Witham Community Care 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 newly registered 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 registered managers had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety, they investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Every opportunity to learn from events was taken. When things went wrong or when things were handled particularly well, they were seen as opportunities for learning and these learning points were shared with all staff. Accidents and incidents were reported and recorded within people’s care plans with an overview analysed by the registered managers to capture learning and to drive improvement. A document evaluation folder recorded and highlighted accidents, incidents, medicine errors and held records of body maps where people had sustained injuries or pressure damage. This folder allowed the registered managers to maintain oversight and pick up any trends of themes. A relative told us, “They call us if something goes wrong, communications are very good. They tell us if things need to change.” A member of staff added, “We have an app (mobile phone application) and communication is very good and we pick up issues quickly.”

The registered managers 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. Most short term transitions for example, if a person needed a stay in hospital, were managed by family members however, staff were always able to support with arrangements and transport if needed. The service worked well with other local care agencies and adult social care providers to make sure any moves that people might need away from their homes, were managed smoothly. A professional told us, “The service works closely with us when people are moving from one service to another.” Another professional explained, “Witham have always been very responsive and communicative around pathways and transitions between services. Witham have demonstrated this even when adults have moved on to residential settings and Witham support will be ending , the team ensure that adults are supported between transitions and a full handover is given.” Care plans documented any transitions that people made and included a hospital passport which was an easily accessible summary of people care and support needs.

The registered managers 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. Information was shared quickly and appropriately. People and their loved ones told us they felt safe when being supported by care staff. Comments included, “Yes, we feel very safe with them, all the time” and “Yes, I feel completely safe with them.” Staff had been trained in safeguarding and were able to tell us about situations that would amount to a safeguarding and the steps they would take. Staff were confident to use the whistleblowing process if needed. Whistleblowing allows staff to remain anonymous when raising concerns. Similarly, staff were trained in understanding mental capacity and the need sometimes to make decisions in people’s best interests. Most people supported were able to make decisions themselves or with the support of loved ones however staff were always on hand to support if needed. The registered managers understood the importance of safeguarding, were confident to report and were willing to learn form when things went wrong. Care plans provided clear guidance to staff relating to people’s capacity especially when supporting people living with dementia whose ability to make day to day decisions sometimes varied.

The registered managers 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. Staff understood the importance of risk management and were aware of the individual risks associated with the people they supported. For example, some people lived with catheters. Staff were aware of the need to drain equipment daily to minimise the risk of infection. Others lived with dementia and staff supported appropriately with prompts, reminders and in some cases full support with daily tasks and activities. Relatives told us they were confident that risks were managed well with one saying, “They have become very fragile over time and their needs have increased. They (staff) know about risks. They review and update all the time.” Staff were further aware that people’s presentation could vary from day to day and sometimes risks could become more significant. For example, people were at increased risk of falling when unwell or confused and trying to mobilise. Staff would seek support from other professionals if needed for example, occupational therapists or GP’s. All known risks to people were documented and regularly updated within care plans.

The registered managers detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. During the pre-assessment process a visit was paid to potential clients in their own homes and an important part of that assessment involved looking at the home environment. This considered and recorded essential information such as location of water stop cocks, gas and electricity points as well as any potential hazards around the home. These might include the presence of pets, a crowded environment, fire hazards or any other form of environmental risk. Staff were trained to look for changes in the environment so to monitor and record any emerging risks for example, the build up of items in a particular room that could present a fire risk. Every care plan considered fire risks and risk assessments were in place. A relative said, “They looked around the home as part of the initial visit. Looked for any problems or issues.”

The registered managers 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. There were enough staff to safely meet people’s needs. In the event of unexpected absence or delay in staff reaching calls, the office staff, who were all trained carers could step in or redirect other staff between calls. Staff had received training in all key areas and had regular refreshers. Staff told us the training and the ongoing support given them by the registered managers, gave them the tools and the confidence to do their job. Staff had been recruited safely and staff files contained all the expected documents and safety checks including references and Disclosure and Barring service records (DBS). DBS checks helped managers make safer recruitment decisions. Staff received a thorough induction to the service with opportunities to shadow more experienced staff before being expected to work independently. Ongoing support was provided to staff through regular supervision and appraisal meetings where staff told us they could raise issues or concerns with confidence. Also unannounced practical supervisions and medicine competency checks. The registered managers told us that supervision meetings could be held more frequently if requested by staff or there was an operational need. A relative told us, “They (relative) have the same staff and they are never short staffed. If anything happened to cause a delay they tell us straight away.”

The registered managers assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Infection prevention and control policies were in place and regularly reviewed. Staff had been trained and knew the importance of maintaining hygiene standards and using personal protective equipment (PPE) appropriately. There were plentiful supplies of PPE at the service. Staff were provided with a kit bag to carry their PPE and other equipment they might need during care calls for example, hand towels and cleansing wipes. People and staff all told us that staff wore gloves, aprons and masks appropriately and that they washed their hands between each task.

The registered managers 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. Most people were either independent with their medicine management or were supported by relatives. However, all staff were trained in medicines and received regular competency checks and refreshers. Staff were able to support people when required. Often this support was in the form of prompts or reminders but some people needed full support and care staff recorded administration on medicine administration records (MAR). The registered managers audited medicine records and were able to see each day, using the mobile phone application, when medicines had been administered. The registered managers told us that if no medicine review had taken place within 12 months they would contact the person’s GP and request one. There were clear instructions for the administration of as and when required (PRN) medicines and staff were able to discuss this with us and tell us the procedures they followed. Medicines were stored safely and securely in people’s homes, for example, in locked cupboards that were accessible to those responsible for administering.