Daily Comfort Healthcare Ltd

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 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 62 (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.

People and staff felt confident in raising issues and told us they were confident senior staff would address their concerns. One person told us, “I was given information on how to contact the office, but I haven’t needed to, I’ve had no complaints and anything arising the staff can deal with.” The registered manager had a good oversight of incidents, accidents and complaints. They had used feedback to implement lessons learnt to continually make improvements and embed good practice. An example of this was an investigation following a complaint. Although this was not upheld, the service retrained staff, completed a reflective practice exercise and a follow up with staff to improve communication with people’s families.
 

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.

This provider arranged for staff to receive training in the hospital before a person came home to start the package of care. The provider ensured care was organised flexibly, with adjustments made to meet people’s changing needs. This included when people attended appointments, when their health needs changed or when they were admitted to or discharged from hospital. The provider also checked with the hospital to confirm discharge times to ensure people receive care as soon as discharged. This helped to promote continuity in their care services.
 

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 and relatives told us they felt safe receiving support from the staff. Staff had a good understanding of safeguarding procedures and understood how to recognise the signs of abuse. The provider had effective policies and procedures in place around safeguarding. Senior staff demonstrated a thorough approach to investigating safeguarding concerns, to help reduce the risk of people suffering abuse or coming to avoidable harm.
All staff were trained in safeguarding adults and children, and knew what signs to look out for and who to report this to. One staff told us, “I report anything that could affect a person’s safety or wellbeing, such as signs of abuse, poor care, or sudden health changes. I report directly to my manager following the organisation’s policy.”
 

Although the provider aimed to work with people to understand and manage risks, these were not clearly documented. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
Although the provider considered risk to people as part of their assessment , how staff were to support people to reduce the risk of harm was not clearly documented in people’s care plans. For example, one person who had been assessed as at risk of developing pressure ulcers did not have a risk management plan in place. There were also concerns raised from a professional who had reviewed a person’s care plan where they were at risk of choking, without a suitable risk management plan being in place. This put people at risk of poor care as there was not sufficient guidance for staff. We did find staff mitigated some risks of pressure ulcers by applying barrier creams, but people’s records did not show this always took place. Staff told us they were aware of how to manage risks, although these were more general, and did not specifically address the issues we found. People and relatives were mixed about how staff managed their risks. One person said, “The staff apply a barrier cream as a precaution against pressure damage.” However, another person told us, “There have been moments of feeling unsafe in hoist practice, it’s lucky I’m able to shout stop. I’ve no idea if there is any risk assessment .” This person only had a very basic risk assessment for hoisting in their care plan with insufficient information to guide staff in providing moving and handling support safely.

Therefore, the service was in breach of legal regulation in relation to people’s safe care and treatment.
 

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 carried out assessments of people’s home environments to identify and reduce any risks related to the delivery of care. This included checking when hoists were last serviced and arranging for hoist to be inspected to make sure they were safe to use. The provider had invested in technological solutions to aid the delivery of safe care. This included electronic care planning systems and telephone systems, which helped to improve safety and the provider’s ability to monitor how care was delivered.
 

The provider made sure there were enough qualified, skilled and experienced staff. However, some recruitment practices needed to improve. We reviewed 4 recruitment records during the inspection. These included Disclosure and Barring Service (DBS) checks. Recruitment records did not always record all the required pre-employment checks to show how the provider ensured only suitable staff would support people. The provider made efforts during the inspection to obtain this information. A suitable recruitment policy was in place.

People and relatives told us consistency of staff was important to them, and they would like a copy of their rota to help with knowing which staff were supporting them. Although people received care from regular staff, they found changes of staff challenging at times. One person told us, “It’s lack of familiarity, and sometimes language or communication difficulties, that make occasional carers really not very good. I’d like a rota of which staff are coming, so at least I’m prepared.” Relatives gave us mixed feedback about staff’s timekeeping and whether they were always informed when staff were running late.
Some people also told us visit times were not always at appropriate times. One person said, “One day I had a midday visit at 11:25, which was too soon after a late breakfast visit and too long until the next visit; in fact, I never know when the evening visit will be.”
The provider made sure staff received effective support, supervision and development. Records evidenced staff received an appropriate induction including training and shadowing. Training for staff across all mandatory subjects was up to date and exceeded Skills for Care guidance. Staff training was a combination of in-house or external face to face and online, with the registered manager being train the trainer qualified.
We spoke with the registered manager about people’s concerns. The registered manager said they would review scheduling information provided to 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 raised no concerns in relation to infection control. They told us staff wore appropriate personal protective equipment (PPE) whilst they were providing care. One person said, “They (staff) make full use of (PPE).”
The provider had effective infection control policies and procedures in place. Staff told us there were adequate supplies of PPE, but some people raised concerns some staff had to be prompted to use this equipment appropriately. The registered manager was aware of this and had addressed concerns with regular spot checks. This helped to ensure staff were following effective infection control procedures.
 

The provider made sure that people received their medicines as prescribed and medicines management met people’s needs, capacities and preferences.

The provider had policies and procedures developed in line with national guidance, to help ensure staff were following best practice when supporting people with their medicines. People’s care plans detailed the support people needed to manage their medicines, and levels of independence people wished to maintain. Staff and management had a good understanding of best practice in medicines administration, including National Institute for Health and Care Excellence (NICE) guidelines for medication management . Staff were trained to administer medicines and their competency to do so safely was assessed. Staff completed an electronic medicine administration record when they administered people’s medicine. This was monitored by the provider and medicine records were promptly updated when people’s prescriptions changed. The provider was aware when people required strict time-specific care calls to ensure they received their time specific medicines as prescribed. The service had gone through a period of change and the provider was working to ensure people received their calls at the appropriate times.