Helping Hands Aylesbury

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. At our last assessment we rated this key question good. At this assessment the rating has changed to 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.

The service was in breach of legal regulation in relation to, people’s safe care and treatment and the ways people’s medicines were managed safely.
 

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.

The provider did not always have a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Care staff were regularly reporting concerns or changes observed. However, improvements were required to ensure lessons were learnt to continually identify and embed good practice.

Records did not always demonstrate risks reported by care staff were routinely followed up effectively. For example, where people had fallen or had an unexpected event these incidents had not been appropriately reviewed by senior staff to ensure lessons were learnt to reduce the risk of recurrence.

We found examples where some lessons had been learnt across the organisation and action taken. For example, the provider identified short notice rota changes caused stress and confusion and took steps to establish a communication channel solely to capture late running of visits and to and inform people in a timely manner. One person told us, “Yes, they always let me know if they're late.”

Systems were in place for staff to report accidents and incidents and told us they had confidence to escalate concerns. One member of staff told us, “When recording incidents, l use the notification form. l explain what happened in detail including the person involved, time, date and if there is an injury occurred”.

The registered manger was aware of the requirements under the duty of candour regulations.

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.

We found the service worked well with external healthcare professionals. Where people’s needs had changed, we noted the service referred them to the district nursing services. For example, where staff had noted new wounds or breakdown in skin the district nursing service was contacted.

The provider told us, “We work closely with a wide range of partners, including GPs, district nurses, occupational therapists, pharmacists, mental health teams, speech and language therapists, tissue viability nurses and safeguarding teams.” A staff member told us how a person they supported was prescribed compression stocking after they had informed the office about a deterioration in the person condition.
 

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.

Systems were in place to report safeguarding concerns to the local authority. However, we found potential safeguarding concerns had not always been reported when required. One person had been harmed when staff were supporting them move position, although the harm was not intentional it had not been reported to the local authority as potential abuse. In addition, where people were at risk of self neglect this had not been reported to the local authority to ensure support was available to the person.

Staff had received training on how to recognise and respond to abuse, and posters were displayed in the office. Staff were able to demonstrate how they applied the training they had received comments from staff included, “I feel confident about raising abuse concerns” and “l feel confident because l have done the training on how to handle abuse situations and how to notice abuse.”

People told us they felt safe with the staff visiting them, comments from people and their relatives included, “I don't have a problem, and I feel safe with them [staff]. I've not had any falls while they're [staff] around” and “[person] absolutely feels safe. Most [staff] treat them as a [family member]”.

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.

Systems were in place to assess and monitor risk to mitigate harm, however, these were not always robust. Risk assessment had not always been reviewed following changes or new events in people’s conditions.

People who had been diagnosed with diabetes, had care plans in place, however they did not always contain enough information about the individual, their usual blood sugar levels and any signs of deterioration in health.

We found other people had conditions or incidents which had presented risks to them. The risk assessments completed were not adequate to mitigate potential harm to people. For instance, people who were at risk of a deterioration in their skin integrity did not always have an up to date risk assessment in place which assessed the level of possible harm. One person’s records showed they had open wounds however, the risk assessment had not been updated since 2023. We discussed this with registered manager who arranged for the assessment to be updated. However, the updated version still lacked accurate information, as it stated the person had no history of skin breakdown.

People who used heat pads did not routinely have risk assessments in place to highlight potential harm and how to reduce this.

People who lacked insight to risks associated with their own environment, did not have clear support plans which provided guidance for staff on how to support them and minimize harm. One person had been exposed to risk of fire, however, we found no additional information was available to staff on how to reduce this risk.

We found people who were at high risk of falls had risk assessments in place, however, records relating to falls did not always show what action had been taken to prevent a reoccurrence or any referrals made to external healthcare professionals.

Staff told us they had access to information about risks to people and were able to understand their role on how to prevent harm to people. One member of staff told us, “Most of the time I feel I have enough detailed information available to me to manage risks, but of course I also have to be on a constant look-out for risks”. Staff also told us “Our managers are very quick to act, and they act in the best possible ways to make sure we understand the problems and we can correct our ways. The effect of this on the quality of people’s care is usually immediate”.

