Affinity Trust - Domicilary Care Agency - Leeds

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 people’s safe care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service was developing a culture of openness, learning and continuous improvement. Accidents and incidents were reported however, the required follow‑up actions were not always completed. For example, some incidents involved unexplained injuries or bruising with no documented follow‑up, while others lacked enough detail to understand what had occurred or what action had been taken. The investigations we reviewed showed that the Duty of Candour had been considered and applied when necessary. Despite this, learning was not consistently shared with staff, as updates to care plans and risk assessments were not always made to reflect changes in 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 service made timely and appropriate referrals to relevant multidisciplinary professionals when required. Documentation also evidenced effective collaboration with external healthcare services, including speech and language therapy (SALT), physiotherapy, social workers and general practitioners (GPs). Hospital passports were in place to support people’s wellbeing and ensure essential information was available should they require admission to hospital.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

A safeguarding policy and associated log were in place. While safeguarding incidents were investigated, there was limited evidence that actions had been taken to mitigate future risks. For example, 1 person experienced 5 falls, yet we found no evidence of measures implemented to reduce the likelihood of further incidents, and falls continued to occur.

Another person experienced 5 incidents of aggression during which they shouted and swore at staff without an identified trigger and physically assaulted another person. No action was taken in response to these incidents, and no referrals were made to the Care Quality Commission or the local safeguarding team. This meant we could not be assured that these incidents had been managed appropriately to minimise the risk of them reoccurring. Following our feedback the provider told us they would investigate and send the relevant referrals.

Most staff had completed online safeguarding training, and the manager had identified those who were overdue updates, with plans in place to address this.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

During the assessment, we found evidence that risk assessments did not always reflect people’s needs. For example, 1 person had experienced multiple falls, several of which resulted in head injuries; however, there was no information to demonstrate what actions had been taken to reduce the likelihood of further incidents. Another person had experienced significant changes in their physical health needs, yet this was not reflected in their risk assessments. Additionally, we identified an example where a person was sleeping with a bed rail in place, but no corresponding risk assessment had been completed to ensure this equipment was being used safely. During our assessment the provider told us they were in the process of reviewing all care plans and risk assessments.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Environmental audits carried out by the management team did not consistently identify health and safety risks across all houses assessed. At 1 service, a rodent infestation had been identified, posing a significant risk to people using the service.Following the assessment the provider showed a chronology demonstrating that steps were being taken to resolve the problem.

People were unable to access the garden area due to long‑standing hazards that had not been addressed. The garden had not been assessed since before the pandemic and contained multiple risks, including broken pathways, damaged fencing and rotting outdoor furniture. Managers were aware of these issues and confirmed that actions were being taken to remedy them.

There was also a lack of clarity around cleaning responsibilities. The house manager in 1 service was unaware of the cleaning rota and who was responsible for completing cleaning tasks. Conflicting information was given by managers, and the evidence available showed gaps in recording and did not clearly set out the cleaning programme in place.For example, a freezer located in the laundry room required defrosting, and there was no schedule displayed to indicate when this task should be carried out. Following our feedback the provider replaced the freezer.

During the assessment visit, the house manager made contact with the Housing Association and other contractors to begin addressing the concerns identified. Fire safety arrangements were in place, and certification relating to electrical and gas safety was up to date.

The provider ensured there were sufficient numbers of staff to support people daily. Safe recruitment practices were followed, with all new permanent staff completing full pre‑employment checks, including Disclosure and Barring Service (DBS) clearance, before commencing their roles.

However, staff did not consistently receive effective support, supervision or opportunities for development. We found inconsistencies in induction processes, including 1 staff member whose induction had remained unsigned for eighteen months. Staff supervisions and team meetings were also not being carried out in accordance with organisational policy. As a result, staff missed opportunities to enhance their knowledge and receive appropriate managerial support. Although this was a concern, staff told us they felt supported by the managers.

Training compliance was not always maintained. At 1 service, 12 staff had not completed self-harm awareness training, the Oliver McGowan training, and 10 had not completed their moving and assisting competency assessment. At another service, 10 staff had not completed the Oliver McGowan training, 6 had not completed epilepsy training, and 13 had not completed catheter care level 2 training. Although the training compliance report showed an overall regulatory training rate of 93%, which is above the organisational target, gaps remained in specific training areas directly relevant to staff roles and the needs of people they support.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection prevention and control (IPC) policies and procedures were in place and were robust. All staff had access to online IPC training; however, some staff were overdue updates, which the provider was aware of through their internal audit processes.

We observed that toilets did not have toilet roll holders, and bathrooms and toilets did not have paper hand towels available. This presented a hand hygiene risk and increased the potential for infection transmission among people living in the home. The cleanliness of toilet facilities also posed an infection risk, as communal toilets and a handrail were found to be soiled. These concerns were highlighted at the start of the assessment but had not been addressed by the time we left the property. Cleaning schedules were inconsistent, and staff were unclear about their specific cleaning responsibilities, which further increased the risk of poor infection control practices.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

People’s medication administration records (MARs) and care plans included information on how people preferred to take their medicines and any known allergies. Staff training was generally up to date, although some staff still required refresher training, which the provider had identified.

In several cases, medicines were being altered (such as capsules being opened or drugs crushed) without documented pharmaceutical guidance to confirm this was safe or appropriate. Medication support plans did not always record when formulations required alteration. We also found inconsistencies between prescribed directions and how medicines were administered, including ointments applied less frequently than instructed and time‑sensitive medicines given at incorrect intervals, increasing the risk of reduced effectiveness or avoidable harm.

Medication no longer in use was stored alongside current medicines, increasing the risk of accidental administration. Some staff were unclear about the purpose of certain medicines, including an anticoagulant. The persons support plan did not state how an anticoagulant would change the support needed by this person, for example, post fall/accident.

Management oversight was not effective in identifying or addressing these issues. Medication audits showed low scores and repeated concerns, including incorrect stock checks, missing PRN protocols, and outdated documentation. Several required actions remained outstanding months after they were identified, and Mental Capacity Assessments (MCAs) relating to medicines were not consistently updated to reflect people’s needs.