Home Healthcare Delivery - South Tyneside

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 changed to 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 good governance at the service.

This service scored 59 (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 promoted a culture where staff generally felt able to raise concerns and there were systems in place to report, investigate and respond to incidents, safeguarding concerns and complaints. Action was taken when concerns were identified, including investigations and appropriate disciplinary processes where required.

The provider demonstrated examples of learning and improvement following incidents and concerns. However, learning was not always fully embedded or consistently effective in reducing risk and preventing recurrence. For example, learning from audits and incidents was not always translated into sustained improvements in practice, as similar concerns relating to self-neglect, records, visit times and medicines-related issues continued despite action having been taken.

Systems to support learning, reflection and improvement were in place, but these were not always effective in identifying patterns, mitigating risks or driving consistent service improvement. The provider had already begun implementing additional measures before the assessment, and further improvements were introduced following our visit to strengthen oversight, learning and governance.

The provider generally worked well with people and healthcare partners to establish and maintain safe systems of care. Staff supported referrals, hospital discharges and reviews, challenged unsafe discharge arrangements, sought clarification when information was incomplete and escalated concerns where needed. This helped people access services and supported continuity through established pathways and familiar care teams.

People usually experienced coordinated care when moving between services. Information was shared between providers and healthcare professionals, and staff took action when concerns were identified. Hospital or service handover information was sometimes incomplete or delayed. Staff took steps to reduce immediate risks and meet people’s needs; however, some records did not provide sufficient assurance that needs, risks and care tasks had been consistently monitored and delivered as planned.

The provider had systems to coordinate care, record visits and monitor tasks. Electronic tasks listed the care activities staff needed to complete and had to be read with the person’s full care plan or initial assessment. Leaders monitored people’s moves between services and were improving how information was shared and care was checked.

The provider worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They focused on improving people’s lives and protecting their right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider had not always shared concerns promptly or appropriately.

Before the assessment, the provider did not always identify or manage risks to people effectively. Concerns relating to self-neglect were not always recognised, recorded, reviewed or reported promptly enough. Although safeguarding training and policies were in place, some staff still did not always recognise when people were at risk.

During our assessment, we found the provider had acted to reduce the risk of harm from self-neglect. People received additional support, concerns were shared with relevant health and care organisations, and staff completed further training. Where learning was identified, the provider also used supervision and competency assessments to strengthen staff practice. However, these improvements required time to become fully embedded and to demonstrate sustained impact.

Although the provider worked with people to understand and manage risks, staff did not always deliver safe care that met people’s needs.

People’s care plans described the risks linked to their care. However, daily care notes did not always show that staff were providing care in the way planned. Some risk assessments did not include enough detail to help staff care for people safely. The registered manager provided assurances that the issues identified would be addressed and confirmed that action had already been taken.

People and, where appropriate, their relatives were involved in decisions about their care and how risks were managed. Staff demonstrated a good understanding of people’s individual risks and how these should be managed in practice.

The provider had established systems to identify and manage risks in people’s homes. These included risk assessments, regular reviews and referrals to the Fire Service, assistive technology, ACTS and safeguarding teams. Equipment, facilities and technology also supported the delivery of safe care.

People were supported in their own homes, and staff were expected to identify, record and report environmental risks. Most risks were monitored and managed through established processes. However, for some people experiencing self-neglect, deterioration in their home environment had not always been recognised, recorded, reported or acted on quickly enough. This had increased risks to people, staff and visitors.

The provider worked proactively with health and social care partners, including the Fire Service and other agencies, and repeatedly escalated concerns when people needed additional support. Following the concerns identified, the provider took action and continued to increase the number of risk assessments, home visits, monitoring and referrals.

Environmental risks were regularly reviewed, with higher risks leading to increased oversight and support. The provider used input from different professionals to help people remain safely in their own homes. Although management oversight had not always led to timely action for some people experiencing self-neglect, the provider responded to the concerns and continued to strengthen its monitoring and support arrangements.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, staff were not always deployed effectively to ensure timely and consistent care.

Staff deployment was not always effective. Calls did not always take place close to the planned time, and rotas did not always allow enough travel time. Systems were in place to monitor attendance, identify delays and escalate concerns, and time-critical visits were generally prioritised. However, concerns about punctuality, overlapping visits and travel time had not yet been resolved.

We reviewed call-monitoring records for 7 of the 236 people using the service. Delays were found across all 7, with 204 visits, or 21%, taking place more than 30 minutes early or late. There was no evidence of missed care, delayed medicines or missed personal care that resulted in harm. However, the repeated pattern showed that rota planning and staffing deployment were not yet consistently effective.

The provider had identified call-time and rota management as areas for improvement and introduced AI Dimensions before the assessment. It also monitored people’s support and outcomes through other quality systems. These were positive steps, but the new system was not yet fully embedded and sustained improvement had not been demonstrated.

Staff were supported to complete training in key areas, including autism, equality, diversity and inclusion, positive behavioural support and de-escalation. Staff were safely recruited, and the required recruitment checks had been completed.

The provider had not always assessed or managed the risk of infection. They had not always detected and controlled the risk of it spreading or shared concerns with appropriate agencies promptly.

Some people’s home environments were unclean and unhygienic, and staff had not always identified or escalated these concerns appropriately. This placed people at increased risk of infection and avoidable harm. Some people had ongoing issues relating to self-neglect in their home environment, which meant the provider needed to take further action to prevent and reduce infection risks. At the time of the assessment, staff had received additional training in this area, and the provider had introduced additional measures to support staff to escalate concerns and mitigate risks where necessary.

Staff had received training in infection prevention and control (IPC), supplies of personal protective equipment (PPE) were observed in the office and staff told us they had access to PPE when they needed it. The service had an IPC policy which set out their IPC expectations.

The provider had systems to support safe medicines management and monitor whether medicines met people’s needs.

The provider used audits, dashboards, eMAR reviews and trend monitoring to oversee medicines practice and took action when concerns were identified. Most alerts related to recording issues or cancelled visits rather than confirmed missed medicines, and there was no evidence that people had been harmed. However, repeated recording problems, medicines incidents and doses scheduled too close together showed that oversight and follow-up had not yet consistently achieved sustained improvement. Since the assessment, the provider has strengthened its medication audit processes, but these changes require time to become embedded and demonstrate sustained effectiveness.

Staff received medicines training and their competency to administer medicines safely was assessed. Training records confirmed that staff were up to date with medicines training, and the provider used supervision, observations, investigations and competency checks as part of its response to identified concerns.