AA-I-Care - 35 Southwell

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 requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had established a process of learning from events that had either put people and staff at risk of harm or had caused them harm, to improve the service. Openness and transparency about safety was actively encouraged and embedded in the service. Incidents and accidents records were completed, reviewed and scrutinised by the management team. When identified, lessons were learned, discussed and communicated to staff via messages to work group chats, emails, regular supervisions and visits. Staff understood their responsibilities to raise concerns and report incidents and near misses; they were fully supported when they did so. A staff member told us, “I appreciate how they address staff and clients’ concerns.”

People and their relatives confirmed they felt confident to raise concerns, felt they were listened to and believed actions would follow. One person told us, “I’m sure they would do anything I asked them to; they are very helpful.”

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.

The service worked with people and those close to them to establish their plan of care and comprehensive individual transition plans, prior to the person moving between services. This helped eliminate any risks of harm and ensured the person received continuity of care. Pre-assessment paperwork was always completed involving people, relatives and partners prior to services commencing and these assessments were shared with staff.

We received positive feedback from 3 health and social care partners about working in partnership to maintain safe systems of care for people. One professional told us, “I have found them to be professional and clear with actions and responses. They respond quickly to any problems or queries. Their availability is good at short notice to be involved in reviews with service users, other professionals, and family.”

People were supported by staff to attend healthcare appointments and when they needed hospitalisation. We received positive feedback from people and their relatives about maintaining continuity of care and their involvement in creating and reviewing people’s care records. Comments included, “I’ve had this company since about 2018/2019, they came and did a care plan with me. I have had reviews since about once a year.”

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 their relatives confirmed they felt the service provided by AA-I–Care was safe. People were protected from harassment and abuse in the community, and were supported to develop skills to protect themselves, in a way that did not infringe on their independence or rights.

People were supported to understand what keeping safe means. They were encouraged and empowered to raise any concerns they may have about this and were appropriately supported when they felt unsafe or experienced abuse or neglect.For example, we reviewed 1 person’s care plan which included detailed guidance for staff on how to support this person to keep themself safe whilst remaining an active member of their neighbourhood.

The provider had established effective safeguarding systems, policies and procedures and managed safeguarding concerns promptly using local safeguarding procedures whenever necessary. There was a consistent approach to safeguarding and matters were always dealt with in an open, transparent and objective way. Where required, investigations were thorough.

All staff had participated in safeguarding training and demonstrated a comprehensive awareness and understanding of their roles and responsibilities. Staff knew how to recognise the signs and symptoms of abuse and who they would report concerns to both internally and externally. They told us they felt confident management would listen and act if they raised concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. People had the necessary assessments in place to ensure their rights had been fully respected. The provider followed principles and requirements of the Mental Capacity Act (MCA) where people were deprived of their liberty under the Deprivation of Liberty (DoL) in the community setting through an order by the Court of Protection. Deprivation of liberty occurs when an individual is not free to leave a community setting due to restrictions placed on them, for their safety and well-being. There was a clear understanding of DoLS, they were used appropriately and only when it was in the best interest of the person.

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.

Risks to people’s health, safety and welfare were identified. For example, risks associated with people’s mobility, skin integrity and malnutrition. These risks were assessed before people started to use the service and amended as needed. Risk assessments were created and maintained within the provider’s electronic recording system and updated once a year or when things changed. Relevant health and safety concerns were included in people’s care plans.

Staff told us they were given enough information about people’s risks and how to keep people safe when providing their care. For example, how to support people to reduce the risks they faced when outside of their homes.

People and their relatives felt involved in managing risks, and risk assessments were person-centred, proportionate and reviewed regularly. People and relatives, including legalrepresentatives, confirmed they were, when appropriate, involved in creating and reviewing people’s care plans. Comments included, “We have a care plan, and we had a care plan review 3 months ago after a GP review. I am in contact with them nearly every week and they are in contact via group messages as well.”

The provider embedded a proactive approach to anticipating and managing risks to people. People were enabled to take positive risks to maximise their control over care and support. They were also actively involved in managing their own risks along with their relatives, friends and others important to them. Restrictions were minimised so people felt safe but also had the most freedom possible, regardless of disability or other needs. The manager told us, “We are an enabling service not a disabling one. For example, we supported a person to self-medicate for 2 weeks as they were adamant, they wanted to be independent with their medication. They were not able to do it safely, but we have done everything we could to support their wish.”

Health and social care professionals confirmed, “The provider actively promotes people’s independence and autonomy, encouraging participation in outings and personal interests.”

The provider detected and controlled potential risks in the care environment.

