A&J Assisted Living T/A Radfield Home Care Loughborough, Charnwood & Melton Mowbray Also known as Radfield Home Care Loughborough, Charnwood & Melton Mowbray

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. This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

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.

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 provider’s systems and processes for monitoring quality and safety including the auditing of records, speaking with people and staff, and staff competency checks to ensure that any issues or potential issues were quickly identified and resolved. For example, managers told us how frequent contact from a staff member had identified further training needs so further training was provided.

Managers reviewed key aspects of the service during meetings to identify any risks so action could be taken such as contacting external healthcare professionals. Records of these weekly meetings showed key issues including risks to people who use the service, staff, any events occurring out of office hours, and staff rota planning were discussed in detail and actions required were planned for.

The provider had an incident reporting system that staff understood and followed. We looked at incident records and saw staff were reporting incidents and action was taken to reduce further risk. For example, a person was found to have sore skin, staff were reminded to thoroughly wash and dry the affected area, and a referral was made to the community nursing team. Another person had difficulty taking their prescribed medicine so additional support was provided.

The registered manager reviewed all incident forms and reports and looked for patterns and trends. These were discussed at staff meetings along with lessons learned. For example, professional boundaries were discussed and staff were given scenarios to work through. They were reminded of how crossing professional boundaries can have a detrimental effect on people using the service. Staff were reminded about what to do in the event a person had a fall and about the importance of accurate record keeping so that any emerging risks could be identified and minimised.

The provider attended weekly meetings with the franchise group partners and compliance managers to discuss learning and best practice within the wider sector.

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 told us they received care and support from a consistent staff team who understood their needs and knew how to meet them. They told us about the assessment that took place when they first began using the service and about staff liaising with other healthcare professionals to ensure continuity of care. An external healthcare professional said about the service, “I feel they are a very safe service, when we were arranging some delegation of care, they were very thorough in checking this was safe for the staff to carry out, and ensure the person came to no harm”.

Staff involved people’s relatives (where appropriate) in decisions about care and support and to establish a comprehensive plan of care. They kept them informed and updated about any changes.

The provider had electronic systems for monitoring calls attended and care and support provided. Systems alerted the office team to any missed calls or missed medications or activities so action could be taken quickly to ensure people were safe and had their needs met.

The provider ensured staff understood policies and procedures designed to keep people safe through training, supervision, staff meetings and policy updates. Staff were required to sign to confirm the had read and understood all policies. Staff we spoke with confirmed they were supported to provide safe care and were encouraged to contact managers for support when necessary.

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.

People told us they felt safe and knew what to do and who to contact if they had any concerns at all.

Staff we spoke with understood their responsibilities to protect people from abuse and avoidable harm. They had undertaken training in safeguarding children and adults which was regularly updated. Staff knew how to recognise the signs of abuse and were clear about reporting procedures including contacting the local authority safeguarding team and CQC.

Protecting people from abuse and avoidable harm was discussed during staff supervision and team meetings. Managers used real life examples of incidents or concerns to support discussions, reflection and learning.

People were supported to understand their human rights, rights under the Mental Capacity Act 2005 and their rights under the Equality Act 2010. These were promoted and protected.

The Mental Capacity Act is the law in the England and Wales that protects individuals who lack the capacity to make specific decisions regarding their care, finance or treatment. It gives them opportunity to make their own choices where possible.

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.

People and their family members felt fully involved in the assessment of risk. Risks were assessed and managed. For example, risks of developing pressure sores, and risks associated with eating and drinking. Where risks were identified, management plans were in place, so staff knew what to do to keep people safe. Managers reviewed and updated risk assessments regularly or as soon as changes to people’s needs were identified.

The registered manager provided examples of action they had taken in response to emerging risk. For example, following an increase in falls, managers contacted the person’s next of kin to review the frequency and length of call times. Changes were made which effectively increased the persons safety and reduced the risk of falling.

Staff had training about risk management and how to keep people safe. Training was provided online and face to face.

Risk enablement was part of the providers core values with an emphasis on balancing risk against freedom. Staff understood that people had the right to take risks to maximise opportunities to be in control of their lives. A staff member told us, “There are effective care plans not just lists of dangers; they focus on enabling independence and identifying how to manage risks so the person can still live a fulfilled life.”

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

Environmental risks were assessed when people first began using the service. This included fire risk and evacuation plans.

Where people had a fall or had mobility problems and required supportive equipment, staff requested a community occupational therapist assessment.

Health and safety risk assessments were reviewed at least every 3 months.

Home security and action staff must take was included in care planning and staff tasks.

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 told us staff arrived on time and stayed for the required amount of time. People said staff were well trained and competent. One person told us, “They come on time and they have never missed a call.” Another person said, “I am never rushed and the carers stay as long as they should and quite often, we have time for a chat before they leave.”

A relative told us, “The care staff are extremely well trained, and they know how to look after people with dementia.”

Staff told us they had enough time to spend with people and could meet their needs. They told us if this was not the case, they would speak to their managers and suggest adjusting the call times to suit the person’s needs. Managers told us how they reviewed care plans and call times along with feedback from staff. Adjustments were made through consultation with people and their family members to ensure people’s individual needs could be met.

Staff received the training they required including induction training when they first began their employment. They were given opportunities to shadow more experienced staff. This was usually for 3 days but staff could ask for further support if they required this.

Staff received mandatory training and this was refreshed in line with the providers policy. The registered manager monitored training needs to ensure staff were up to date with all required training. Compliance with training was high for most staff and reasons were recorded when this fell below expected levels. Staff competency was checked every month during spot checks carried out by field care supervisors.

Staff we spoke with were knowledgeable about the people they supported, they knew what to do to keep people safe and improve their quality of life.

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.

The provider had a policy in place about infection prevention and control (IPC) and had received training about this. Staff competency for effective hand hygiene and use of personal protective equipment (PPE) such as gloves and aprons was routinely checked.

People’s care plans instructed staff to use PPE as required including shoe covers when entering the person’s home. People spoken with confirmed staff used PPE appropriately.

Infection control audits were carried out monthly to check all staff had up to date training in IPC, had their competency checked, had sufficient supplies of PPE and were following best practice guidance to reduce the risk of infection.

Staff understood the importance of food safety, including hygiene, when preparing or handling food. They followed required standards and best practice.

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.

People told us staff managed their medicines well, they said they received their medicines on time and in the correct way.

Staff received training about the safe management of people’s medicines. They had their competency checked to ensure their practice was safe and they understood their responsibilities. Staff confirmed they had received this training and had their competency assessed. They told us they felt confident managing people’s medicines.

Medicine records we reviewed were accurate and included clear instructions for staff to follow such as how the medicine should be given and at what time. Where medicine had to be given before food this was recorded. Medicines prescribed for ‘only when required’ had a separate protocol so staff knew when it should be given, and when further advice should be sought from a healthcare professional.

Topical medicines such as creams had a ‘body map’ to show staff exactly where to apply the medicine. One person was prescribed a medicine ‘patch’, staff were not using a body map or clearly recording the area the patch was applied to. It is important the site of application is rotated for each patch change to reduce skin irritation. The registered manager took action to remind staff this must be completed in line with their policy and expected procedures.

The provider had a medicine policy which adhered to best practice guidance and the principles of safe medicines management. Risk assessments were carried out to ensure the level of support provided by staff to ensure effective and safe management was correct. The provider’s medicine policy and procedures were comprehensive, included risk assessment, and promoted people’s independence.

Procedures were in place for the event of a medicine error. Records showed staff were encouraged to report any medicine errors and to take action including seeking medical advice. Staff were supported and provided with refresher training in the event of a medicine error.