Delight Supported Living Ltd

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 newly registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.
 

This service scored 59 (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. Whilst staff listened to concerns about safety and investigated and reported safety events, lessons were not always learnt to continually identify and embed good practice. Individual matters were discussed and shared with staff on a case-by-case basis. However, this approach needed more work to formalise learning more widely. Although clear records were kept about any incidents at the service, we found there was a lack of narrative analysis of incidents, accidents and safeguarding matters to draw out themes and trends and reduce the risk of reoccurrence going forwards.

The provider worked well with people and healthcare partners to establish and maintain safe systems of care. However, they did not always make sure there was continuity of care when people moved between different services, due to inconsistencies in care planning records. This posed a potential risk to people as their support needs would not be accurately recorded if they transferred into the care of another service. Despite this, feedback was positive about care staff in practice, including the office team who would cover care visits if required. A relative told us, “We haven’t had any major health incidents, but I am confident [the service] would deal with it if there was anything. We had to wait [on 1 occasion] because a care worker was staying with a previous client whilst their health was sorted out, they (care workers) would do the same for us.” A staff member confirmed this process, stating, “[Management] sent someone from the office when I had to wait with a person for an ambulance.” The service made referrals as needed to support people. A relative said, “We have always been told about any accidents. [Person] had a gash on their heel from frail skin, and the care workers raised it, and it’s now regularly dressed by a nurse.”

The provider sought to work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They concentrated on improving people’s lives and protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider did not always share concerns quickly and appropriately with all relevant stakeholders. We found the service completed investigations and made referrals to the local authority safeguarding team as required. But the service did not notify the CQC about these safeguarding matters, which is a legal requirement. The registered manager confirmed notifications would be completed retrospectively. Despite this, everyone we spoke with felt the service was safe. One relative told us, “Yes [person] is very safe with them (the care workers). [Person] tells me they feel as though the care workers are friends.” Another person’s relative described the care team as, “Lovely people”, adding, “[Person] is really safe with them.” One person using the service said, “My carers, but [staff name] in particular, makes me feel safe and even if they are very busy the carers make me feel very comfortable.” Staff were also confident any concerns they raised with the management team would be followed up appropriately.

The provider did not always work well with people to understand and manage risks. Staff did not always have the information they needed to provide care that was safe, supportive and enabled people to do the things that mattered to them. Whilst risk assessments were detailed in some areas, this was not consistent and we found a number of areas where information was not sufficient to mitigate potential risks. For example, we identified multiple care records where people were at risk of choking without there being a specific choking risk assessment in place. The registered manager acted straight away to update these records during the inspection process. However, other documents did not have clear information in areas such as falls risks, seizure management, dehydration or risks associated with self-neglect. The registered manager told us they were moving across to a new system for storing care plans and risk assessments, and this would be addressed as part of this process.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We saw evidence in care records people were supported with safety measures in their home environment. This included onward referrals to other agencies such as the fire service, to ensure people had access to working fire alarms and advice as required. The service also completed an assessment of the home environment, to review any risks which could cause slips, trips or falls. The provider had a business continuity plan in place in case of emergencies such as adverse weather, which could impact on service delivery. This included a list of people and their care and support needs, to facilitate the prompt prioritisation of visits.

Staff worked together well to provide safe care that met people’s individual needs. However, the provider could not fully demonstrate there were enough qualified, skilled and experienced staff, due to shortfalls in recruitment practices. Although the provider completed recruitment checks to ensure staff were safe and suitable, we found some gaps and inconsistencies in these records. This included shortfalls such as a lack of full employment history, and unclear information about whether key checks such as proof of address or the right to work in the UK had been completed before employment start dates. The provider told us they planned to strengthen recruitment oversight systems going forwards. Feedback about day-to-day staffing in practice was positive. People told us they were informed if care staff were going to be late and had never experienced a missed call. The provider operated an electronic call monitoring system, where care workers ‘logged’ in and out of visits using a code on their mobile phone. This helped to ensure people received support in line with their assessed needs. A relative told us, “[Care workers] are timed in and out on their phones, but they are not rushed ever, and they do everything that is needed and ask us if they need anything.” Most people felt they had good continuity of care, and that staff were well trained, competent and understood their needs. Another person’s relative said, “The care workers are very well trained, and [person] feels safe with them.”

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. We received positive feedback care workers consistently wore the appropriate personal protective equipment (PPE) and disposed of this safely and hygienically. A relative said, “The care workers wear gloves and aprons. They put them on after they come in and put them in the bin before they leave.” Staff received training in infection prevention and control and were aware of how to promote good hygiene practices to keep people safe. This included in relation to food safety standards when preparing meals and drinks. A staff member said, “My food hygiene training is all done.”

The provider made sure that medicines and treatments were safe and met people’s needs. However, some care records did not clearly show people’s involvement in managing medicines, including relevant mental capacity assessments. We raised this with the provider who confirmed this would be reviewed, and signposted them to support from the local authority. Where support was provided with medicines, this was completed safely, and we received positive feedback about staff practice. One person said, “[Care workers] do my medication on my first visit and then because I cancelled the last call, they leave my night tablets out for me which works well.” The provider used an electronic Medication Administration Record (eMAR) system which showed staff support with medicines in real time. This helped to ensure people received their medicines as prescribed. For example, we saw a person who needed to take their medicines at a similar time each day to provide the most benefit for their healthcare condition. Records showed this was consistently met. Another person needed a protocol in place for the use of inhalers to help with their breathing. We saw detailed information was available to guide staff on how best to support the person. A staff member said, “I just ensure that the key principles of safe medication administration are always followed. The right person, right medication, right dose, the right time and the right route.”