CCS Home Care Services (Hillingdon)

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.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

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 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.

People and relatives told us they understood how to raise questions or concerns about the care and if they had identified a concern the provider had responded appropriately. A relative said, “I have not made any formal complaints, I have contact with the office and will talk to them about my concerns I may have, they are generally proactive.”

The provider had made improvement to the system used to record and investigate incidents, accidents and complaints. Staff completed forms for incidents, accidents and complaints with any lessons learned recorded following a review of the issue. The registered manager explained common trends related to the issues were identified and discussed at manager’s meetings. The registered manager said information was shared with staff through meetings and newsletters. Where required, existing training was updated or new training courses were developed to fill any gaps in staff knowledge to reduce future risks. The provider had made improvements to ensure that following incident, accident and complaints investigations, people’s care plans and risk assessments were updated to include any actions identified so staff were provided with guidance on how to reduce possible future risks.

Staff confirmed lesson learned following investigations into incident, accidents and complaints. Their comments included, “Incidents are reported and reviewed in meetings. Lessons are shared so the same issues don’t happen again”, and “When something goes wrong, it is reported and investigated. Feedback is shared with staff to prevent similar issues in the future and improve care quality.”

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 registered manager explained there were different pathways to care for people depending on if they were being supported through the reablement service or receiving long term home care.

Care coordinators met with the hospital discharge team and the council social care team 3 times a day to review the support needs of people ready to be discharged. A care needs assessor worked with a multi-disciplinary team including physiotherapists and occupational therapy to identify any additional support the person required to assist their reablement. The provider worked with social workers at the end of the reablement period to assess the outcome of the support provided and if additional care was required. These could include ongoing care at home, support from another type of service such as a care home or if the person no longer required any additional support.

When a person was identified as requiring long term care the provider received information on their support needs. Staff reviewed the information to ensure the person’s needs could be met, identify any risks related to their care needs and if the person required additional input from other healthcare professionals.

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.

The provider had a safeguarding adult’s policy which was shared with staff. The registered manager told us they followed the local authority safeguarding procedures, and they worked closely with the local authority team, people being supported and relatives to investigate and resolve any issues. People’s care plans and risk assessments were updated following an investigation to indicate how staff can reduce the risk of reoccurrence of the concern. Staff confirmed they had completed training on safeguarding adults and children. Staff were able to demonstrate their understanding of safeguarding and how they would raise any concerns.

The registered manager explained they carried out monthly audits of any safeguarding concerns. The concerns were reviewed to identify if there were any similar issues raised across the service, who raised the concern and the outcome. Following an investigation into a safeguarding concern any actions were discussed with any staff members involved through supervision and reflective practice.

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.

Staff confirmed people had detailed care plans and risk assessments which they read regularly to ensure they provided appropriate and safe care. A staff member commented, “The people I visit have clear and detailed care plans and risk assessments. These documents provide important information about their individual needs, preferences, and any potential risks, helping me deliver safe, personalized, and consistent care.”

The provider had a process for identifying possible risks. The registered manager explained they supported people and relatives to identify possible risks and to develop risk assessments which had actions which were the least restrictive possible while keeping the person safe. The risk assessments were regularly reviewed to ensure they were up to date.

The provider had made improvements to the development and updating of risk assessments to ensure they provided staff with guidance on how to support people to receive safe and appropriate care. People’s care plans included risk assessment which covered issues related to the person’s health, wellbeing and the care being provided. There was detailed information on people’s medical conditions which included guidance for staff on symptoms and any possible impact on the care being provided. There were also risk assessments relating to falls and mobility, which were updated with actions to reduce possible risk, if the person experienced a fall. Risk assessments had been developed to provide staff with guidance on risk management if they were supporting a person with activities outside their home.

Staff undertook training which included health and safety and mobility to develop their knowledge on how to manage possible risks. The registered manager explained specific staff acted as champions in relation to falls, diabetes and oral care to assist other staff with their understanding and skills.

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

The provider carried out checks on the person’s home environment to identify any issues and how these could be managed to reduce possible risks. A risk assessment of the person’s home environment was completed to identify possible risk to the person or staff. A fire risk assessment provided staff with guidance on if smoke alarms were in place and how to support the person in case of an emergency including if they needed help to evacuate in case of a fire. Regular audits of the environmental risk assessments were carried out to ensure they provided staff with up-to-date information on possible risks.

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.

We received a range of feedback from people and relatives, who were receiving long term care, when asked if staff arrived on time and stayed for the full visit. Some people confirmed that staff arrived as planned, let them know if they were running late and stayed for the full visit while other people said staff did not always arrive on time or stay for the full visit.

The staff confirmed they had enough time to provide the care during a planned visit with a staff member commenting, “Yes I do [have enough time] but sometimes I may take a little longer as I like to spend a little time talking to the person.”

The provider had made improvements in relation to the management and monitoring of the visit rota, with further developments ongoing. The registered manager explained they had developed systems and processes to identify, monitor and respond to any issues in relation to the staff rotas. The electronic call monitoring (ECM) system was used to monitor visits times and durations, and the provider was working with the software company to develop improved tools to monitor data in real time. The registered manager told us they had employed a rota manager who would oversee workforce planning, resourcing and undertake the audits of the rota records.

The analysis of the visit records we carried out showed that some people had visits which did not always occur at the planned time and some staff did not always have travel time between visits.

The registered manager told us that for the people receiving reablement support, their visits were more flexible as the amount of time staff needed to provide support reduced as the person became more independent. This was confirmed by the feedback from people receiving reablement support. The registered manager explained that visits were usually allocated on a geographical basis to reduce the travel time between visits so the electronic rota would show a short travel time.

There was a recruitment process which enabled the provider to identify if applicants had the appropriate skills and knowledge for the role. The provider undertook checks including obtaining references, right to work in the United Kingdom and criminal record checks. Staff completed a number of training courses including the Care Certificate, understanding their role and duty of care. New staff completed an induction and shadowing of more experienced staff providing care. Staff were supported through regular supervision, appraisals and team meetings.

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.

People and relatives stated that staff wore personal protective equipment (PPE) when providing care. Staff told us they had completed training on infection control, The registered manager confirmed staff completed infection control competency assessments of their knowledge and practice. Staff confirmed they always used PPE and they had access to supplies of gloves, aprons and masks when required. The provider carried out regular audits to review the implementation of infection control best practice by staff.

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.

The registered manager explained staff completed 3 competency assessments following their medicines administration training. The provider employed staff with clinical experience to review people’s prescribed medicines to ensure there were no issues or interactions. The registered manager explained that issues such as discrepancy in dosage or what medicines were prescribed following reviews of people’s prescribed medicines. The specialist staff worked with the GP and other professionals to ensure people received their medicine in a safe and appropriate manner.

People’s care plans included medicines risk assessments which identified the level of support they required and any possible issues which could occur with the administration of their medicines.

The provider completed regular audits of the electronic medicines records to ensure they had been administered as prescribed. Any issues that were identified had the appropriate actions taken to resolve any issues.