Extra Care Service

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 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.

The provider regularly reviewed incidents and accidents to identify opportunities for learning and improvement. Staff understood how to report risks and recognised their responsibilities in keeping people safe. Reviews were focused on understanding the facts and ensuring the right actions had been taken to protect and support people. Any learning was shared with staff through handovers and team meetings, including anything they needed to be alerted to. Staff were encouraged to raise safety concerns and felt confident that the management team would act promptly to protect people.

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.

Staff visited prospective people who would need support, where possible, to confirm the service could meet their needs. The management team also reviewed relevant history, case notes and safeguarding information. The management team told us that introductory meetings were arranged to help people get to know the staff and the service, and trial stays in interim accommodation were sometimes offered to assess support needs. The provider had preadmission assessment processes, and the information gathered was used to create care plans that guided staff practice. Staff said they followed these plans and received handovers when new people joined the service, a staff member explained, “We are introduced to new people, usually one-to-one, to help them feel comfortable.”

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.

People using the service told us they felt safe. Feedback from people using the service included, “Yes, of course I feel safe, they are darlings,” and another person said, “Yes, I feel safe. It’s fantastic actually.” People told us they knew how to raise concerns if they ever needed to.

The provider had clear safeguarding procedures and had raised safeguarding concerns appropriately. Staff had received training that helped them recognise and respond to concerns. Staff were able to describe different types of abuse and demonstrated a good understanding of their responsibilities. They told us they felt confident reporting issues and trusted that the management team would take appropriate action. Staff also had access to an anonymous whistleblowing email address if they wished to raise concerns confidentially, and they were aware that they could report issues externally, including to the Care Quality Commission.

The provider did not always work effectively to document individual risks. This meant there was not always assurances that all staff, especially new or temporary workers, would have clear guidance. The managementteam understood people’s risks and could clearly describe the actions they took to keep people safe, but this was not always reflected in the written records. For example, one assessment stated that a person experienced episodes that could lead to hospital admission and advised staff to “be aware and report any concerns.” However, it did not describe what these episodes involved, the early signs to look for, or the agreed response. Another person had a fire risk assessment that did not include the increased fire risk associated with emollient creams, leaving staff without the information needed to manage this risk safely.During our visit, the management team assured us they would review peoples risk assessments following the feedback provided, and we were later sent evidence that this work had started.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental risk assessments had been completed to identify potential hazards in people’s homes and to help ensure the environment remained safe. These assessments considered areas such as the use of electrical plugs, trailing leads or wires, the presence of rugs, and other common environmental risks.

Staff also completed a health and safety inspection checklist within the office every three months. The office was used by various staff and included checks such as fire safety measures and general housekeeping to ensure the premises remained safe and well-maintained.

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, however, the provider did not always carry out comprehensive pre‑employment checks.

Staff files were stored electronically at the local authority offices and were not easily accessible during our visit. Some recruitment checks had been completed, including Disclosure and Barring Service (DBS) checks. DBS checks provide employers with information about any convictions or cautions held on the Police National Computer to support safer recruitment decisions. However, staff files did not include a full employment history. Only the previous ten years were routinely checked, meaning earlier roles involving health or social care, children or vulnerable adults were not explored. This limited the provider’s ability to fully assure themselves that staff were suitable and safe. Assurances were provided that recruitment checks for the service would be reviewed in response to this feedback.

The service had processes in place to ensure all staff received an induction, and new staff were able to shadow experienced colleagues. Staff received training relevant to their roles, and this was refreshed regularly to maintain skills and knowledge. Although all staff had completed mandatory training, some were overdue refresher courses, however, a training audit showed these had already been scheduled to be completed. Staff told us this training supported them with their role, one member of staff told us “I did a lot of training like medicine, manual handling and basic life support. Some were in person. The training is really helpful, we have regularly refreshers that are also really helpful.”

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 service carried out a monthly infection control audit, which included checking that there were sufficient personal protective equipment (PPE) supplies for staff, observing staff hand hygiene practices, and reviewing staff knowledge around infection prevention. Staff had completed infection control training, which supported them to understand their responsibilities and follow the correct procedures to reduce the risk of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were supported to take their medicines in a way that reflected their best interests and wishes. Staff had received medicines training and had also completed competency assessments. However, PRN (as required) medication protocols did not always contain sufficient detail or clear guidance. For example, one PRN pain relief protocol stated that decisions about when to administer the medicine should be made by a healthcare professional but gave no further information to support staff in assessing when it was needed. In addition, we identified gaps in the monitoring and risk assessment of higher risk and time sensitive medicines. While no harm occurred, these issues increased the risk of delayed or inconsistent administration and unclear decision‑making for staff.