Affinity Trust- Domiciliary Care Agency- Central

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 worked to develop a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.The registered manager could describe some improvements that had been made following incidents. For example, lessons were learnt and shared across services when a person sustained sunburn. However, there was a lack of effective oversight and analysis of incidents where people were distressed but had not met the incident reporting threshold. This is important to demonstrate robust oversight ensured improved outcomes for people’s safety. We found repeated incidents of a similar nature, including incidents of distressed behaviours, which resulted in harm to people and staff teams. Incidents had not always resulted in analysis across the service therefore opportunities had been missed to identify and improve safety from themes and trends across individual and multiple people. This demonstrated lessons were not always learnt to continually identify and embed good practice. The registered manager was working towards improving these areas following the inspection, but this still needed to be embedded within the service.

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 management team told us they had good working relationships with other professionals involved in people’s care. Managers told us how assessments were undertaken prior to the start of a person using the service and received information from external agencies and commissioners involved in people’s care. A manager told us, “We do our own assessment and compare with information that has been given to us. For example, a recent assessment highlighted an unmet need that we had identified but had not been included in the person’s initial application. We have been able to support referrals to relevant agencies, so this need is met as part of the transition into the service.” People, and where appropriate their relatives, were involved and consulted during this process. This information was used to ensure the move between services was managed to reduce the risks of people receiving inappropriate care.

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. Staff demonstrated they understood their role and responsibilities in protecting people from harm. Records showed staff had reported concerns to the local authority safeguarding team, who were responsible for investigating concerns of abuse. Staff had completed training in safeguarding and their understanding was regularly assessed. Managers maintained up to date and accurate records relating to people’s DoLS (Deprivation of Liberty Safeguards). This helped to mitigate the risk of people being unlawfully restricted.

The provider worked with people to understand and manage risks by thinking holistically. However, improvements were ongoing in risks and how to mitigate them were documented. People told us they felt safe with their care and support. Their comments included, “I feel safe because there is always someone here with me” and “I feel safe here. Staff listen to me and know what I like.” A person described how staff had assessed risks associated with them getting in and out of bed and their wheelchair and put in place equipment to mitigate these risks. They told us, “Staff carried out an assessment to make sure I could cope with the strategies to keep me safe. ”People’s care plans included risk assessments and guidance for staff in how risks were being mitigated. However, the documents varied in quality, and some were not always fully reflective of people’s current needs. For example, we found care plans refenced equipment for people that was not supported by a risk assessment. Where a risk had been identified for another person, their risks strategy was not sufficiently robust to support a timely response to mitigate the known risk. We found some people’s positive behaviour support strategies included conflicting information around the recording of people’s distress. Accurate and consistent recording is essential to support safe and effective oversight of risks and ensure safe care. The registered manager amended records we identified as a concern. However, we could not be assured improvements were fully embedded into staff practices at the time of our inspection visit.

The provider detected and controlled potential risks in people's homes and where people received support. Risk assessments were undertaken by the management team on people’s homes. Guidance was provided to staff on how risks were mitigated to ensure they and people who used the service were safe during care visits. Staff supported people to keep safe and to escalate concerns about their environment to the relevant agencies including landlords. They provided advocacy to enable people to understand their tenancy agreements in line with Reach Standards. The Reach Standards are a set of nine principles designed to ensure that individuals who have Down's syndrome, as well as others with learning disabilities and autistic people, live as equal citizens with the same rights, choices, and responsibilities as everyone else.

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. The registered manager told us the service had enough care workers to undertake the planned visits to people and recruitment was ongoing. People and relatives told us they were happy with their established staff teams as this meant they received consistent care and built positive relationships. Comments included, “Staff can vary tremendously but the ones that have been there a long time are excellent,” “The staff are very good. I can tell because [Name] is doing really well and is settled” and “They always let us know in advance if there are staff changes. There are phases when some of them go, but the new ones always shadow the experienced ones first. [Name] receives consistent care. ”However, in some areas people and relatives were not always satisfied with the use of agency staff pending recruitment. A person told us, “It would be better if I had consistent staff. Agency staff are used that I’ve never met and they are doing my personal care which isn’t right”. A second person told us, “I like the staff, but I don’t like some agency staff as they are always talking on their own phones. ”A relative told us, “The constant change of staff is affecting [Name’s] mental health. Some of the staff can’t speak English well, including bank staff. People can’t understand them and communication doesn’t flow. There is inconsistent care. ”We raised these concerns with the registered manager who was aware of staffing issues and had begun to address these through recruitment and additional training for staff, though agency and bank were used in the interim period to ensure people received safe care. Ongoing training kept staff up to date with the requirements of their role and they could undertake relevant qualifications. Staff told us they received the training they required to meet people’s needs, including specific health conditions and learning disabilities. A staff member told us, “The training is good and we are also encouraged to be proactive and think outside the box to meet people’s needs.” Staff told us they received good induction ,support and guidance from their managers. The registered manager was in the process of introducing an enhanced induction programme for new staff. Records showed staff were safely recruited to the service including checks with the Disclosure and Barring Service (DBS) before their employment to ensure they were suitable to work in the service.

The provider assessed and managed the risk of infection. We received feedback from people and relatives who were satisfied with the infection control measures employed by the service. Daily care records showed regular cleaning being undertaken by staff as agreed in people’s care plans. Staff had access to personal protective equipment (PPE). Staff received training in infection, prevention and control and food hygiene to support good practice in this area.

The provider 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. People told us they were satisfied with the support they received with their medicines, when this was required. A person told us, “The staff support me to take my medicines. They are in medicine packs. The staff help me to take them on time. ”People’s care plans included information on their medicines and any specific guidance to ensure staff administered these safely and as prescribed. This included medicines prescribed as and when required and medicines administered through a PEG feed(a tube that delivers food, fluids and medicines directly into the stomach). Staff worked with health professionals to ensure people’s medicines were regularly reviewed and remained necessary and effective in line with STOMP (Stopping Over Medication of People with a learning disability, autism, or both).The provider had systems and processes for the safe management of medicines. Staff received appropriate training and had their competency to administer medication regularly checked by the management team. Regular medicines audits were undertaken by the managers. Where medication errors had occurred, actions had been taken and lessons learnt to reduce the risk of further errors.