Custom Home Care

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 people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has remained 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 provider had systems and processes in place to record, review and analyse accidents and incidents. The registered manager identified lessons learned from accidents and incidents and shared these with members of staff.

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 had good links with health and care professionals and received their initial assessments which were used to develop more detailed plan of care and support. This ensured continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve for this to be achieved. 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. The provider raised concerns with people’s safety with local partners and followed local safeguarding processes. There was a safeguarding policy in place and staff received training to keep people safe. A member of staff told us, "I have access to safeguarding policies and training. If I suspect any abuse, I will report immediately to my line manager and follow safeguarding procedures. I keep people safe by following care plan and reporting any concerns. I would report any colleague providing dangerous and unsafe care." A person told us, “I feel safe with [staff] because I trust them.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. We were not assured the principles of the Mental Capacity Act 2005 (MCA) were understood by the provider or the registered manager. There were no references or evidence of assessing or reviewing people’s capacity following the principles of the MCA. This was identified as an area for improvement for the service and we discussed this with the registered manager.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do the things which mattered to them. People’s care needs were risk assessed and reviewed. There were details about how care should be provided in line with people’s expectations and preferences for each care call. However, some elements of people’s care plans lacked detail. For example, a care plan for a person with epilepsy did not have an epilepsy-specific care plan and there was limited information about what members of staff should do in the event of an epileptic episode. There were no records of any epileptic episodes and their epilepsy appeared to be well managed and all other aspects of care and support had care plans in place.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider reviewed and analysed electronic call monitoring information to ensure people received their care in line with their requirements. Where people had moving and handling equipment, risk assessments were in place and members of staff received appropriate training and support. A family member told us, “When the hoist was introduced, the registered manager came round to make sure carers knew how to use it.” Another family member said, “[Staff] are competent using the hoist. The carers always explain what they are going to do.”

The provider made sure there were enough qualified and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care which met people’s individual needs. Members of staff received training to deliver care safely, however, there was limited evidence of training to support staff to understand the needs or provide care and support to people with a learning disability or autistic people. We discussed this with the registered manager and asked them to take action. Members of staff were recruited safely and pre-employment checks completed appropriately. People and their family members told us there was continuity of staff which enabled them to build rapport. Timekeeping of care calls was good and if members of staff were going to be late, people received a phone call explaining why. Members of staff stayed for the allocated time for the care call and on occasions over the allocated times to ensure care was completed as required. A family member said, “On the whole there is continuity of carers, males and females. Time keeping is good.”

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 requirement to use personal protective equipment (PPE) was detailed in people’s care plans. Members of staff confirmed they had access to PPE and training to manage and control the risk of infection. A member of staff told us, “I have access to PPE, and I have completed infection control training.” People and family members told us members of staff wore gloves and aprons appropriately and there were no concerns about hygiene. One person told us, “[Members of staff] respect my home and me. The kitchen is always left clean and tidy.” Another person said, “[Member of staff] keep the place tidy for me.”

The provider made sure medicines and treatments were safe and met people’s needs and preferences. Staff involved people in planning, including when changes happened. The provider had policies and processes in place which ensured the safe administration of medicines. Medicine administration records (MARs) were audited and reviewed by the registered manager. People were satisfied with the administration of medicines by members of staff. One family member had concerns about staff awareness of the importance of giving medicines which were not in the blister pack or ’Nomad’, for example, antibiotics, analgesia, or anticoagulants and these had been addressed this with the registered manager. People told us about the administration of medicines, “[Staff] give the medication. Lots of changes to medication but they use a ‘MAR’ chart, so it is all ok.” Members of staff confirmed they received appropriate training and support to administer medicines. One member of staff told us, “I have received full training and competency checks in medicine management. If an error were to occur, I would report it immediately to my manager and the office, seek medical advice for the client if needed, and ensure the incident is documented correctly so we can learn from it and prevent it from happening again."