The service provided support in people’s own homes, they were not responsible for the upkeep of these premises. However, risk assessments were in place to ensure the environments in people’s homes were safe to protect people and staff from harm. For example, there were effective arrangements in place to manage risks associated with fire or slips, trips and falls. Smoke and carbon monoxide alarms were checked by staff every week. When people used equipment, there was a system in place to make sure that this was serviced, checked and safe for use.

The service made sure staff could always contact them in an emergency. Staff told us, “They are always available for a call in any emergency” and “Whenever I need assistance, they come.”

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.

We received overwhelmingly positive feedback about staff. People and their relatives expressed that they were happy with staff supporting them. One person told us, “My live-in carer is great, just great. [They] know what [they] are doing. [They] do my meals, exactly what I want. [They] do my shopping and take me to my appointments.”

People and staff told us the provider ensured staff’s skills and experience were carefully matched to the needs and preferences of people they supported. A member of staff told us, “I noticed the management concern to match the carer with the client’s profile, needs and goals.” People were supported by a regular staff team, and care was delivered through agreed routines which meant people experienced continuity of care. Comments from relatives included, “The carers are all just excellent, very well trained. [My loved one] has a permanent live-in carer and if [they] are off, we have a regular replacement and that is so good to have.”

Staff had the right mix of skills to make sure that practice was safe and they were able to respond to unforeseen events. Staff told us they felt supported and received appropriate training and supervisions to enable them to fulfil their roles.

Appropriate recruitment checks were carried out as standard practice. Recruitment processes were robust, and staff were recruited safely. The manager told us they had no vacancies and staff retention was very good, so they had not needed to use agency staff to cover absences.

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 as much as possible from the risk of infection because their home environment and equipment were kept clean and hygienic. They were supported to maintain their own personal hygiene in line with their needs and preferences. Staff were provided with and used Personal Protective Equipment (PPE) such as disposable gloves and aprons, which met recommended national guidance and were appropriate for the care they were delivering and the level of infection risk. One relative told us, “The carers use their PPE and are very clean, very particular.” Visiting health and social care professionals confirmed, “Carers promote keeping people's homes clean and tidy and work to keep a pleasant home environment for them.”

There were clear roles, responsibilities and procedures around infection prevention and control that meet current and relevant national guidance. Staff received appropriate training on infection prevention and control (IPC) and understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in the premises and their own personal hygiene, including hand hygiene.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines policies, procedures and systems did not always follow current legislation, professional guidance and relevant best practice so that people’s medicines were ordered, administered, recorded, stored and disposed of safely. The provider had a medicines policy in place however, it was not always followed by all staff. Staff did not always keep accurate medicines records. Staff did not always complete electronic medication administration records (MAR) following medicines administration and did not always note the reasons for this using the reason codes provided. When codes for not administering medication were used, they were not always used correctly.

The provider’s medicines policy instructed staff to report any refusals to the office at the earliest opportunity. We reviewed daily care notes for 3 people and found no evidence this was taking place. This meant people were at risk of harm from medicines errors occurring and remaining undetected. We raised this with the provider, and they took immediate action to address this. We will assess the effectiveness of the improvements made at the next inspection.

The provider did not assess risks associated with potentially flammable creams and emollients. Flammable topical creams present a risk because they can transfer from the skin onto clothing, bedding, dressing and other fabric. Once there they can dry onto the fabric and build up over time. In the presence of an ignition source, fabric with emollient dried on it can catch fire much more quickly and burn hotter than clean fabric. Staff who might not be familiar with the risk presented by such creams were not provided with guidance on how to mitigate the risk. This meant people were at risk of severe burns and even death. We raised this with the manager, and they took immediate action to rectify this.

The provider did not follow best practice guidance for storing medicines in people’s own homes We found no evidence the provider agreed and recorded in people’s care plans how they stored their medicines and what level of support was required for this, which is particularly important where a person has declining or fluctuating mental capacity. This agreement should be reviewed at intervals appropriate for each person. When a person required full support to store their medicines, there was no detailed guidance or clear processes for staff to follow to cover safe and appropriate access outlining who has access to medicines and how to store them safely or securely.

People and their representatives were appropriately involved in decisions and reviews about their medicines and the level of support (including self-medication) they needed to manage their medicines safely. People’s wishes and preferences about how they like taking their medicines were clearly recorded in their care plans. Personalised protocols were in place for all medicines prescribed ‘when required’ (PRN). Records were kept when 'as required' medicines were given however, the effectiveness and risks were not documented. This meant people were at risk of experiencing pain or discomfort if their PRN medicines were not effective to manage their symptoms.

Staff told us they had training, and competency checks to make sure they gave medicines safely. They told us they felt supported regarding medicines management. Comments included, “Manager comes to access medication competencies regularly and also through the medicines audit if there appears to be a problem, they will contact me to amend or question why.”