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

Potential risks associated with the person’s home were assessed and mitigated. For instance, areas of the home where any repair was required or had potential risks were identified. For example, frayed carpets and poor lighting. Staff were made aware of safe exits in the event of an emergency.

We found examples where staff had supported people to ensure the security of their home was maintained. For instance, a staff member had found keys in a front door on arrival at a care visit and escalated the concerns to family members to ensure locks were changed.
 

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.

During the inspection, we found staffing levels were sufficient and met the needs of the people.

Staff were appropriately qualified, experienced and deployed to ensure effective care. Staff had completed The Care Certificate which is the nationally recognised standards all care staff need to meet. The standards include communication, privacy and dignity, equality and diversity and working in a person-centred way. Systems were in place to ensure staff were up to date with mandatory and bespoke training, where training dates had expired the registered manager ensured they were not allocated to support people until training had been updated. Staff told us, “We have to retake all our trainings yearly, including safeguarding training. I think I did mine [training] last autumn. I keep my notes from my learning with me so I can check my test when the need arises”.

Recruitment processes were robust, with all staff having up to date Disclosure and Barring Service checks. These provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions. We found references and employment history were verified before staff starting work.

Staff received 1:1 meetings with a line manager and an annual review of their performance, staff told us they felt supported. Comments included, “Normally my manager would come on the field and do supervision, they go through everything from safety, hygiene, how to administer medication, infection control and what to do and who to contact when risks occurs” and “I think we are being supervised every 3 months. I really like these sessions as we can freely speak up about anything that concerns us or is not clear, every time I raise an issue, my office is really helpful to fix it for me.” Another member of staff told us, “I receive regular supervision and feel supported by my manager. Supervision gives me the opportunity to reflect on my practice, raise concerns and discuss development.”

We highlighted the need for additional risk assessments for some staff to ensure they were appropriately supported with any health conditions they had. The registered manager responded quickly to this feedback. In addition, we noted some improvements were required on how the service checked staff competency. We found competency judgements were based on limited exposure to complex tasks, for instance, how to support people move positions. We discussed this with the registered manager to ensure staff competency was checked prior to them supporting a person who required equipment, to help them move position.

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.

Systems were in place to ensure staff received training in infection control and food hygiene. Staff had access to personal protective equipment (PPE) and would visit the office to collect. We observed the office had a good supply of PPE. People told us staff did wear PPE. Comments from people included, “Yes, she wears the gloves” and “If they have a cold they will wear a facemask”.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Systems were in place to monitor and audit medicine management; however, they did not identify the issues we found.

People’s medicines were not always managed safely. We found records regarding medicines were not always completed in line or follow National Institute for Health and Care Excellence (NICE) guidelines. We found daily notes had been completed to show a care worker had supported a person with eye drops and antibiotics, however, these were not listed on a medication administration record (MAR) and no additional information was provided to staff to ensure they were administered safely.We spoke with the registered manager about our concerns and they took action to ensure improvements were made.

We noted some staff were recording medicines were not required. However, there was no clearly recorded authorisation for this. One person’s MAR contained conflicting information regarding when a medicine was stopped by the GP. However, staff had still administered this medicine on three occasions after. This meant changes in medicine had not been clearly recorded or acted upon to ensure people received prescribed medicines safely.

Care and support plans were not always clear on the level of support people required with their medicines, or staff did not always follow the guidance. One person’s records clearly stated they needed medicine to be administered by staff. However, staff were routinely leaving this medicine out for the person to take at a later time. The staff had then found the same medicine not taken. This meant there was a risk to people being under or overdosed.

We found some improvements were needed for, ‘as required’ medicines (PRN). Not all PRN medicines had additional guidance for staff to follow on when, how and why to administer the as required medicine. We spoke with the registered manager who confirmed this would be added to the person’s care plan as a priority.

However, people were supported by staff who had received training in the safe administration of medicines. People and their relatives told us they had no concerns with how people received their medicines.