Open Doors Healthcare Services Ltd

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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

There were processes in place to record and investigate accidents and incidents. Staff were involved in discussions to learn from incidents to prevent them happening again. Staff were able to share their ideas to improve people’s care, and these were listened to by managers. People’s risk assessments included guidance for staff to prevent people having accidents, such as falls.

Staff told us they were kept up to date when people’s needs changed, through group discussions and encrypted group chat messages, to make sure they had the reviewed plan of care before entering people’s homes.

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 their relatives were involved in an assessment of their needs before care started. Other healthcare professionals, such as occupational therapists to ensure the correct and safe equipment was in place were involved where necessary. Care plans and risk assessments were detailed and personal, so when people needed to leave their home for additional care, such as to a hospital or a care home, information about the person was available to support a smooth transition. A relative also told us, “Managers have visited my mum in hospital.”

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.

Managers had identified concerns that needed to be reported to external agencies to make sure people were safe. They kept people informed when they had needed to do this.

Staff were aware of their responsibilities in relation to safeguarding people. They knew who they should report to, including outside of the organisation. Staff had received appropriate training, and were able to share what they knew. They were confident the registered manager would act quickly if they raised a safety concern. A person told us “I feel very safe. I would speak to my support worker if I didn’t.” A relative said, “I would contact the managers if I had any concerns, I have never had a problem talking to them and things are dealt with very quickly”.
 

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.

The registered manager had completed care plans with detailed information about people’s care needs and individual risks. People and their relatives confirmed they were involved in the care planning process, including how to manage risks in the way they wanted. Staff had clear guidance to enable them to provide support safely while respecting people’s wishes. Some people were clear about how they wanted things done, with a risk that their safety may be compromised. The registered manager was clear what staff could and could not do and this was discussed with people and their relatives, and included in detail in the person’s risk assessment. Staff were able to fulfill their role providing safe care in the way people wanted, respecting their right to make decisions, and at the same time maintaining the safety of staff.

A person was at serious risk of infection which could be life threatening. Their care plan and risk assessments provided significant detail to ensure staff were aware of the risks, how to recognise infection and what they must do if they suspected signs of infection were present.

People’s care plans had detailed, individual information about what people could do for themselves and what they needed assistance with, supporting safety and maintaining independence. A member of staff commented, “Care plans are very informative. They include everything, medical history and getting to know what they like. The people we support love it, that we know about them before we even get there.”

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 registered manager carried out a risk assessment of people’s property during an initial assessment, including a check of the safety of any equipment in use, to identify any hazards such as slip and trip risks, or poor lighting. Where necessary, a risk assessment was completed to keep people and staff safe.

The provider did not always make sure safe and robust recruitment practices were in place or followed. 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.

Safe recruitment procedures were not always followed. References were not always robust and sometimes new staff had not provided documents that held the same address. The registered manager took action immediately and followed up the concerns raised with the relevant staff. They provided an action plan shortly after the assessment site visit, detailing the action they had already taken and how they would ensure the oversight would not happen again. We will check this at our next assessment.

There were enough staff to provide people with the care they needed at the time of the inspection. People and relatives confirmed they thought there were enough staff, they did not have to wait for staff to arrive at their homes and had not experienced staff not turning up.
Staff told us they thought there were enough staff, they did not feel as though they had to rush and could always spend the full amount of time with people.
A person commented, “Yes, I do know them, they are all very lovely. I don’t feel rushed, and I can take my time.” Relatives told us, “The company has been very good at ensuring consistency.” “Always on time, no issues with timings at all. I think they work at his pace they do not rush him.”

Staff received the training they required to meet people’s needs, including individual needs, such as catheter care and stoma care. Staff had received regular one to one supervision and confirmed they had regular unannounced checks of their practice while providing care in people’s homes, to ensure they continued to provide good quality safe care. A member of staff told us, “I am supported very well. We have supervision every 2 or 3 months and the registered manager discusses safeguarding and training. We have briefings every day through (encrypted group chats) which include updates and training materials.”
 

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.

People’s care plans and risk assessments included guidance for staff to take to prevent the risk of infection. This included when to use disposable gloves and aprons to provide protection and how to dispose of them.
 

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.

Some people needed staff to support them to take their medicines, and some people managed this themselves, or a family member or friend helped them. Where people needed staff support, their care plans provided the information needed for staff, to enable them to provide safe support. This included, the medicines people took and what they were for, any side effects or special precautions, where medicines were kept in the person’s home, and how they liked to take them.

The registered manager sent communications out to staff if there were any changes to people’s prescribed medicines, so they were aware of this before visiting. Staff told us they received regular communications through the electronic recording system, backed up with messages through encrypted group chats.

Staff had received training and had their competency checked regularly to ensure they administered people’s medicines safely.