The Care Bureau- Home Support 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.

This is the first assessment for this service. 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 did not always have 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 not always learnt to continually identify and embed good practice.

The registered manager and deputy manager reviewed any incidents to see if there were any actions to help them learn and improve. Whilst the provider had a quality assurance process, completed audits did not always identify specific areas so improvements and learning in certain areas went unknown. For example, in relation to managing covert medicines safely and accuracy and quality of daily records. The provider’s compliance manager said there was no structured process to check the accuracy of the registered manager’s audit, meaning opportunities for further learning and improving were not made. A lack of networking meant there was no naturally occurring opportunities to learn how to improve practices through learning lessons from others.

Staff did not always feel lessons were always learnt across the provider’s other services. One staff member felt the domiciliary care and home care service, although under the same provider and in the same office, was managed differently. For example, 1 staff member said, “Medicines were left out (of blister pack) for staff to give at nighttime. Management said not to do this again, but nothing happens after. There are no communication or staff meetings to discuss things like this.”

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.

People and relatives shared positive feedback about how other health professionals were consulted, involved and listened to, to support the right care and treatment. One relative told us health professionals had supported them to ensure continued treatment and reviews helped maintain their family members health and wellbeing. Information about people’s health, communication, immediate support needs, medication and their wishes for future care would be shared with other healthcare professionals in an emergency. This would help support a true reflection of the person so the right decisions could be made if needed.

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 and relatives said they felt safe, secure and comfortable with those staff who cared for them in their own home. Staff understood what safeguarding meant and what to do, to report instances of abusive care. One staff member said, “I would make sure the person was safe, report it to higher management or the police.” This staff member said they would also report to local safeguarding teams. Other staff told us they would refer to us (CQC) or their senior management team. The registered manager knew what and how to raise concerns of poor practice. The registered manager said staff received safeguarding training which made sure they knew what to do to keep people safe. This was confirmed by staff.

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.

One relative said care records had been improved. This relative said they were involved in providing more important details because they wanted to know their family received the right levels of support. They were happier now that their care plan was more reflective of their family member’s needs and wishes. One relative was confident risks were managed safely. They said, “It’s about keeping me, staff and [Relative name] as safe as possible.”

We found risks to people’s care were assessed, recorded and monitored. We saw people’s individual risks related to their individual circumstances were considered and actions put in place, to tell staff how to support people safely. Some of the care plans we saw showed these risks were written from the person’s perspective, showing how they wanted staff to respond in a potential risk-based situation. Risks to manage people’s individual characteristics and potential triggers, were known by staff. This helped staff support people safely. The registered manager told us they formally reviewed people’s care and risk assessments periodically but if any changes were required, these were included when needed. There were also recent improvements made to people’s care records through feedback from local commissioners.

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 risks within people’s own homes were identified at the start of the assessment process. Information to manage aspects of a person’s home where risks may exist, such a risks of fire and trip hazards, was included in people’s care plans about any actions staff should take to keep people, relatives and staff safe.

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.

The registered manager was confident staffing levels met people’s needs. There were enough staff to support people and the provider’s care call system showed people received a small and consistent team, meaning staff knew people well. People and relatives confirmed staff arrived on time and stayed for the length of time agreed, and the staff who supported them or their family member were their usual staff. A relative said this worked well for their family member who thrived with consistency.

Staff told us they cared for the same people, meaning they knew people and their preferred routines. Staff confirmed they were trained, however if experienced in care, they did not always shadow experienced staff. However, staff said there should be an introduction to those they would support, but this did not always happen. We discussed this with the registered manager that they may need to satisfy themselves this did not negatively impact on people. Following our visit, the deputy manager told us, “Where the complexity of a package increases, or where a package involves more specialist support needs, we would arrange a package specific induction/shadowing process with an experienced member of staff prior to the worker undertaking shifts independently.”

The provider had effective processes to ensure all safe recruitment checks had been completed prior to staff starting with the service. Recruitment checks included staff identity checks, references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions.

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 told us staff wore appropriate personal protective equipment (PPE) such as gloves and aprons. People said staff disposed of contaminated items safely. Staff told us they had enough stocks of PPE, including masks, should people ask them to wear one, or, if staff themselves wanted to wear a mask to minimise cross-infection risks. Staff said they had received infection and prevention training to help them keep their skills and knowledge updated.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People were assessed whether they needed staff support to administer their medicines. Some people received medicines from their family members, whilst other people could self-administer. Where staff administered people’s medicines, staff said they had received training and were confident to support people.

There were processes to check staff administered people’s medicines safely, but these did not identify specific risks with how some people took their medicines. For example, 1 person required their medicines to be disguised in food and fluids but there was no information to tell staff how to give those medicines safely.

Staff understood why they had to administer medicines disguised in food and fluids and staff said they followed the care plan and the medicine administration record to do this. Whilst they told us how they administered those medicines, we nor they could be confident, it was safe to do so in the absence of specific guidance for each medicine.

Medicines audits were completed, however they failed to include certain checks, such as checks on administration of covert medicines, topical creams, storage and ‘as and when’ protocols. The registered manager and compliance manager agreed to improve their audits to improve the administration of medicines. Following our visit, the registered manager told us they had contacted the GP and pharmacy to obtain instructions on safer administration practice for certain medicines. They also confirmed improvements to their medicines audit.