Home Instead Leigh

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• 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. This is the first assessment since the office location changed and the service was re-registered. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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. However, lessons were not always learnt, or documented to continually identify and embed good practice.

The provider had systems for documenting accidents and incidents. These detailed what had occurred, where and who had completed the form. However, records contained limited information on actions which had been taken and there was no section to document what learning had occurred, following a review of each incident. As such we could not be assured a robust lessons learned process was being utilised.

The incident process had been communicated to staff, who were able to tell us what action they would take. One staff member stated, “We do have a process to follow. If an incident or accident occurred on my visit I would contact the office and report as soon as possible. I would phone the ambulance or the police if required. I’d also fill out an incident report and document in the care notes.”

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 provider worked closely with commissioners and other stakeholders, such as social workers, to ensure people’s transition into and out of the service was successful. This included ensuring detailed information was sought during the referral process, to ensure needs could be met and people would be safe. We noted examples of the provider making contact with the local authority to request changes to care packages when issues had been noted. These did not always relate to the person being supported, but also to their wider support network. For example, staff noted one’s person’s relative was struggling with their caring responsibilities, so enquired whether the local authority could provide more support with this.

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.

People using the service felt safe when being supported by care staff. One person told us “I certainly do [feel safe], they all follow the rules and they are great.” A relative stated, “Yes, [relative] is safe. They [carers] treat her like their own mother and she is very comfortable with and around them.”

Staff understood their duties around safeguarding people and how and when to report safeguarding concerns to the relevant person or agency. One staff member stated, “The types of abuse include physical, sexual, financial, emotional, neglect, domestic and discrimination. An example of financial abuse could be a family member exploiting the person for money, stealing money from them or controlling where their money goes. If I witnessed this in a visit, the first thing I would do is report to the office with a detailed account of what I have witnessed. This would also be documented in my notes.”

The provider had reported any safeguarding concerns timely to the local authority, in line with policy and procedures. The provider had attended any follow up meetings with the local authority, ensuring actions generated had been carried through.

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.People were supported to stay safe. One person told us, “They [carers] are all good at their job, they know what they are doing which gives me confidence in them.”

The provider had discussed potential risks with people and/or their relatives, to ensure they were involved in the risk assessment process, and help ensure the correct support could be provided to keep people safe. During this initial care consultation meeting, the provider also considered environmental and lone working risks. Following commencement of care visits, the provider completed a next day courtesy call and a 2 week service review, to ensure the person was happy with their care and support and risk assessments were appropriate. Where necessary these had been tweaked to ensure they were fully effective.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, improvements were needed with some people’s environmental risk assessments, to ensure they were person centred and contained achievable and effective control measures.

Environmental risk assessments had been completed as part of the assessment process, to help promote staff and people’s safety. Whilst some assessments we reviewed were detailed and personal to them, others lacked detail, were generic in nature and control measures documented were confusing. For example, an identified risk area on one person’s risk assessment was the ramp to the front door. The risk assessment stated the ramp both had and did not have handrails. The control measure was for staff and the person to use handrails if they were present. The risk assessment should assess what is actually there and how any associated risks can be managed. We also noted another control measure was for a person’s call times to be moved during winter to daylight hours, to reduce risks to staff when walking through the local neighbourhood. As this person required support to get ready for bed, it was not clear how this would be managed if the call time was changed.

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 relatives told us staff were punctual, reliable and remained for the duration of the care visit. Comments included, “Yes, they are on time, they are very good. Usually, they will call if they are running late but it rarely happens” and “There is a rotation of 3 at the moment. [Relative] knows them all. [Carer] is absolutely wonderful, [relative] really looks forward to her coming.”

To ensure continuity of care, the provider used existing staff working extra hours to cover any shortfalls due to sickness or other absence. As a result, some staff felt more carers were needed to help out. One stated, “I feel like we could have more care staff, as when there is staff off the hours can be very long.” However, all staff told us they had enough time on calls to meet people’s needs and enough time was allocated to travel between visits.

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 when they left each person’s home.

Staff received relevant training on a regular basis, to ensure they had the necessary skills and knowledge to carry out their roles safely and effectively. The provider also completed spot checks to assess staff competency in key areas. A staff member told us, “Induction was thorough and informative making sure I knew what I was doing on the job. It made me feel confident when I went to my first calls. Ongoing training is informative and up to date to ensure we keep our skills relevant.” Staff also confirmed they received supervision and appraisals to help them continuously learn and improve in their roles.

People’s feedback about care staff’s ability to complete their role, supported the staff’s positive feedback on training. One person stated, “They are all good at their job, they know what they are doing. They are all so confident, which gives me confidence in them.”

There were safe recruitment practices at the service. The provider carried out the necessary checks on staff when they applied to work at the service, to make sure they were suitable to support people.

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.

Care staff were provided with relevant training to help them reduce the risk of infection in people’s homes. The provider made sure staff had access to supplies of personal protective equipment (PPE) to help them minimise infection risks to people. Feedback from people and relatives supported this. One person stated, “They always wear gloves and aprons. If any of them have a cold, they will also wear a mask.”

Where required, people’s care plans contained detailed information about any infection risks and how to manage these. For example, one person was prone to infections, so staff wore full PPE at all times. Another person required specific support with nail care, to help support good hygiene and reduce infection risk. Guidance for staff on how to provide this was very detailed.

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.

Care staff received training and had their competency assessed to ensure they could administer medicines safely. People received their prescribed medicines consistently and at the right time. Administration was recorded consistently by care staff on the provider’s electronic recording system.

Clear guidance was in place to explain what medicine people took, how and when this should be given. This included ‘as required’ medicines such as paracetamol and emollient creams. Care staff documented the time of administration, to ensure enough time was left between doses. One person we spoke with told us, “They put it down to the minute and make sure that it’s [medicine] given 4 hours apart each time, I have no concerns with medicines.”