Archived: Quality Homecare

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 remained 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. Accidents and incidents were reported and recorded. Staff knew the process to follow and how to immediately highlight when things went wrong. Reports were completed on staff mobile phones and then were accessible to managers for any follow up actions. Staff knew to prioritise making people safe. Managers reviewed all actions taken and reports were audited to identify any themes or recurring concerns. Staff told us that they received feedback about minimising chances of things going wrong again and this was done sometimes by emails, discussion at team meetings or individually for specific learning. Managers carried out dip sampling of care documents and completed monitoring forms as part of the auditing and learning process.

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 loved ones told us of positive support received during transitions between services. This included the initial referral which sometimes included moving back to their homes from a stay in hospital. A professional working in a hospital told us, “They assess and implement their services in a timely manner to ensure a smooth transition from hospital to home.” The service worked well with other professionals involved in people’s ongoing care. For example, some people received support and some respite care from local hospices. Another professional said, “Both care staff and co-ordinators/assessors appear to have widespread knowledge and skills in relation to client needs, they are able to identify when a client has experienced a level of deterioration and seek support from the appropriate agencies.” The service made appropriate referral, provided thorough paperwork at handovers and maintained contact with people throughout any absence from home.

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 when receiving support. Comments included, “I feel safe when they use the hoist. They are competent,” “I feel safe with them. They buck me up” and “I can tell her (carer) anything. I trust her. I feel safe with her.” Similarly, relatives confirmed they were confident that care was provided safely. Staff were trained in safeguarding and were confident to report concerns when they arose. Staff were able to tell us what situations would amount to a safeguarding and the steps they would take. A staff member said, “I’ve never had to but I’m confident. Would be any form of abuse, neglect, can spot maybe when dressing them. Sexual, physical, financial. If a fall at home I know what to do, make safe and comfortable, call paramedics.” Safeguarding and whistleblowing policies were in place and staff told us they were confident to whistle blow if needed. The registered manager had reported safeguarding matters appropriately.

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. Risk assessments were in place for people and were updated at regular intervals or following incidents. Risk assessments related directly to people, specific to their needs. For example, within care plans we saw risk assessments for pressure sores, falls, Parkinson’s disease and diabetes. Each assessment described the specific risk and gave instructions to staff as to how to avoid something going wrong. The assessment then described the actions staff would take following an incident, who to inform and what steps to take to minimise a recurrence. Relatives told us they were confident that staff could identify changes and knew the steps to take, one telling us, “Carers noticed bed sores and now the district nurse comes in, but carers position her, so she is off the sore.” Staff told us they had received relevant training and knew the correct steps to take to minimise risks to people. Staff knew people well and were able to detect changes when people were not feeling well of were otherwise at risk. A staff member said, “With pressure sores, we have in the system everything we need, body maps and report to family and office. We ring and assessor will decide if we need to take a photo.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Part of the pre-assessment process involved an environmental risk assessment being completed of people’s homes. These assessments included practical information for example, locations of water and electricity supplies and location of key safes. Safe and most appropriate access and egress to people’s homes were noted and any trip or other obvious hazards were recorded. Staff told us that they always checked the home environment for any safety issues. Some people lived with lifeline devices, an emergency button they could push to attract assistance if they fell or felt unwell. Staff carried out regular checks of these devices.

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. Staff had been recruited safely. Staff files contained the required pre-employment documentation including, references, full previous employment history, photographic identification and Disclosure and Barring Service (DBS) forms. DBS help employers make safer recruitment choices. Staff received a comprehensive induction which included initial training and opportunities to shadow more experienced staff. Ongoing support was provided with regular supervision meetings, appraisals and competency and spot checks carried out by supervisors. The service had a training unit which provided all the training courses and refresher training that staff needed. Before agreeing to support people with new or complex needs, the service ensured that there were enough staff with the right training and skills to be able to safely provide that support. Staff were split into geographic areas to minimise travelling time between care calls and to allow staff to support the same, small group of people.

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 and their relatives told us that care staff wore masks and used personal protective equipment (PPE) appropriately. Some people used specialist equipment that required daily cleaning. A person told us, “The nature of the (specialist equipment) is such that it has to be scrupulously clean and the staff all wear appropriate PPE. I do know that they get regular training.” Another person told us, “They are careful with basic hygiene, use aprons and gloves regularly.” All staff received training in infection prevention and control (IPC)and received regular refreshers. Care plans had a section relating to IPC and gave details of any specific requirements that people had.

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 were independent with their medicines or received help from family members, but some were supported by staff. All staff were trained in administration of medicines and people told us they had no concerns with the way they received support. A new electronic Medicine Administration Record (eMAR) had been introduced which helped to minimise the chances of errors occurring and enabled managers to immediately see when medicines had been given and to identify where there were delays or omissions. Medicines were stored safely in people’s homes. As and when required (PRN) medicines had separate, documented protocols and staff were able to tell us the procedures they went through. Staf also told us, correctly, what they would do if medicines were spoilt or a person refused their medicines. GP’s regularly reviewed people’s medicines.