Caremark Lewes and Wealden North

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 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 registered manager 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. Accidents and incidents had been reported and recorded correctly and were overseen by the registered manager. Any trends or patterns identified were shared with all staff. Staff felt confident to raise concerns where they identified potential risk to minimise the chances of accidents happening. For example, a member of staff told us about a worn carpet in a person’s home which they raised with the family who replaced it straight away. The registered manager told us they had debriefing meetings with staff when things went wrong to establish what could have been done better to prevent the occurrence. They used a learning tool called ‘topic of the month’ which anonymised people involved in an incident but enabled information to be shared with the whole team without blame.

The registered manager 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 registered manager made sure everything was in place before a person moved between services. Information was provided to hospital staff for example, if a person needed to spend time in hospital. When returning home a full review of their care and support needs were carried out. A professional told us, “They always ensure the transition from hospital to home is completed in a timely manner with adequate care in place as well as often arranging for the carer to meet immediately when home so they are not returning to an empty house, alone for too long.” Most appointments needed by people for example, GP or dentist were arranged by family members but staff were able to assist if needed.

The registered manager 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 and their loved ones told us they felt safe when supported by staff with comments including, “Absolutely safe,” “Yes, they are safe when supported by them” and “They are very caring and I always feel safe.” Staff had received training and regular refreshers in safeguarding and were able to tell us what amounted to a safeguarding incident and the steps they would take if required. Staff were also confident to use the whistleblowing process, a legal process where concerns could be raised anonymously. Some people lacked capacity to make some decisions and were supported by family and staff to make decisions that were in their best interests. People’s mental capacity was always considered and reviewed. When people needed specific support, decision specific mental capacity assessments were carried out to check people’s understanding. People’s varying ability to make decisions was reflected in care plans. This was also recorded at the beginning of assessments and reviews of people’s care to make sure the right support was present for people.

The registered manager 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. Staff knew people well. They knew about specific risks for people, the best ways to prevent things from going wrong, and the actions to take if something did happen. Staff would report any changes in people’s presentation or apparent needs to minimise risks. For example, a relative told us that a person who was having more frequent falls needed extra equipment support in the bathroom. This was immediately arranged, liaising with the service and other professionals. A Field Care Coordinator who had carried out the person’s pre-assessment would always carry out the first care call for a person new to the service. Staff would shadow these calls so they could understand the risks involved when supporting people. Combined risk assessment documents were in place which covered known risks but also highlighted where risks may overlap, for example a change in medication might increase a person’s ability to mobilise. Some people needed support in relation to diabetes and catheter care. Clear instructions were available to staff about what action to take if required, to make people safe and comfortable.

The registered manager detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental checks of people’s homes were carried out as part of the pre-assessment process. Potential hazards were identified and recorded and the location of important utilities such as water stop cocks, and electric fuse boxes were identified. Access to people’s homes was recorded and included the location of key safes and any seasonal potential hazards for example, pathways that may be icy in winter. Home fire safety checks were offered and arranged when needed. Environmental risk assessments were in place and new staff were able to familiarise themselves with people’s homes before starting their care calls.

The registered manager 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. Staff were safely recruited. Staff files contained all the required documents relating to pre-employment checks including references and Disclosure and Barring Service (DBS checks. DBS checks help providers make safer recruitment decisions. Staff told us about a thorough induction program which included shadow shifts and visits to people’s homes to understand environmental issues. Staff were further supported with regular visits from managers to carry out checks on the way they worked and their competencies with medicines. Staff were fully trained in all aspects of care to enable them to provide the best support to people. Regular training refreshers were in place. Although the staffing team was relatively small, there were enough to cover all care calls. Staff had regular supervision meetings with the registered manager where their progress and any support needed were discussed.

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.Staff had received training in infection prevention and control and the registered manager included compliance as part of their unannounced, on-site, supervisions. People and their loved ones told us that staff wore personal protective equipment (PPE) appropriately and staff confirmed there was always a good and available supply of PPE.

The registered manager 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. Most people were independent with their medicines or were supported by their families. Staff however sometimes helped with prompting, reminders and occasionally with administration. Staff had been trained in medicine administration and had regular knowledge checks. Care plans provided details of people’s medicines so staff could check for side effects and so they knew what the medicines were for and the consequences of them not being taken. Medicines were stored safely in people’s homes and family members arranged repeat prescriptions and GP reviews.