Thames Homecare Services Greenwich Branch

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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 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.

We identified a breach of the regulations in relation to the management of risks and the safe administration of medicines.

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.

Systems were in place to support staff to report safety concerns and incidents, however these were not being consistently applied.

We found incidents which had not been reported in line with the provider’s process. We found care plans which had not been updated in response to previous safeguarding concerns. For example, a person had sustained a pressure injury which had been investigated by the provider. However, the person’s care plan had not been updated after the incident to help mitigate the risk of the injury occurring again. These shortfalls meant we could not be assured there were robust systems to learn from past events and embedded good practice.

We raised this with the provider and they have accepted that the connection between incident learning and subsequent care-plan updates required strengthening and have addressed this through their action plan.

The provider worked with people and healthcare partners to establish and maintain systems of care. They made sure there was continuity of care when people used and moved between different services.

Care coordinators conducted home visits to ensure they were able to provide the care needed prior to accepting people to the service. A member of staff told us, “When we receive a referral, we visit the client to carry out the initial assessment to make sure we can meet their needs. We then do a follow-up after a week to make sure everything is going as planned.”

People told us they were satisfied with the assessment process. A person said, “I had an assessment at home with a manager, and everything was explained.”

The provider worked with external professionals including General Practitioners (GPs), district nurses, social workers and specialist healthcare services to ensure support remained coordinated and responsive.

The provider worked with people and healthcare partners to understand what being safe meant. There were systems in place to protect people from the risk of abuse and improper treatment. Staff worked with the relevant agencies when concerns about people were raised.

Staff had completed safeguarding adults and children training and knew their responsibilities around protecting people from harm. Staff could explain potential signs of abuse and knew when to escalate concerns. A member of staff said, “We get training on all the different types of abuse. If I saw anything concerning, I would report to my manager as soon as I could.”

People told us they felt protected from abuse and avoidable harm. Comments included, “I feel absolutely safe. The carers are very reassuring, I am very happy, no abuse ever” and “I feel safe as the carers are very good and give me confidence.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider’s arrangements for assessing and managing risks to people were not always effective. Care plans and risk assessments showed staff identified risks but risk management plans did not contain sufficient information about how to mitigate these. We found guidelines were not sufficient for the management of risks in relation to a range of risks and care needs including skin breakdown, falls, epilepsy and diabetes.

For example, many people had been assessed as being at high risk of skin breakdown and required regular repositioning by staff to reduce the risk of developing pressure ulcers. We found repositioning records to be inconsistent so we could not be assured people were always being repositioned regularly in line with their care plans.

Several people required support with catheter care, however, there was insufficient information in people’s risk assessments and care plans about how to carry out these tasks safely or the signs of potential issues to look out for. The lack of robust risk management plans exposed people to the risk of harm as staff did not have all the information they needed to ensure they knew how to mitigate the risks to people’s health and wellbeing.

Despite our concerns with the provider’s risk management processes people told us they felt safe. Comments included, “I know mum is safe with the carers” and “I feel very safe as I have known my carer a long time” and “It is a real comfort to me knowing [family member] is safe and being well cared for.”

The provider detected potential risks in the care environment; however, we could not be assured all risks were sufficiently controlled. Although the provider was assessing the risks associated with people’s environments, we were not assured all necessary preventative measures were in place when risks had been identified. Several people had been assessed as being at increased risk of harm from fire and would benefit from a London Fire Brigade home safety visit. In many cases there was no evidence that referrals had been made to help advise people on how to reduce the risk of harm from fire in their home. We found personal emergency evacuation plans lacked sufficient detail to ensure staff would know how to support people to evacuate their home in the event of a fire.

The provider did not always make sure staff were effectively deployed to meet people’s needs. People did not always receive their care visits as planned. Prior to our assessment we were informed there had been a rising number of complaints in relation to staff timekeeping and attendance. The provider was using an electronic call monitoring (ECM) system with the aim of ensuring care visits were scheduled and attended in line with people’s care plan. Analysis of the ECM data showed persistent issues with timekeeping and people not getting 2 staff attending at the same time. We also found the scheduling of staff rotas was an issue as staff were not always being given sufficient travel time in between care visits.

Feedback from people about timekeeping was mixed. Many people spoke positively about the punctuality and timeliness of their care visits. However, some people told us timekeeping was a problem and they were not always informed when times changed or staff were running late. A person told us, “I wish they would notify me if they are going to be late, it is a common courtesy.” Positive comments included, “The carers are on time, and they will inform me if late.”

The provider did not follow safe recruitment processes to ensure staff were suitable to work with people with health and social care needs. The provider was not following their own recruitment policy as they had not obtained a full employment history when recruiting new staff. Staff told us the practice was to gather a 10-year work history only. This meant there was a risk that staff were not suitable for their roles.

The provider had a training programme to ensure staff had the skills and abilities to fulfil their role. Staff told us they were happy with the training and support they received. Comments included, “The induction and shadowing were very good when I first started” and “We get ongoing training in all aspects of the job and regular supervision.”

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. People told us staff observed safe hygiene practices and wore appropriate PPE when carrying out care and support. Comments included, “My home is kept clean” and “They always wear gloves and are continually washing their hands.”

Staff had received infection prevention control training to help reduce the risk of infection in people’s living environments. They had access to personal protective equipment (PPE) to minimise these risks.

Despite these generally good practices further improvements were needed as care plans and risk assessments did not contain information about how to manage the risk of infection.

The provider did not always ensure people’s medicines were managed safely. We identified a range of issues with medicine care plans and recording. The provider had not adequately assessed the risks associated with each person’s medicines and there was insufficient information about potential side effects that may affect people’s health and wellbeing. For example, several people were being prescribed medicines that increased the risk of bleeding. The provider had not identified this as a risk and had not provided any information to ensure care workers would take the necessary action in the event of an emergency. Directions for when required (PRN) medicines such as paracetamol were not sufficient. We also found medication assessments did not always have accurate information about what medicines were currently being prescribed.

Despite the issues with records people and relatives told us staff managed medicines well in practice. Positive comments included, “They give me my tablets, I have never had a problem, and they always check I have taken them” and “My medication is in packs; they give it to me at every visit plus cream on my skin wearing gloves.”

Staff demonstrated a good understanding of their responsibilities. They told us they ensured people took their medicines as prescribed, and they escalated any concerns they had to senior staff. A member of staff told us, “If my client refuses to take their medication, I will try and understand why and try to explain to them how important it is. If they still don’t want to take it, I record it and tell my supervisor.”