Belong at Home Domiciliary Care Agency - Wigan & Southport

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. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The provider had effective technological systems and processes which ensured that when things went wrong, they were thoroughly investigated and used as opportunities for learning and improvement. The registered manager completed a monthly analysis of safety events and responded to any themes. For example, recently the registered manager had identified someone had experienced an increase in falls and had responded by ensuring all alerts would be sent to them so they could monitor this more closely.

Leaders and staff had key performance indicators to meet. One of these was used to monitor leadership’s responsiveness to safety concerns, with data showing issues were often addressed on the same day. Investigations were comprehensive and person centred, involving people and their families to ensure transparency and shared understanding.

The provider ensured learning was effectively embedded across the service. Staff received regular feedback through organisational communications, including ‘Belong Briefings’ which shared learning from incidents and highlighted changes made as a result.

Leaders had a clear understanding of their responsibilities under the duty of candour, acting with openness and integrity. People and their families were provided with timely, honest explanations when things went wrong, reinforcing trust and confidence in the service.

Staff knew what incidents to report and how to report them. Staff raised concerns and reported incidents and near misses in line with the provider’s policy. Staff told us how they were actively encouraged and rewarded for raising concerns about safety and ideas to improve.

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.

All referrals for the service came through a central enquiry manager who reviewed the initial information and then shared this with the registered manager. Following this, a leader would contact the person for a telephone consultation prior to deciding whether they were appropriate for the care offered by the provider. If this was the case, a visit to the person would take place.

The provider ensured people’s transitions into the service were seamless. The provider ensured they worked closely with others to ensure the safety of the person when they were admitted or discharged. For example, the registered manager had recently completed an initial assessment with a community matron from the NHS Continuing Healthcare (CHC is a package of care funded entirely by the NHS for people with significant ongoing health needs). This showed there was a collaborative approach to working with partners to identify and manage shared risks.

The provider demonstrated a strong awareness of the risks to people across their care journeys. The provider had access to GP direct which enabled them to escalate concerns to a primary care professional, ensured early interventions and enhanced their overall awareness of risks for people. People had hospital passports. This was a one-page summary of the key information hospital staff needed to know about the person including their medical history, current GP and allergies.

Staff told us the assessments completed by senior members of staff were comprehensive and they were always provided with sufficient detail prior to working with a person.

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.

The provider had a strong understanding of safeguarding across the service and there were clear roles and responsibilities for leaders and staff. The provider had appropriate policies in place and made referrals appropriately, and in a timely manner.

Staff received training specific for their role on how to recognise and report abuse. Staff could give examples of how to protect people from harassment and discrimination, including those with protected characteristics under the Equality Act. Staff knew how to identify adults and children at risk of, or suffering, significant harm and worked with other agencies to protect them. Staff knew how to make a safeguarding referral and who to inform if they had concerns.

People were supported to understand safeguarding, what being safe meant to them, and knew how to raise concerns when they did not feel safe or had concerns about the safety of others.

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 ensured people and/or relatives had access to their care records, via the electronic system used. Leaders of the service ensured care plans were audited every 90 days, and any updates were discussed with people and/or their relatives.

The provider completed regular review meetings with people and/or their relatives which reviewed the care being provided and discussed any improvements which could be made. We saw an example of a review meeting which evidenced a multi – disciplinary discussion with the registered manager, a community matron from CHC and the person’s relative. The person’s deterioration in their condition was discussed and appropriate actions were agreed.

The provider demonstrated a strong commitment to involving the person receiving care and their family in safety planning. For instance, they had identified potential risks, such as if the health of a person’s primary carer declined and had proactively put mitigation plans in place. This ensured the care remained consistent and responsive, even when unexpected challenges arose.

Risk assessments were mostly detailed and were directly linked to the needs assessments which had been completed. Staff had access to risk assessments which detailed how to support people in emergency situations during a visit. These were person-centred and included names and details of loved one’s specific to the individual.

