Dimensions South West Counties Domiciliary Care Office

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 62 (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 and leaders listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Incidents and accidents were recorded on an electronic system which enabled managers to have oversight and to review incidents. For example, 1 person who struggled to regulate their emotions had benefitted from the introduction of some specific recording of incidents in relation to those emotions which helped staff to identify triggers. Once these were identified they were able to support the person to manage their emotions better and reduce the number of incidents. This had also led to a reduction in the medicines they were prescribed and also had enabled the person to start accessing their community for the first time in several years.

The provider worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

The provider had recently won contracts to start support work in several homes in the Wiltshire area and could demonstrate they had supported people well through this transition. For example, the registered manager demonstrated how in 1 home they had positively supported several people, who had recently moved from their family homes, with this transition. The people had engaged in creating a home environment, had agreed jobs within the house and had set up a system of house meetings to ensure they were able to talk through how living together and away from their family homes for the first time was for them all.

We were told of several people who had been referred to an external service to help them find voluntary work. They were now engaged in work relating to their interests. This enabled them to develop work and social skills and as their skills develop there was an opportunity for them to look for paid employment.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff worked to improve 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 told us they felt safe in their home and families confirmed they felt people were safe. Staff understood what safeguarding was and could identify how to ensure people were kept safe. The provider had a clear policy on how and when to safeguard people. They ensured staff were supported to attend safeguarding training and refresher training on a regular basis.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some support plans did not identify choice or how to enable the person to be empowered. This was evident in 1 home where people had higher support needs. Staff told us that because of the complexity of people’s needs they did consider supporting people with such things as daily living and that they did everything for people. For example, staff completed all food preparation and people were not using kitchen equipment. This was discussed with the provider and they took action to ensure people could use their kitchen and to be involved in the preparation of their food.

However, in other homes people were supported proactively in relation to risks. Staff demonstrated a good understanding of risk and how to manage and review them with the people they supported.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Not all risks had been monitored and reviewed. For example, some people were using wheelchairs, and the provider could not demonstrate the wheelchairs were being regularly serviced. Two people used bed rails with rail protectors, yet the protectors were worn and damaged. A further person had a suction machine which was broken. The provider had not identified these shortfalls which put people at risk of harm.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

For example, at one home staff had not received the appropriate refresher training or competency assessments to enable them to safely use a suction machine. The home also had a staffing shortage and people were being supported by a team made up of predominantly agency staff who could not access all records or record daily notes for people. This meant the provider could not be assured that people were being supported safely and in a way that followed their care plans. The manager had started to address the staffing shortfalls identified at the inspection.

Other homes did have enough staff who had received adequate training. One member of staff stated they would like more supervisions with their manager. This was fed back to the provider who said they would ensure this happened.

Pre-employment checks were completed before staff started working. New staff received induction and were able to shadow more experienced staff. One member of staff stated they had been allowed to shadow colleagues until they felt confident to start lone working with a person.

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 completed infection protection control training and we observed staff using equipment appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. For example, some people had out of date medicines, with several prescribed creams not being disposed of safely.

Another person had been administered an “as required” (PRN) medicine for several months without the provider referring this to their doctor to ensure this was appropriate. Records showed staff should leave a gap of 6 hour between doses of the medicine but the Medicine Administration Records (MARs) demonstrated routinely staff were only leaving a 4 hour gap between doses. This put the person at risk of overdosing on their medicine..

Records did not always identify where and how people liked to take their medicines. This meant people were not taking always medicines in a person centred and dignified way. We spoke to the provider about the shortfalls identified and they took steps to address them.