Domiciliary Care Services (UK) 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.

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 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 provider had a 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.

Systems and processes were in place to learn from incidents to prevent reoccurrence and promote safety. A family member spoke of how they had raised a concern with the registered manager regarding how staff on one occasion had not secured the ‘key safe’, containing the key to their relative’s property. The family member said the registered manager acted promptly, and there had been no repeat incidents.

Staff were aware of the services reporting processes regarding accidents, incidents and concerns. The registered manager reviewed records detailing accidents or incidents, and any necessary changes were made to staff practice or the care and support provided to mitigate against repeated incidents. A member of staff told us, “We discuss any issues, including points, which arise in practice at staff meetings.”

The provider worked with people and partner agencies 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.

Referrals to the service were from either the funding local authority, or direct from the person themselves. Referrals from local authorities were accompanied by an assessment of the person’s needs, which included any known safety concerns and measures required to promote safety. Assessments of people’s needs were undertaken by a member of the management team to ensure the needs of the person could be met, with consideration to safety.

A family member told us how information about their relatives’ care needs were supported when they were discharged from hospital. “A care plan was first drawn up by the hospital and then followed by DCS (Domiciliary Care Service), which lists the tasks to be done and a timetable.”

The providers’ systems and processes supported a collaborative approach between themselves and social care partners, people and their family members. This enabled the delivery of safe care and was kept under review.

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.

Safe and effective systems, processes and practices were in place and implemented to protect people from abuse and neglect. Safeguarding alerts and concerns were recorded and monitored.

Staff confirmed they would document safeguarding concerns within the electronic care record system and alert a member of the management team. Staff expressed confidence their concerns would be escalated to the appropriate agency and our evidence supported this. Staff were aware of the signs, which may indicate a person was experiencing abuse. A staff member told us, “Mood changes, fearful, anxiety, unexplained money issues or injuries.”

Systems were in place to assess people’s capacity to make an informed decision, where it was believed a person lacked capacity. At the time of the assessment, the management team advised that everyone receiving care and support had the capacity to make informed decisions relating to the day-to-day care. Records we reviewed supported this.

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.

We identified one aspect of a person’s care was not sufficiently documented within a care plan. Action was taken by the operations manager, who updated the care plan during our assessment of the service, to fully document the person’s needs. All other care records viewed reflected people’s care, which included indicators for potential risk. For example, indicators of a urine infection for people with a catheter, and information as to the signs of a hyper or hypoglycaemic attack (high of low blood sugar levels) related to diabetes management. Identified risks were regularly reviewed and people’s care records updated.

People were fully involved in decisions about potential risk. A person told us how staff worked with them to promote their safety, based on their needs and ability. They said, “Staff encourage me to be independent, they ask me to stand up in the shower, which I only do on the days I feel safe to do so.”

Staff spoke confidently of the needs of people and of their role in providing care, with many staff having supported people for several years.

Following the previous inspection of the service we found improvements had been made in promoting people’s safety who were at risk falls. Care records provided information as to how staff were to reduce risks of falling, and detailed what equipment and how it was to be used. A member of staff told us, “I’ve had training in moving and handling, using a slide sheet, a hoist and sling.”

Staff had undertaken training to promote people’s safety, in several key safety areas, which included, moving and handling people, pressure area care, fire safety, health and safety, and basic life support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Potential risk related to people’s home environment were assessed to promote both the safety of people and staff. Assessments focused on potential trip hazards such as rugs or uneven floor services and considered the tasks to be undertaken by staff in the delivery of people’s care. The registered manager ensured the person or their family had any equipment used by staff in the support of people’s care, such as a hoist was serviced in line with the manufacturer’s guidance.

Important information about people’s homes was documented to enable staff to take appropriate action in the event of an emergency. For example, the location of utility services and how these could be isolated in an emergency.

The registered manager, where appropriate, sought specialist support when environmental concerns were identified in a person’s home, which included referrals to the local authority and environmental health.

Potential risks to staff when working alone were assessed and reviewed in response to any individual needs. Staff had undertaken training in lone working. The registered manager told us staff were provided with appropriate safety equipment, including torches, personal alarms and high-visibility arm bands.

The provider had a lone working policy and an out of office procedure which staff could use to contact for support or advice.

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.

People and family members told us the service they received was reliable, and that care was provided by staff who knew them well, which had a positive impact on them. A family member said, “The carers are always there on time, and my relative feels safe with them.” Family members also spoke of the flexibility of the service, enabling staff to respond if a person’s needs required this. A family member said, “Staff stay for as long as required and can sometimes stay longer if necessary.”

The provider used an electronic scheduling system to plan and monitor care visits. This allowed the provider to see in real time when staff arrived and left a person’s home. Electronic records showed staff arrived and departed within the agreed timeframes.

Records showed staff undertook training in a range of topics enabling them to meet people care needs, which included catheter care, diabetes awareness, dementia awareness and training specific to the needs of people with a learning disability. The registered manager ensured staff had the skills and knowledge to enable them to provide good quality care, through the provision of an induction programme, training, supervision and on-going assessments of staff’s abilities.

Staff were recruited in a safe way. Appropriate checks were carried out prior to people commencing work, to enable the provider to be confident that suitable staff with the right skills and experienced were employed.

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.

Staff received training on food safety and infection prevention and control (IPC), supported by an IPC policy in line with good practice guidance. Staff had access to Person Protective Equipment (gloves and aprons).

People’s care records included information of the signs and symptoms of an infection, where people were at greater risk, such as a urine infection.

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’s care records included information about their prescribed medicines and the role of staff in providing support. In response to the previous inspection, risk assessments had been put in place for people who were prescribed anticoagulant medicines (to help thin the blood and prevent clots). This provided guidance for staff of the increased risk of excessive blood loss in the event of an accident or injury, and the importance of contacting health care professionals in a timely manner, including emergency services. People’s care records included a body map and information where people were prescribed topical creams, to ensure these were applied to the correct area.

Staff were knowledgeable and had training on the safe administration of medicines, and confirmed they didn’t administer medicines for most people, often their role being to prompt or remind people to take their medication. Most people’s medicine was managed either by themselves or a family member.

Systems and processes were in place, underpinned by the provider’s policies to ensure people’s medicine was managed safely. Staff completed medicine administration records when they administered people’s medication. The registered manager, as part of the oversight of the service, reviewed both electronic and paper medicine administration records so as any anomalies or concerns were identified and any required action taken.