Best West Bridgford Home Care Ltd Also known as Home Instead Central Nottingham and West Bridgford

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

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

Whilst the registered managers demonstrated an open and positive culture of safety, where staff felt able to raise concerns and speak honestly about care delivery, a learning culture was not consistently embedded across the service. Not all staff understood their responsibility to recognise and escalate safety events, including accidents and incidents, to the management team. This meant the provider could not be assured that learning was always identified, completed, or shared with the staff team following incidents.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

There was no effective system or process in place to ensure care records were consistently updated with clear and relevant information when other healthcare professionals were involved. As a result, information provided by healthcare professionals had not always been accurately reflected within people’s care plans. This meant there was a risk staff may not always have access to the most up‑to‑date information needed to support people safely and in line with their assessed needs. The registered manager took immediate action and arranged a care plan review.

People were protected from the risk of abuse; however, safeguarding systems were not always effective. Not all incidents were reported in line with the provider’s safeguarding and incident reporting policy.

We found incidents recorded in people’s daily notes that had not been escalated to management. As a result, we could not be assured that all incidents were appropriately reviewed, investigated, or used to reduce future risk. The registered manager told us they addressed this immediately with staff.

People and their relatives told us they felt safe using the service. Relatives said they were confident raising concerns and that the registered manager took prompt action when issues were identified. One relative told us, “There had been one [staff member] that myself and [family member] had felt uncomfortable with and had asked for [staff member] not to be sent again, and they were removed from her care.” This demonstrated that when concerns were raised, management responded appropriately to safeguard people.

The provider did not always work effectively with people to understand and manage risks. Staff did not consistently provide care in a way that met people’s needs safely, supportively, or in a manner that enabled people to do the things that mattered to them.

There was not always accurate or detailed written guidance in place to manage risks associated with people’s health and wellbeing, including their mental health, skin integrity, and catheter care. For example, one person’s daily records showed that staff provided support that was not always in line with best practice, as there was no care plan in place to guide staff. This placed people at risk of receiving inconsistent or unsafe care, as staff did not always have access to accurate, up‑to‑date information to support them to manage risks effectively. The registered manager took immediate action and arranged a review of the person’s care.

The provider identified and managed potential risks within the care environment to help ensure people received safe care. They ensured that equipment, facilities, and any technology used supported safe care delivery. As part of the initial care consultation visit, staff assessed people’s home environments to check they were safe and suitable before care commenced.

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 mostly met people’s individual needs.

Relatives told us there was always enough staff to meet people’s needs. One relative said, “It’s mostly the same person who comes, and when she is off there is another regular person who comes instead, so there are only two of them who come on a regular basis. The timing is always around 10:45am, and if they are late the office contacts me to let me know, but it’s very rare that they are late.” Training records showed staff had completed relevant training and completed an induction, Staff had received regular one‑to‑one supervision to discuss their practice and development. Recruitment processes were followed to ensure only suitable staff were appointed. Checks including, interviews, references and Disclosure and Barring Service (DBS) were completed before staff started working at the service. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helped employers make safer recruitment decisions. Staff at all levels had opportunities to learn and develop.

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.

Although staff had completed infection, prevention and control training, practices were not always in line with best‑practice guidance. We identified examples where appropriate infection prevention measures were not followed when staff supported a person with an injury where skin damage had occurred. This placed people at risk of harm. Relatives told us staff did wear personal protective equipment (PPE) in line with good practice. One relative told us, “they always put gloves on to administer the eye drops.”

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. Medicines were managed safely and in line with current guidance. Staff were trained and competent, and medicines administration records were accurate and completed appropriately. People received their medicines as prescribed and in a way that respected their preferences. Regular checks and audits supported safe medicines optimisation and helped protect people from harm.