Homelium West Sussex

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 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.

This service scored 56 (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 based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. The provider acknowledged accident and incident reports were not always completed consistently. We reviewed records which showed only one incident had been recorded in the past 12 months. The nominated individual told us, “The issue is we know [care manager] is doing this on a daily basis, but we do not feel this has been fully recorded.” One staff member told us, “I have reported a few incidents in the past, but we do not have any specific lessons learnt or forms we complete,” and said, “concerns were reported directly to the care manager.” There was no analysis of accidents and incidents to identify themes, trends or recurring risks. There was no evidence that lessons were formally shared with staff. This meant the provider could not be assured that safety events were consistently reviewed and used to improve people’s care.
 

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. Pre-assessment records had been completed before care started and showed people and those important to them were involved in developing their care plans. A service user guide was available to help people understand what to expect from the service. One relative told us, “We had an initial assessment with an occupational therapist and a Homelium staff member to discuss [relative’s] current needs and requirements,” Staff made referrals and shared information on people’s behalf so they could receive input from healthcare professionals, including their GP when needed. This meant people’s needs were understood before care started and they could access further professional support when required.
 

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People and relatives told us they felt safe with staff. One person told us, “I feel very safe with the carers who come and see me.” Staff received safeguarding training and understood how to recognise and report concerns. One staff member told us, “I have reported a safeguarding concern in the past, although I did not hear anything back after reporting it, so I think something was done about it.” We found systems were not always effective at ensuring safeguarding concerns were recorded, monitored and acted on. We found only one safeguarding concern had been recorded in the past 12 months. When we discussed this with the care manager they told us, “There may have been other safeguarding concerns, but these may not have been recorded correctly.” This meant the provider could not be assured all safeguarding concerns were identified, shared and acted on, or that people were consistently protected from avoidable harm.
 

The provider did not always work effectively with people to understand and manage risks. Risk assessments did not always identify people’s individual risks or give staff clear guidance to provide safe and supportive care. People told us they were involved in discussions about their care. We found care plans were written in the first person and recorded what mattered to people, their preferences and some individual risks. However, some risk assessments were incomplete and did not identify relevant risks or the control measures staff should follow. A recent care review recorded concerns from a relative that they had occasionally been asked to act as the second carer during double-handed visits. There was no evidence this arrangement had been agreed or risk assessed by the provider or a professional. One person’s care plan recorded a history of seizures, but their risk assessment did not provide specific guidance for staff about how to recognise, respond to, record or escalate when a seizure occurred. We discussed this with the nominated individual and they told us, “We are changing how we do our risk assessments for people, but this will take time.” This meant staff did not always have clear guidance to manage risks consistently, increasing the risk of people receiving unsafe care.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. We reviewed care records and found that environmental risk assessments were in place. However, these were not always fully completed and did not consistently include clear control measures to reduce identified risks. For example, one environmental assessment recorded that fire and smoke alarms had not been tested. The assessment did not confirm whether the alarms were functioning correctly, whether there was sufficient fire detection coverage or whether appropriate arrangements were in place to support safe evacuation. It also identified that suitable measures were not in place along escape routes for the person. Despite these concerns being identified no mitigating measures were documented to address the risks. This meant the provider could not be assured that people and staff would be alerted promptly or able to evacuate safely in the event of a fire, placing them at increased risk of serious harm. Another environmental risk assessment identified that floors could become slippery when wet but did not include control measures to minimise the risk of slips, trips and falls for people using the service or for staff. This demonstrated that identified environmental risks were not always effectively assessed, managed or mitigated to help keep people safe.
 

The provider did not always deploy staff effectively to make sure people received care at the agreed time. Recruitment records showed the provider carried out appropriate pre-employment checks to assess staff suitability before they commenced work. Staff completed an induction programme, training, shadowing opportunities and competency assessments. Records also confirmed staff received regular supervision and appraisal. This helped ensure staff had the knowledge, skills and support required to carry out their roles safely and effectively. People and relatives gave mixed feedback about the reliability of care visits. Some told us staff arrived on time and that they were supported by regular staff members, which promoted continuity of care and positive relationships. However, others described late or rushed visits and said they were not always informed when staff were delayed. One person told us, “They are often late without any call to let me know, which is not great, but I know they do their best.” We reviewed staff rotas and found some visits were scheduled back-to-back or with only five minutes allowed between calls at different locations. Staff told us they were not always provided with sufficient time to travel between visits. One staff member said, “There is never quite enough time. After three or four calls we are then running late.” This meant delays could accumulate throughout the day, affecting staff punctuality and increasing the risk that people would not always receive care at the agreed time. The provider could not therefore be assured staffing arrangements consistently enabled staff to meet people’s individual needs in a timely and person-centred way.

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 had received infection prevention and control training and had access to a policy which provided guidance about safe practice. One staff member told us, “We have training in infection prevention and control (IPC) and in handwashing. This is especially important in my role.” People gave positive feedback about staff practice. One person told us, “The staff are great at keeping my house clean and free from germs.” This helped maintain a clean and safe environment and reduced the risk of infection spreading between people and staff.
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff received medicines training and competency assessments. People generally gave positive feedback about the support they received with their medicines. One person described their medicines as being handled “well and conscientiously by the carers.” Medicines administration records were not always clear or complete. Some contained gaps or entries which did not establish whether people had received their medicines. When we raised these concerns, the provider reviewed the records. They told us some gaps were caused by scheduling, connectivity or system issues. However, their review confirmed unexplained gaps remained for several people and further investigation was required to establish whether medicines had been administered. One record showed a medicine prescribed to prevent blood clots had not been administered because it could not be located. Although the omission was recorded, there was no evidence the staff member had reported it to the office or sought professional advice. Another record showed part of a prescribed antibiotic course had been refused with no evidence the pattern of refusals had been reviewed or escalated for clinical advice. This meant the provider could not always be assured that people received their medicines as prescribed or that omissions and refusals were acted on promptly, increasing the risk of avoidable harm.