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• 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 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 kept a log of incidents, and a policy was in place to provide guidance to staff. Details of actions taken were available on the electronic system. Incidents and accidents were regularly reviewed in the newly established home care managers meeting. This provided an opportunity to analyse any themes or concerns and ensure appropriate actions were taken promptly. Learning or changes to practice were shared with staff.

Staff told us they were confident in reporting accidents and incidents. One professional noted that there had been discrepancies in the reporting of an incident. Although this did not cause harm to the person, it could have impacted on safety or staff response. This was shared with the management team.

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.

When people received support from different services, the management team prioritised safety and continuity of care for the individual. Care plans and risk assessments gave staff the information they needed to ensure people received joined up care and support.

There were effective working relationships with other stakeholders to promote consistency.
 

The provider worked with people and healthcare partners to understand what being safe meant to them. 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 effective safeguarding systems, processes and practices to make sure people were appropriately protected from abuse. Safeguarding concerns and referrals were raised as necessary and these were reviewed in the home care managers meeting and discussed in staff meetings. Staff collaborated with other professionals to keep people safe from abuse and neglect.

Staff told us they would raise any concerns, and they understood the different types of risks people could face. When we asked one staff member about raising concerns, they told us, “We would always raise concerns about safeguarding, of course – yes, yes, yes, yes, yes. These people can be vulnerable, if I don't help them and stand up for them, who will?”

One person’s relative said, “Yes, the carers are very conscious of safety and report issues to me and the office.” Other relatives told us they knew who to speak to if they had concerns and they were confident appropriate action would be taken if necessary.

The provider was reviewing the frequency with which staff attended training updates for safeguarding. This was monitored using a training matrix and staff had either completed training recently or were scheduled to attend training.

Some people had restrictions in place to keep them safe. Any decisions about limits on people were made in the person’s best interest and involved their family and other professionals.
 

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.

Care plans and risk assessments were in place and available to staff. These were up to date and were being reviewed by the new home care manager. People or their relatives were involved in reviews of care plans and risk assessments where possible.

Care plans and risk assessments contained important information such as people’s needs, preferences, healthcare conditions and moving and handling support. Care records also included specialist clinical tools to assess needs such as pressure care, falls and nutritional risks. This meant staff had access to information to help them assist people to manage known risks or know what they should do if there were changes to people’s needs.

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 was not responsible for the premises because they supported people in their own homes. The management team carried out environmental assessments of people’s homes to understand risks and support staff to deliver safe and effective care. For example, risks related to falls, the use of equipment and substances or fire risks within the person’s home.

Several people lived in areas which were at risk of flooding or being isolated due to weather extremes. The provider was aware of potential risks and assessed and managed these effectively.

Personal emergency evacuation plans described what support individuals would need in the event of an emergency.

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 received training and an induction before they supported people independently. This helped to ensure they were competent and knowledgeable in their role. One relative said, “The staff are obviously all trained in the same way to give the same care - whatever needs to be done it's always done in the same way. Consistency is good.” In the staff survey, some staff noted that they would like to have more training.

The provider used an electronic system which enabled managers to monitor staff activity and ensure people received the support they needed. The home care manager had recently reviewed rotas to ensure these were efficient and clear.

Although there had been some gaps in formal supervision and appraisals for some staff, all the staff we spoke with said they felt supported. The newly expanded management team was ensuring all staff received regular formal supervision as well as carrying out more spot checks and observations of practice. Poor staff performance had been managed appropriately.

Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. The service sponsored some staff from other countries. Records showed all necessary checks were carried out.

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.

Staff had undertaken training in infection prevention and control in line with current national guidance and standards. Care records included information about the safe use and storage of cleaning materials and personal care supplies. When staff were responsible for food preparation, care records included information about hygiene and food safety. The provider ensured that staff had appropriate access to personal protective equipment.
 

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning where possible, including when changes happened.

Staff received training in medicines and their competency was checked to ensure their practice was safe and in line with current guidance and legislation.

When staff supported people with their prescribed medicines, this was recorded electronically. This meant standards could be monitored and there was oversight by managers.

Regular audits of medicines administration and management were undertaken. When shortfalls were identified, improvements were documented and monitored in an action plan. Policies were in place and reflected current guidance.