening cans of drink. This was mentioned to the manager following the assessment.

Training records showed staff completed a range of training courses to enable them to meet people’s support needs including dementia, understanding the role and managing skin integrity. A staff member told us, “I have completed [a number of training courses], and I regularly attend refresher courses to keep my knowledge and skills up to date.” Staff were supported through regular supervision and team meetings.

The manager explained as part of the recruitment process, they spoke with applicants to ensure they understood about the role and identify their motivations for applying for the role. New staff completed a 3-day induction followed by up to 10 visits shadowing an experienced staff member.

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.

Relatives told us staff wore personal protective equipment (PPE) when they provided care, they said, “They wear their gloves all the time, take them off when they leave”, and “Yes, they wear gloves and put them in the bin when they leave.” Staff said they wore PPE and had access to adequate supplies. A staff member said, “I always wear PPE and never allow myself to run out.”

The registered manager told us staff completed regular training on infection control and had a competency assessment completed. Staff confirmed they had completed training on infection preventions and control. The daily care task list provided to staff for each visit included reminders on how to ensure infection control best practice was followed. Staff completed a competency assessment to monitor their understanding of infection control procedures.

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.

Relatives told us staff supported their family member with their medicines with a relative saying, “They check and remind them to take [family member’s] medicines.”

The provider had a policy for the administration of medicines. Staff recorded when they administered people’s medicines on a medicines administration record (MAR). Regular audits of the MAR were carried out to ensure peoples medicines were being administered safely and as prescribed.

People’s care plans included a medicines risk assessment which indicated the level of support required, the types of medicine prescribed and how they are stored. Where a medicine had been prescribed to be given as and when required (PRN) there was guidance for staff on when and how to administer the medicine. Staff completed medicines management training, and they told us they felt confident supporting people with their medicines. A staff member commented, “I feel confident as I follow the medication administration policy, checking the MAR record details on the App, checking the dosage, expiry date and ensure the client takes their medication as prescribed. If I have any concerns, I report them immediately to the office.” Staff competency assessments were also completed to monitor staff members’ understanding of best practice.