Blay Domiciliary Services

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 inspection 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 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 promoted a culture of openness where opportunities for improvement were shared. The provider implemented systems to record and review all accidents, incidents, safety concerns and opportunities for improvement. Lessons learned were used to identify and develop good practice. Staff understood the process for reporting any accidents, incidents and concerns and expected input and support from the leadership team to ensure best practice. One member of staff told us, “Debriefs usually take place with a team leader following an incident, the incident is discussed, lessons are learned, and staff are supported.”

People knew who to contact if they had any concerns and had telephone numbers to cover 24 hours. One person told us, “They [staff] are really nice when I ring the office. Any problems I’d ring the office and speak to [name of team leader].”

Staff knew people well and understood how best to meet people’s needs.

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.

The provider implemented comprehensive pre-admission procedures to ensure safe, person-centred care. The process included a review of the referral information, including the identified care needs by senior staff, involving the person, their relatives and professionals involved. A comprehensive risk assessment was completed to identify the areas of risk in people’s lives. Personalised care plans were developed based on the person’s assessed needs. The provider used an electronic care record system. Staff had access to the system, as did people who were supported. Reviews of people’s care took place within a month of the care package starting, ensuring people were happy with the care they received and if there was a need for any adjustments to the care offered. One person told us. “I have a care plan folder, I do my meds and yes, they [staff] always ask before doing anything. I feel very safe with the carers; we get on ever so well”.

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 were safe and knew how to raise concerns about abuse or neglect. Staff understood how to ensure people were protected from abuse and neglect. Staff were comfortable to raise any concerns and were confident any concerns raised would be dealt with appropriately by senior staff. One member of staff told us, “I feel confident to raise concerns because I have had my safeguarding training”. The provider shared concerns appropriately, ensuring the relevant agencies were informed.

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 provider had developed a thorough risk assessment document. This was completed by staff with the appropriate knowledge and skills with all service users and/or their representative. This information informed care plans which provided staff with the information necessary to support people to keep safe. For example, the risk assessment and care plan for a person who lived with diabetes contained information to mitigate the risks associated with diabetes. This included information for staff to identify and respond to diabetic emergencies. Examples of other health issues also risk assessed, included moving and handling, tissue viability, choking and management of medicines. Where people experienced anxiety or distress staff understood how to respond to this using active listening and distraction techniques identified in a person’s care plan.

Risk assessments and care plans were reviewed regularly in line with the provider policy and procedure. Staff accessed people’s care records electronically so they could be kept up to date with changes to people’s needs. People felt safe and were happy with the support they received. The provider used regular reviews to continuously improve people’s care plans. It was identified during inspection there were areas for improvement to ensure information in care records was consistently person centred. For example, recording the learning from day-to-day interactions to enhance the guidance for how to support someone when anxious to effectively deescalate a potential situation. The provider had identified this as an opportunity to improve outcomes for people and was working towards this.

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 completed an assessment of people’s homes with them. Staff understood their responsibilities to report any safety concerns and did so as required. Concerns were acted upon. People told us staff carried out checks of the equipment in their homes. For example, staff checked the hoist before using it.

Staff treated people’s homes with respect and followed people’s wishes and preferences whilst in people’s homes.

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. The provider followed their policy and procedure to ensure the safe recruitment of staff. Sufficient suitable staff were deployed to meet people’s needs. People were supported by staff who they knew well. People received the care they needed and confirmed staff arrived at the planned call time and stayed for the agreed length of time for the visit. Staff received training appropriate and relevant to their role. Training was refreshed at regular intervals and staff competency checks were carried out to ensure required knowledge and skills were maintained. People were happy with the carers deployed to support them. One person told us, “Carers are brilliant, we have a good group of carers who are well trained and treat us with dignity and respect”.

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 were protected as much as possible from the risk of infection. They were supported to maintain their personal hygiene in line with their needs and preferences. Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in people’s own homes, as well as their own hygiene, including hand washing. Staff were provided with and used personal protective equipment (PPE), in line with recommended national guidance. One person told us, “Staff are good, they [staff] wear gloves and an apron and put them in my bin”.

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.

The provider had made improvements to systems to ensure the safe management of medicines. This included the consistent and accurate recording by staff of the administration of medicines. The provider had introduced an electronic system for the management of the administration of medicines. Staff accessed the system and identified when medicines were required to be administered. The system identified if a medicine administration task had not taken place. The system was monitored by the senior staff team; any incidents were immediately picked up and actioned. The manager had oversight through a weekly monitoring report and took action to identify and address any themes or trends of incidents to further reduce errors. Staff told us this system was easier to implement, caused less confusion and resulted in less medicine administration recording errors.

A further improvement made by the provider was the introduction of a system to ensure early action was taken so medicines were always available to administer as prescribed. Team leaders worked with people and their families and staff as well as the prescribing GP and dispensing pharmacy to ensure medicines were ordered and delivered or collected to ensure outcomes for people.

Opportunities to improve the instruction for staff to administer as required medicines were identified during the assessment. A review of a number of the electronic medicine record sheets identified the reason for administration of as required medicines was not consistently recorded. Also, guidance for the administration of topical medicines did not consistently include the site of application. The manager advised this was covered in training for staff and checked during competency checks. Staff understood why, when and how to administer medicines in accordance with people’s preferences. The provider was responsive to feedback and undertook to review the as required medicine protocols to ensure all the information was consistently recorded.