Deep Heart Care Wiltshire

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.

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 did not always have a proactive and positive culture of safety based on openness and honesty. The provider did not always identify concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The provider had a structured process for identifying and learning from incidents, but this was not robust which meant management of incidents was not consistent. The provider could not be assured staff had seen learning points which were shared in meeting minutes and in some staff supervisions. Attendance at meetings was not high so the provider was reliant on staff reading minutes in their own time.

Points raised as learning had not been embedded into practice which meant incident management was not consistent. For example, 1 person had developed a bruise. Staff had not recorded this bruise on a body map which was part of the incident management procedure.

The provider told us they were reviewing electronic systems for recording accidents which would improve their oversight and enable them to check staff had seen outcomes and learning.

We saw some evidence of learning shared in staff supervisions and staff told us there was a learning culture at the service and there was no fear of any blame. One member of staff said, “If someone has a fall, we review what caused it and update the care plan to prevent it happening again.”

People did not share any concerns about this quality statement.

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 had an ‘emergency grab sheet’ on file for people which recorded key information. For example, information about people’s allergies and next of kin details were recorded on this document. In the event of an emergency or an admission to hospital, this record could be sent with people which enabled medical professionals to have this key information.

If people had any admissions to hospital, copies of discharge records were added to people’s care records. This gave staff information on any changes to areas such as medicines or health needs.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately.

We found some safeguarding incidents had not been shared with the local safeguarding teams. The provider told us some concerns had been shared with people’s social workers, however, the incident had not been referred to the correct team. Also, the provider had not always notified Care Quality Commission of all incidents as required.

Staff had been provided with safeguarding training and understood what needed to be reported to their management. Staff also told us how they would share any concerns outside of the service if needed, for example, reporting to the police or CQC.

People said they felt safe with staff. One person said, “I have no complaints with them [staff], I feel perfectly safe with them here helping me up and down the stairs.” Where people needed additional equipment for their safety such as a pendant alarm, this was recorded in their care records.

The provider worked well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At our last assessment we found risks to people’s safety had not always been identified with guidance for staff. At this assessment the provider had taken action to make improvements and risks to people’s safety had been identified. Risk management plans had details of risks and how to safely provide care and support. These plans had been reviewed regularly.

The provider said the management team were regularly providing care and support to people and identified if people’s needs changed. This enabled changes to be made and any further guidance to be sought in a timely way. People’s care records demonstrated staff liaised with healthcare professionals for advice and guidance and people did not share any concerns about this quality statement.

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.

Risks to people’s safety in their environment had not been assessed to enable contingency planning to be considered. We found there were some mitigating factors to keep people safe, however, further planning was needed to make sure all actions could be taken. For example, for 1 person we saw staff were not able to reach their home due to local flooding. Whilst the person was safe, this hazard had not been added to the risk assessment for the person. This meant it was not recorded in their records that in the event of adverse weather other arrangements for care visits would need to be planned.

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.

There were enough staff to support people safely. The provider told us they had enough staff to safely carry out their planned schedule of visits. If the business increased numbers of people and visits, then action would be taken to recruit more staff.

The provider had completed the required pre-employment checks on staff. Staff had an induction when starting work and regular training updates when needed. Records demonstrated staff had regular supervision and had been assessed for competence in areas such as moving and handling and medicines administration. The provider told us they aimed for an annual check of competence for these 2 areas.

Staff were positive about the training and support they received. They confirmed they had regular supervision and could ask for any training they felt they needed. One member of staff said, “I receive supervision every week which is supportive. I have had an appraisal where performance and development were discussed.”

People said they felt staff were trained and they always completed their care visits. One person said, “They [staff] are here every day, never missed me. They are very helpful and seem very capable of doing their jobs.”

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 were provided with training on infection prevention and control (IPC) and had been given personal protective equipment (PPE) to use in people’s homes. People said staff wore PPE when needed and kept their homes clean.

Guidance on IPC was included in people’s care plans. For example, there was details for staff to know how to dispose of waste safely.

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.

Medicines continued to be managed safely. Staff had been provided with training on safe administration of medicines and had their competence assessed.

People’s medicines records were now all electronic which enabled the provider to have oversight of who had been given medicines and when. This meant if medicines were not administered the provider was able to take prompt actions.

Staff took pictures of prescribing instructions, and these were stored on people’s records. If people had medicines that could increase risk of bruising, this was clearly documented for staff to be aware and what actions were needed.