Domiciliary Care Agency Surrey

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.

Leaders ensured there was a learning culture at the service. The registered manager and regional managers reviewed audits, accidents and incidents across all 26 supported living services. Where events happened at one supported living location, they were reviewed and the lessons learned where shared across all services. This enabled location managers to take proactive action to maintain standards and drive improvements.

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 were supported to transition into the service safely. The provider assessed people’s needs and risks before they received a service. This was to ensure the provider could meet their needs and preferences safely and effectively. After they moved into the service people’s needs were reassessed to ensure staff had accurate guidance in care records. When required, referrals were made to healthcare professionals for specialist assessments. People, their relatives and advocates participated in the assessment, transition and review processes.

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 were safeguarded from neglect and improper treatment by the processes staff followed. Staff received safeguarding training and the provider had an up-to-date safeguarding procedure. Staff told us they understood their responsibility to raise safeguarding concerns. One member of staff said, “I would inform the manager and complete an incident form. I could also contact the safeguarding team direct. I have confidence in how the managers manage safeguarding. They report it.” Another member of staff told us, “I understand how to whistle blow. I would have no problem doing it.” Where safeguarding concerns had been raised, the provider cooperated with investigations and took action in response to their findings. This included the dismissal of staff when necessary.

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.

People’s risks were assessed and care plans detailed how to safely reduce them. For example, one person’s risk assessment identified road safety risks when outside of their home. This risk was managed by allocating one member of staff to them when in the community and engaging in activities. People were involved in their risk assessments. One member of staff told us, “Most people are independent, so they need to be in agreement with risk assessments.” Location managers regularly reviewed people’s risk assessments and updated care plans to reflect changes. Staff discussed people’s risks in a range of meetings. This meant that staff understood people’s changing needs and how to protect them from avoidable harm.

People were protected from health associated risks. For example, where people presented with epilepsy staff received the training they required to support them. Staff had guidance in care records on the actions to take in the event of a seizure. People’s allergies were noted in care records. This meant that staff knew to support people to avoid specific food types, medicines and items such as plasters, should this be required, and the actions to take in the event of an allergic reaction.

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 risks assessments of environments as well as risk assessments for people within their environments. People had personal emergency evacuation plans (PEEPs) in place. PEEPs were personalised and detailed the support people required to exit the building in the event of an emergency. Fire evacuations were rehearsed, and services were fitted with fire detection and alarm systems.

Location manager carried out hygiene, health and safety checks. These were audited by the registered manager. Staff ensured that people’s individual flats and shared areas were safe and clean. However, at one service we visited we found a conservatory area cluttered with unused items. This made the area inaccessible to people. We noted that the provider had taken repeated steps to escalate the issue with the housing association. Following our inspection the provider sent us photographs to confirm that the area had been cleared and could again be used by people.

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.

People received their care and support from staff who the provider assessed to be safe and suitable. The provider followed robust recruitment practices. These included interviewing candidates and checks against criminal records databases. The identities of staff were confirmed along with their eligibility to work in the UK. New staff received an induction and worked through a probationary period.

There were enough staff deployed to keep people safe. One member of staff said, “There are enough staff. It can be a challenge during peak activities. People do a lot, and we need to escort them.” Local managers and the registered manager kept staffing levels under review to ensure people’s needs were safely met.

People received their care and support from trained and supervised staff. Staff received training in a range of areas including medicines, health and safety, manual handling and people’s specific health needs. One member of staff told us, “My training matches people’s needs like epilepsy and autism. So I feel confident.” Staff were supervised by managers and had their performance appraised annually. Staff told us their training was undertaken both in person and online. Staff are given the time and space to compete eLearning. When visiting one service we saw that 2 staff were given protected time to complete online training.

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 were protected against the risk and spread of infection. Staff received training in infection prevention and control and location managers observed their work to ensure they provided care and support in line with their training. Staff used personal protective equipment (PPE) when providing personal care. These were single use items to prevent cross contamination. One member of staff told us, “We have enough PPE in stock. We requisition on time. PPE includes our aprons, masks and gloves.” People told us staff washed their hands regularly and there was hand gel available for people, visitors and staff.

The environments in each of the services we visited were clean. Cleaning schedules were followed, and audits showed high levels of compliance. Enhanced cleaning schedules were followed for frequent contact points such as taps, sinks and door handles. People and staff used bins which were activated by foot pedals to reduce contact. Staff received food safety training and ensured that foods were stored, prepared and served safely.

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.

People received their medicines from trained staff, who undertook regular medicines administration training. Managers carried out supervision observations of staff administering medicines. This was to confirm staff remained competent and managed medicines in line with their training.

People’s medicines were stored securely in locked cupboards to prevent the risks associated with accidental access. Location managers carried out regular stock checks to ensure people had received their medicines.

Where people were prescribed ‘when required’ medicines staff had clear guidance in care records. This included when medicines should be administered and the maximum number of doses permissible before seeking advice from the prescriber.

We checked people’s medicines administration records (MARs) at 4 supported living services. We saw that MAR charts were signed to show people had received their medicines. The appropriate codes were used and explanations were written when medicines had not been administered by staff. Reasons included social leave when people stayed with relatives who administered medicines and when people refused. However, at one service we found inconsistencies in the times when staff were signing for one person’s evening medicine. We spoke with staff who confirmed the correct time the medicines were administered. Although no harm resulted from this error, medicines audits had not identified the issue. Following our inspection the location manager initiated a review of this person’s medicines management.