Right at Home Bexley & Dartford

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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 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 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 registered manager and the provider had fully reviewed accidents and incidents that had occurred at the service. Lessons learnt had been recorded and embedded. For example, the registered manager had reviewed an accident involving a staff member, their vehicle (which was a scooter) and ice. They identified that during winter months, some of the roads used to get to some people using the service were dangerous for any staff using scooters/motorbikes. They deployed staff using scooters/motorbikes to care calls within areas which were likely to be gritted and well lit. These changes were rolled out to keep staff safe.

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 carried out assessments of people’s needs prior to their package of care and support starting. This enabled them to meet people in their own homes. Staff told us care plans and risk assessments were in place when they carried out their care and support visits. A relative told us, “They came out and asked what support we wanted.” Another relative said, “We had a meeting, checked her needs and checked the carers. Reviews happen regularly.”

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 were safe and were protected from harm. Safeguarding and whistleblowing policies were in place and were accessible to staff. Staff were aware of the safeguarding policy. A member of staff said, “I would report it [abuse] to my supervisor/management. If nothing was done, I would escalate to the local authority.” People told us they felt safe.

The provider did not always work well with people to understand and manage risks. Staff did not always have access to guidance about how to meet people’s needs that was safe and supportive. The provider had not always considered all the risks relating to providing care and support and had not always detailed clear actions for staff to mitigate risks. For example, people at risk of constipation did not have a clear risk assessment in place to detail to staff how to escalate concerns of constipation. Another person’s risk assessment for diabetes detailed what staff should do if they were having a hypoglycaemic attack but did not list the signs for hyperglycaemic attack and what staff should do. After the site visit the registered manager amended the risk assessments and care plans to provide clearer guidance for staff.

Staff told us they had access to risk assessments and care plans. A staff member said, “Care plans and risk assessments are clear, I read them before I go.” Relatives told us that staff were aware of risks and used equipment to support people safely. Comments included, “They talk to him and reassure him that he is safe” and “They are good at manual handling.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risks relating to the environments staff were working in had been fully assessed. For example, risks relating to access, flooring, lighting, location of emergency shut offs for gas, electric and water. The provider had made referrals to the fire service for community support for people when required.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. We received some feedback from relatives regarding the quality of training that staff received. For example, we received mixed feedback about staff’s understanding of meeting people’s needs, particularly those with dementia. The management team told us they had completed some additional checks with staff regarding their practice and did a small workshop with staff. Another one had been planned for the whole staff team in September 2025 to enhance their support for people with dementia. This was included on their action plan for improvement.

The provider’s training records showed staff had completed most training to meet people’s assessed needs. A staff member told us, “I have been doing lots of eLearning training, I did this at the office. I did face to face training with 5 of us at the office building. [Trainer] trained us in basic life support, moving and handling, and medications. Moving and handling was more theory and did not include using any equipment.” We spoke with the registered manager about the moving and handling training as staff had reported a concern about how a person had been supported to transfer. The registered manager told us, at the time of the inspection all moving and handling theory training had already been completed. Practical training was provided on a needs-led basis by the moving and handling trainer at the person's home where the equipment was located.

Staff reported they had travel time allocated to them to enable them to travel between care visits. We observed that there were enough staff deployed to meet people’s planned care needs. We received mixed feedback about visit times. Comments included, “They arrive on time. If they are a little late, they will ring”; “Never late. They work over if running a bit late. They let me know”; “On 3 occasions they have been a little late. There has been a time when they were not staying for the time, we spoke to manager, and it has been addressed” and “Sometimes the carers will come on their own instead of in two’s. They have to call her husband when they are on their own.”

The provider used electronic call monitoring. We analysed the data and found that care visits were mostly timely. Our analysis did pick up some issues which we discussed with the management team. They confirmed these issues were known about and had been dealt with.

Staff were recruited safely. We examined 4 staff files, and all of the required checks had been carried out and documents were all in date. In files we saw copies of references, interview notes, photographic identification and Disclosure and Barring Service forms (DBS). DBS 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. The provider had an up-to-date infection prevention and control (IPC) policy. Staff had completed IPC training. Staff told us they had access to personal protective equipment (PPE) to keep themselves and people safe. A staff member said, “I have extra PPE in the car, gloves, aprons, masks and shoe covers. I always make sure there is enough for the next person too.” Another staff member told us, “PPE is always available in offices and client homes. We must wear masks and gloves before providing care.” The provider carried out spot checks of staff practice which included checks to make sure staff were using PPE appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had medicines policies and procedures in place. The management team completed regular medicines audits. Medicines administration records showed that most people had received their medicines as prescribed. However, 1 person was prescribed ‘as and when required’ (PRN) medicines. They did not have the appropriate protocols in place to support staff to know how or when to administer these medicines. Another person had time sensitive medicines prescribed to treat Parkinson’s disease. Records showed these had not always been given at the same time each day. The care plan and risk assessment for this person did not have all the details staff needed to understand why the medicines needed to be given at a particular time. Some people were prescribed a medicine which should not be given at the same time as caffeinated drinks and calcium rich foods. This is because it affects the medicine working effectively. Their care plans and risk assessments did not provide this information for staff. There was no evidence to show that the person had been impacted by this. We reported this to the management team and immediate amendments were made to medicines care plans, risk assessments and medicines administration records to make this clearer for staff.

Staff told us they received medicines training. Comments included, “I have completed medicines training, I apply creams” and “I have supported a client to use an inhaler and taken prescription medicine from the box and prompted the client to take it. I have done medicines training, I would not give medicines that relatives had given me to give the person, only those prescribed.” A person said, “They give my medication, they always check and speak to the pharmacist if needed.” A relative told us, “They support with medication. She gets medication when she needs it.”