Nightingale Homecare East Sussex Ltd

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 manager 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. Accidents and incidents were reported, recorded and any learning from positive or negative outcomes were shared with staff. The registered manager instilled a culture of learning when things had gone wrong, there was no blame culture within the service. A staff member said, “Risks are managed well. They tell me what has happened and what changes are happening to make them safe.” Another said, “I was supported when something went wrong, it was treated as a learning exercise.” Any trends or patterns were considered as part of the registered manager’s overview, for example, repeated falls analysis.

The registered manager 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. Positive working relationships had been established with other professionals that made sure that when people began using the service or if it became necessary for them to move on, the transitions ran smoothly. A professional told us, “They are proactive in supporting packages of care and, where possible, will always try to accommodate referrals to ensure individuals receive timely and appropriate support.” The registered manager told us that if people’s support needs changed and they could no longer be supported in their home then a multi-agency meeting would be held to review the person’s needs and determine the level of support they required. This sometimes involved temporary respite placements or longer term residential or nursing care.

The registered manager 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. People and their loved ones told us they felt safe when supported by their care team. Comments included, “They are very good, I feel very safe with them” and “I know she is safe as I know the staff know what they are doing.” Staff understood safeguarding, were able to tell us situations that would amount to a safeguarding issue and were confident to report. Staff also told us they were confident to use the whistleblowing process, a process that legally protects the anonymity of the person raising the issue, if needed. Safeguarding concerns had been reported by the registered manager in a timely way with full disclosure to the local authority and the Care Quality Commission. Where appropriate, decision specific, mental capacity assessments had been completed for people who needed some support in making certain decisions. These were recorded in care plans.

The registered manager 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. Known risks were managed well. People were assessed regularly and any changes in their presentation or needs were reviewed and changes made to their support if required. Some people were at risk of falls. Risk assessments were in place that considered all contributing factors that could increase the risk of a person falling, including foot ware, obstacles in their home or worn carpets and the presence of pets. All these factors were considered by staff during their care calls, and staff were able to tell us the steps they would take in the event of someone falling or if they arrived finding a person had already fallen. Staff knowledge relating to risk was comprehensive and reflected the training they had received and their knowledge of the people they supported. A relative told us, “They know about risk. They are very good at picking up on things, anything that is different.”

The registered manager identified and managed potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People’s home environments were under constant review during every care call by care staff. In addition to assessing any trip or other clear hazards, care staff also carried our regular checks of people’s safety devices for example, lifeline alerts and falls detectors. Environmental risk assessments were in place and were subject to regular reviews. People were referred, if they wanted to be, for a free fire service assessment. Key information relating to gas, electricity and water controls were clearly shown within care plans. A person told us, “They looked at my room when they first started with me and some things got moved around as they thought I may trip.”

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. Staff had been safely recruited, and staff files contained the required documents which included, references, interview notes and Disclosure and Barring Service (DBS) records. DBS checks support providers in making safer recruitment decisions. New staff had an induction period followed by opportunities to shadow more experienced staff before then working independently. Staff were further supported with regular supervision and appraisal meetings and training refreshers. A member of staff said, “Training is good, regular. Gives me the skills to do my job.” Staff were further supported by the registered manager and wider management team with regular spot checks, unannounced visits to supervise staff as they worked. The registered manager told us they used these spot checks not just to observe staff supporting people but to check they were wearing personal protective equipment (PPE) and name badges correctly and to assess their medicine administration. There were enough staff employed to cover all care calls. In the event of unexpected delays or staff sickness, available staff were re-deployed to cover calls.

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. An infection prevention and control policy was in place that had been regularly reviewed and updated. Clear instructions were available to staff relating to minimising the spread of infection. Personal protective equipment (PPE) was readily available to staff, and this was used appropriately by staff during care calls. People told us that their care team always wore aprons and gloves which they would change between tasks. They also told us they washed their hands frequently and always in-between carrying out different jobs.

The registered manager 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 managed their own medicines or were supported by their relatives. However, some required staff to remind them to take their medicines and a small group required direct help. All staff were trained in administering medicines. People’s medicines were clearly recorded on a mobile phone application used by staff. Staff completed a form to show that people’s medicines had been administered and recorded if there were concerns or refusals. Separate protocols were in place for PRN, ‘as required’ medicines for example, pain relief.