Alina Homecare - Epsom & Ewell

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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 for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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. Lessons were learnt to continually identify and embed good practice.

The service used a tracker to record accidents and incidents, together with actions taken and lessons learnt. Only records reviewed by the operations manager and quality team could be closed which helped to ensure consistency in response to these events.

A monthly audit was completed to look for themes and trends, and learning was shared with staff. This included with 1 person where there were concerns about their skin integrity and this was discussed with staff. A staff member told us, “The office does the paperwork and there is a note that is sent out to everyone."

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’s initial assessments included anyone else involved in their care. This included family members or health professionals. This helped ensure that relevant information was shared and recorded so staff had as much detail about the person as possible. A relative said, “We went through all the things we had to go through. I was involved in all of that, regarding my mum’s needs, the needs of her property. I was very involved.”

Staff supported people to have smooth transitions when leaving hospital and returning home. This included 1 person who required some aids to support their mobility. Staff spoke with the hospital discharge team and suitable equipment was arranged and in place for the person’s return. A relative told us, “I rang 3 agencies when my family member was in hospital and immediately, I spoke to [registered manager] I was assured they could offer what I wanted.”

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.

Staff understood what constituted a potential safeguarding concern and knew how to report it. Any allegations of abuse were investigated by the registered manager and reported appropriately. This included, where a care call was missed and the registered manager reported this to the local authority safeguarding team as well as CQC. A staff member said (if they suspected abuse), “I would call the office and let them know and then complete a report.”

Staff used key coded entry systems to access some people’s homes, and the service had implemented a secure protocol to safeguard the codes. This helped ensure they were stored confidentially and accessible only to staff authorised to know them.

A relative told us, “My family member is very comfortable around everyone who visits her and has not raised any concerns to me about anyone.” Another told us, “I have zero concerns about his safety.”

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’s care plans contained good detail around their individual risks and how staff could help keep the person safe. This included where 1 person had a specific dietary need, another who was at high risk of falls and a third person who would sometimes get up at night. Their relative told us, “He is often up at night, and they (live-in care staff) will get up too and check on him.” Some people wore alarm pendants so they could attract attention should they fall and within their daily schedule it was clearly recorded that staff should always check the person was wearing their pendant. A staff member said of 1 person, “She has a hospital bed and an air mattress (to reduce the risk of pressure sores).”

The service maintained a contingency plan to address emergencies beyond its control, including adverse weather conditions and failures such as computer systems. This helped ensure continuity of care and minimise disruption to people. Each person had their own contingency plan in place which recorded key contacts and others involved in the person’s care. They also recorded the person’s dependency to help ensure people were appropriately prioritised.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Each person had a full environmental assessment carried out by staff which helped ensure that any risks, such as uneven paving stones, or threshold steps were identified. Staff could then be mindful when supporting someone with their mobility, for example. One person’s care plan recorded that although they had an upper floor in their house, it was not used due to the person’s risk of using the stairs. It was clear therefore on the rationale for the person living on the ground floor only.

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 a sufficient number of staff available for people receiving a care package. People told us that staff turned up on time and stayed the full time expected and no one said they had ever had a missed call. A staff member told us, “There are enough staff and the travel time is quite good.”

Travel time was factored into staff rotas to help ensure their timing was reliable and staff did not feel rushed. A relative said, “The staff arrive on time, we’ve had a couple of times where they were late in the morning due to traffic, but that’s not really an issue.”

The service had an out of hours service where people could speak with someone should they need assistance outside of normal working hours. The registered manager said, “The on call will not go to sleep until the last call is completed.” A handover took place each morning to discuss any concerns or issues from the previous night’s calls, which ensured any relevant information was shared.

Staff underwent a thorough induction programme which included 3 full days of interactive training, covering all the Care Certificate standards and incorporating the Mental Capacity Act 2005, safeguarding, dementia and autism. They also attended face to face first aid and moving and handling training. The Care Certificate (a set of foundational standards for health and social care workers in the UK) was part of the induction. A staff member said, “If there are times where I felt I am unsure I get booked on the training.” A relative told us, “The carers all seem well trained.”

Staff were recruited through a robust process which included them providing a full work history, references, evidence of their right to work in the UK and their fitness for the role. Each prospective staff member also underwent a Disclosure and Barring Service check prior to starting work. Disclosure and Barring Service checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer 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.

Staff were provided with sufficient personal protective equipment (PPE) to support them to carry out their role in a safe way. This included gloves, aprons and masks when appropriate. Stocks of PPE were available at the office for staff to collect. A relative told us, “I check to make sure the carer has arrived and I always see that they (staff) are wearing the correct PPE.” A staff member said, “We use PPE to protect the client as well as ourselves. We have enough (PPE).” Another told us, “That’s the most important thing. I wear an apron and gloves and use a sanitiser and may wear a mark. I wash my hands as well many, many times a day.”

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.

The service used an electronic medicine administration recording (MAR) system. This recorded when a person had taken their medicine or included a note if they had refused. We reviewed the MARs for 2 people and found no gaps which indicated people were receiving the medicines they had been prescribed. People told us staff supported them with their medicines. One person said, “They help put on my prescription cream.”

Only fully trained staff administered medicines to people and only when medicines were in their original boxes or in a container filled by a pharmacist. Staff underwent regular medicine competency assessments to help ensure they continued to follow safe practices. A staff member told us, “My manager did my competency check last week, she came to watch how I administer the medication.”