The provider was able to alert staff to review a person’s care plan when their risk level changed. For example, when a person’s risk level had changed from amber to red, there would be a reason provided, and then staff would be asked to review the care plan. The electronic system used was so intuitive, leaders could check if staff had seen the alert and if not could provide reminders.

People who presented with behaviours which were challenging, had extremely detailed behavioural plans in place for staff to follow. These included the nature of the behaviours, what happened when the person was distressed, the frequency, duration, reasons and function of the behaviours, the safety risks, impact and support required.

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 had effective arrangements to monitor the safety of people’s homes premises. The provider completed environmental risk assessments, as part of the initial assessment which detailed key information for staff to be aware of such as the location of water and gas taps.

The provider ensured people had fire risk assessments in place, which were personalised. The fire risk assessments ensured staff had detailed information on what to do in the event of a fire.

New staff were provided with a guide on how to work safely when they started working for the provider. This included detailed information on several topics including hoists and slings, first aid, managing spillages of blood and bodily fluids and the control of substances hazardous to health (COSHH).

Staff described feeling confident with moving and handling procedures and said they received excellent training and competency assessments by leaders.

People had detailed moving and handling risk assessments in place, which considered their medical history, weight bearing ability, cognitive impairments, their level of independence in walking, balancing and moving between positions such as sitting, standing, rolling and turning. The assessments also detailed the equipment provided, such as stand aids, hoists, shower commodes and chairs and included details on the servicing history for each piece of equipment.

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 ensured there were appropriate staffing levels and skill mix to make sure people received consistently safe, good quality care that met their needs. Call monitoring data showed staff were punctual, had enough travel time and no rotas seemed particularly onerous.

The provider ensured there were robust and safe recruitment practices which made sure all staff, were suitably experienced, competent and able to carry out their role.

Staff received training appropriate and relevant to their role. The provider ensured staff had access to a variety of training modules. Overall, the completion rate for training was extremely high. Staff were extremely complimentary of the training received and said it was more than adequate to deliver safe care. Staff also had access to regular supervision, appraisals and were supported to develop.

The provider ensured there was a detailed induction package for all new members of staff which was for 4 days. The induction provided face to face training for key components of the role including moving and handling and basic life support. There were detailed and informative modules on dementia and nutrition and hydration, amongst other key topics. Staff completed shadowing shifts and having a competency sign off to ensure the person was ready to commence in their role. Following the successful induction and shadowing of a new starter, regular supervisions/check ins were scheduled and completed every 4 weeks to ensure continued development, confidence and safe practice.

The provider completed regular spot checks. Spot checks are unannounced visits completed by staff in senior positions to check staff are completing their job roles in accordance with their job specification and provider values. The spot checks covered a variety of areas including infection prevention and control practices, accurate recording of notes, medication, dignity and respect and timeliness. The provider had also incorporated a question-and-answer section into the spot check. Staff were asked questions on a variety of topics including safeguarding practices to ensure learning was embedded.

Staff at all levels had opportunities to learn, and poor performance was managed appropriately.

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 ensured there were clear roles and responsibilities around infection prevention control (IPC). They had appropriate policies in place and completed regular checks on IPC practices, including spot checks and an annual hand hygiene audit for all staff.

Staff understood the importance of using personal protective equipment (PPE) and were aware of the providers policies and procedures.

People had no concerns regarding staff not abiding by IPC 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.

The provider had a medicines policy which was in date and had been reviewed.

It was clearly recorded in peoples care plans and risk assessments which medicines the service provided support with. Where relatives were also involved in care this was clearly defined and communication between staff and relatives was documented in the care system.

Medicines administration systems recorded medicines information including the time of administration and where necessary any non-administration codes. At the time of admission to the service, information was clarified using a digital GP system to ensure accuracy.

The system was also used by the service to relay messages and ensure up to date information was available to care staff.

When required, body maps were used to assist in the safe administration of topical medicines and risk assessments were in place.

The provider tracked staffs training and competency and annual assessments were completed. When errors occurred, these were reported, reflected upon and learning shared. Audits were in place to provide assurance for medicines administration and processes. Any actions identified were logged and a named person was allocated to ensure the action was completed.