Delight Support Services - Main Office

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• 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 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.

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 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. However, governance and oversight required further strengthening to provide increased oversight and support continued improvement. While the service identified learning when things went wrong, records did not consistently show how actions from incidents, audits and other quality assurance processes were tracked and embedded into practice. The registered manager was open and responsive to feedback and showed a willingness to make changes where needed. Revised management arrangements had recently been introduced in response to the service’s growth to strengthen oversight and accountability. However, these were not yet fully embedded and further time was needed to demonstrate their effectiveness in driving and sustaining improvements.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Overall, they made sure there was continuity of care, including when people moved between different services. However, aspects of some care records did not always provide sufficient guidance to staff to allow them to support people effectively or provide sufficient information if shared with other parties. Records evidenced input from external professionals and positive feedback was received from professionals of partnership working.

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 protected from the risks of abuse and staff were trusted to keep them safe. People and their relatives consistently told us they felt safe with the support provided by the service and spoke positively about the care provided by staff. One relative told us, “Oh yes [person] is definitely safe with them [staff].” Staff we spoke with were confident to report concerns and satisfied that action would be taken to investigate them. One staff member told us, “If I suspect someone is at risk of harm, abuse or neglect, I would take the concern seriously and act immediately. I would make sure the person is safe, listen to them calmly without judging or promising confidentiality, and report my concerns to my team leader, manager or safeguarding team in accordance with the safeguarding procedure. I would record the facts accurately and objectively, including what I observed or what the person told me. If there was an immediate danger or emergency, I would seek urgent help.” The principles of the Mental Capacity Act 2005 (MCA) were understood by the registered manager and there were processes in place to review people’s capacity in line with the MCA. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). We found the service overall was working within the principles of the MCA.

The provider did not always work 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. However, care records and risk assessments for some people were more comprehensive than others and further work was required to ensure staff consistently had sufficient guidance in place to support people appropriately and mitigate all risks. For example, 1 person used oxygen therapy, but further information was needed to ensure guidance around flow rates and related fire risks were clearly documented. Following a recent hospital discharge, another person’s fluid and nutritional guidance had changed. Further detail was needed to ensure this guidance was accurately reflected across all areas of their care plan and risk assessment including clearer guidance for staff when a person with swallowing difficulties chooses to continue eating and drinking as they used to despite known risks. Some information in care records also needed an associated risk assessment, for example, risks relating to fire safety and the use of emollients. These were recording concerns, and we found no evidence of harm to people. The registered manager acted promptly to address the concerns highlighted and committed to a wider review to ensure all care records were consistently detailed and staff had access to all information they may need to support people safely and effectively.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Health and safety checks were completed in people’s homes to ensure the wellbeing and safety of both people and staff. These checks included fire safety assessments and inspections of equipment to ensure it was safe, fit for purpose and in good working order. Regular checks helped to identify and mitigate potential risks supporting the provision of safe care and promoting a safe living and working environment. The registered manager had taken prompt action to strengthen care records by improving guidance related to oxygen therapy and the fire risks of people using emollient-based creams.

The provider overall 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 completed an induction and accessed a range of training to support them to carry out their roles. However, more timely training and guidance was needed when people’s needs changed including for conditions such as dysphagia to ensure staff had the skills and knowledge to provide safe and effective care. Further improvements were also needed to recruitment processes to ensure employment history and reference checks were robust. The registered manager responded promptly to address areas identified during the assessment. We reviewed electronic records of visits completed and queried some call details with the provider who provided explanations which accounted for the issues found. No concerns were raised by either people or families about call times or consistency. One person told us, “Yes, it’s the same staff. They are usually on time.” Another person told us, “Yes [they’re on time]. Some can drive and some can’t and if buses are a bit late, they’re a bit late but they ring me.” A few staff commented that communication around rotas and changes could be improved which we shared with the provider. Staff told us they felt supported in their roles and received regular support and supervision. One staff member told us, “I get great support through regular 1:1 supervision and team meetings. Management listens to what I have to say, works to resolve any issues and keeps me updated on changes.”

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. The provider had policies, procedures and systems in place to support the prevention and control of infection. Staff had access to personal protective equipment (PPE) and monitoring checks were completed by the provider to promote safe care delivery. People and their relatives did not raise any concerns regarding the availability of PPE or the prevention and management of infections. One relative told us, “They [staff] always wear gloves and blue things on their feet and respect the house.”

The provider didn’t always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. We identified some areas where medicines records and documentation required improvement. One person's Medication Administration Record (MAR) received from the hospital was unclear around the exact amount of prescribed thickener to be administered in fluids to reduce the risk of choking. More timely action was needed to clarify the prescribed amount and ensure staff had immediate clear and accurate guidance to support safe administration. Prescribed creams were not always recorded on the MAR and risk assessments for paraffin-based emollients were not always completed. A record of follow up where a person regularly refused some of their medicines was also missing for 1 person. Audits of medicines were in place, but these needed further review to support consistent oversight and monitoring. Although we found no evidence of harm to people these issues indicated existing monitoring systems had not always been effective in identifying and addressing medicines concerns promptly. We discussed our findings with the provider and received reassurance that action had been taken, and systems were to be reviewed further to ensure improved oversight of medicines. The provider had a medicines policy, and this included the principles of STOMP (stopping over-medication of people with a learning disability, autism or both). Neither people or their relatives raised concerns about the way medicines were managed. Feedback received indicated people were satisfied with the support provided by staff and felt confident their medicines were administered as required. One person told us, “Staff do medication and do it right.”