Independence at home Limited

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 safe care and treatment and safeguarding service users from abuse and improper 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.

The provider did not always investigate safety events to identify lessons learnt.

The oversight and management of safety events was not always effective. Where accidents and incidents had been documented, the provider did not always adequately analyse these for understanding and learning. For example, records failed to demonstrate the provider had analysed the causes and circumstances of how safety events might have occurred, and the actions taken for understanding and learning. This meant people were at risk of safety events not being appropriately managed.

There was a lack of an adequate learning culture in other areas, as there was no information to show safety events were reviewed within staff meetings. This meant staff did not have the opportunity to share learning to improve the safety of the service.

The provider did not always ensure safe systems of care. They did not always manage or monitor people’s safety.

Effective systems were not in place to ensure safety events were always adequately analysed and escalated for understanding and learning, care plans always contained relevant information about people’s needs and staff training was always relevant to meet people’s needs. This meant people were at risk of their needs not always being clearly known and understood by staff.

However, the service used effective systems in other areas. For example, the provider ensured safe systems of care in relation to the transition process for people before they moved to the service, the adequate application of the Mental Capacity Act 2005 (MCA), the obtaining of people and relative views and staff recruitment.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on protecting their right to live in safety, free from avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

The provider failed to always manage and report safety incidents that had occurred and affected people’s health, safety and welfare. Where accident and incident records showed people had been exposed to risk of harm, these incidents had not always been adequately reviewed and analysed by leaders, nor reported to appropriate healthcare professionals and external partners, such as the Care Quality Commission (CQC) and the local authority. Failure to ensure safeguarding incidents were adequately managed and reported demonstrated ineffective safeguarding processes which increased the risk of a recurrence of incidents.

People informed us they felt safe at the service. One person told us, "I do feel safe with the staff; they’re very good.”

There was a safeguarding policy in place, records showed staff had completed safeguarding training and staff were able to tell us the action they would take should they have concerns.

We checked whether the service was working within the principles of the Mental Capacity Act 2005 (MCA). Where people had been judged as lacking mental capacity to be able to consent to their care arrangements, decision-specific mental capacity assessments and best interests decisions regarding key aspects of people’s care had been carried out to demonstrate decisions taken on people’s behalf were being taken in their best interests.

The provider did not always work well with people to ensure their needs and risks were clearly understood.

People’s care plans and risk assessments did not always provide information which accurately reflected people’s needs and risks. For example, care records did not always provide information which adequately detailed people’s physical health and safety needs. Where people had needs associated with health conditions, guidance was not always available to staff, meaning staff unfamiliar with people’s needs might not have been able to support them safely. This exposed people to the risk of receiving unsafe care and support as staff did not have clear guidance to follow.

However, there were some examples of care plans and risk assessments containing clear, detailed and person-centred information, and staff were able to tell us about people’s needs and how they involved people in understanding and managing their own risks.

The provider had systems in place to identify and manage risks within people's home environments.

The provider completed environmental risk assessments of people’s homes and undertook observational checks of people’s home environments as part of the quality assurance checks they completed of people’s care and staff.

Staff received health and safety training and demonstrated a were able to tell us how they supported people to maintain their home environments and equipment to mitigate potential associated risks.

The provider did not always make sure there were enough qualified and skilled staff.

Staff had not received training which was relevant to support some people’s needs. For example, records showed not all staff had received dementia, diabetes, mental health, pressure care, continence, stroke and palliative care training. Staff we spoke with also told us they had not received this training. This meant people were at risk of their needs not always being met by trained staff. However, when this was discussed with the provider, they took prompt action to address the issue and provided information to demonstrate all outstanding training had been completed by staff.

Safe recruitment processes were followed, and staff received inductions and regular supervisions with leaders. People and relatives were satisfied staff demonstrated the skills they needed to provide safe care.

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.

Training records showed and staff confirmed they received training in infection prevention and control (IPC), and staff told us they had access to personal protective equipment when they needed it. The service had an IPC policy which set out their IPC expectations.

People and relatives said staff used PPE when providing care. One person told us, “The staff always bring their gloves and aprons when they come to help me.”

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

Staff received training in safe medicines management and staff we spoke with demonstrated good awareness of medicines processes and people’s individual medicine needs.

Clear systems and processes were in place regarding the storage, administration and documentation of people’s medicines.

Leaders told us how they used an electronic medicine system to monitor medicine practices, and they completed regular medicine checks and audits to ensure safe and appropriate medicines practices.

People and relatives told us they were happy with the medicines support they received from staff.