31-32, Southernhay East

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

During this assessment, we looked at all 8 quality statements in the key question of safe. We rated the safe key question as good. Recruitment checks were completed. The service had provided training and people and staff said they could conduct their role. However, there was a lack of oversight to ensure staff had all received appropriate training and competency checks (see well led). Risks to people’s care were well managed with clear information, however this was not recorded consistently (see well led key question). Staff arrived on time and stayed for the required duration of the care calls. People and relatives said they could confidently raise safety concerns, and these were listened to and acted on by the registered manager. Staff followed nationally recognised best practice to ensure infection risks to people were minimised.

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.

People and relatives felt safe and well supported. Peoples’ feedback did not highlight any concerns about the registered manager listening, learning and acting on safety events. They appreciated receiving care from a consistent team of staff they knew well. The registered manager was knowledgeable about peoples’ needs and people were encouraged to raise any concerns. Records were kept but not always in a consistent place or information communicated verbally to staff. This had not had any negative outcomes for people to date. We saw appropriate actions had been taken in response and fed back to the registered manager. They agreed that information was sometimes held on their phone and this was being rectified.

Leaders were not able to evidence how accidents and incidents were reviewed and learning taken from these, other than verbally (see well led section). However, staff knew people well and how to support people in case of accidents/incidents and staff felt they could ring the providers who were knowledgeable about peoples’ needs and acted appropriately. Most staff told us they were informed and kept up to date when incidents had occurred and learning from incidents was shared with them by the registered manager. One staff member told us “We are able to discuss issues if we ring the providers who will help”. For example, one person had decreased mobility issues. When staff highlighted this, the registered manager ensured two staff provided care and an occupational therapist referral was made.

The service did not have any overall quality assurance process for accidents and incidents, but they were known and being recorded. However, in our review of the evidence available, we were assured staff knew how to support people if an incident happened and were able to contact the registered manager. People and staff were encouraged and supported to raise concerns to help identify and reduce risks. The registered manager was knowledgeable about the needs of individuals and agreed to ensure there was a more robust process for oversight given the increasing client numbers. They were working with the local authority to ensure oversight and audits included this issue.

We spoke with people to learn more about their experience of using the service. People’s feedback did not highlight any concerns, and we were satisfied the service was working with people to establish and maintain safe care. People and relatives felt well supported at the start of their care package and told us other professionals were involved in their care, when required.

The registered manager was in contact with relevant healthcare professionals and partners to ensure people's needs were met. The management team told us they worked closely with local external professionals. Care packages were not accepted unless the service could meet peoples’ needs, including undertaking specialist training before a care package started.

Stakeholders did not share concerns about the service. Professionals who worked with the service commented, “[The service] is always available and ready to help with a difficult package of care if they believe they have the correct staff/skills, always acknowledge receiving care plans and rarely hand back a package of care or have good reason and with appropriate time for us to resource” and “They are always professional and polite and will do what they can to ensure that any queries are met as soon as possible. We have not had any negative feedback from people.”

The service worked well with relevant healthcare professionals and partners to ensure people's needs were met. This included completing initial assessments before the start of a care package and liaising with relevant healthcare professionals.

People and relatives told us they felt safe with the care provided. Their comments included, "It is very rare we get a carer we do not know. They do everything they are meant to and are very good, even doing extra”, “They do a lot and do it well” and “I cannot fault them, they are brilliant. They have a good way with Dad and he responds well to them, the manager responds quickly.”

Staff demonstrated a good knowledge of the safeguarding procedures and who to inform if they had any concerns. Staff knew how to report abuse. Their comments included, "Being the main carer for a client who was at a risk of falling; I raised safeguarding concerns to her next of kin and management. This helped to put in place measures to help her have all she needs always within reach and not move around especially when alone to prevent future falls” and “I would document the situation in detail with times and dates- I would also inform management straight away and they deal with accordingly.” The registered manager was clear on their responsibilities and duties to identify and report any safeguarding concerns.

The provider had a safeguarding policy and processes in line with current, relevant legislation. Records showed any safeguarding concerns were reported to the registered manager, recorded and reported promptly to the relevant professionals. The provider had systems to enable staff to report concerns should they arise. Staff undertook training in safeguarding.

People and relatives told us risks to people's care were well managed. Comments included, “The staff seem happy, and I check their books sometimes and they have all the information they need” and “We are very happy with the care we receive and give them 10 out of 10”. People and relatives said they were as involved as they wanted to be in creating and reviewing their care plans and risk assessments.

Staff told us how they managed risks to people's care, such as managing risk of falls or how they safely supported people with their equipment. Comments from staff included, "I was a main carer for a client who had a history of alcohol misuse. I helped to raise a number of risks. This was helpful to other health professionals who were involved” and “We know peoples’ risks and we have the equipment we need.” The management team and staff knew people well and understood risks posed to people and how they could reduce risks.

The registered manager used systems to understand and manage risks by thinking holistically so that care met people’s needs in a safe way. Risk assessments were clear and comprehensive. There was a good level of detail in people’s health risk assessments and care plans. There were instructions for staff about when to seek support from other health professionals. Staff had access to people’s care plans and risk assessments but it was unclear how the registered manager ensured updates and reviews were communicated.

We spoke with people to learn more about their experience of using the service. People’s feedback did not highlight any concerns around their environment. People’s care plans contained good information about their needs but there was no risk assessment for the environment. However, the registered manager was knowledgeable about people’s needs and staff worked consistently with people.

Staff acted on risks in the environment and protected people from risks of infections. Staff said they had received training on manual handling for example and 1 staff member commented on how they ensured personal protective equipment (PPE) was always available and stocked up.

There were policies and procedures in place to control and prevent the spread of infections. These were being followed. People and relatives did not share concerns in this area. There were detailed risk assessments in place and staff knew how to keep people safe.

We received positive feedback from people using the service about staff. People told us “They turn up on time and it’s the same people who come and see me” and “The manager will call if they are running late. The carers are very understanding and do their job well. They know what to do and follow the care plan.”

Most staff said they felt well supported and the registered manager was available to them. Although most staff said they had supervision, there were no records to support this. However, staff spoke about being able to speak to the registered manager who checked in with them informally. There were some records of spot checks in response to issues but no oversight (see well led section). The registered manager they staffed care packages to ensure consistency of care. People mostly received care from the same staff members who then got to know each other well. Health professionals praised the service for ensuring they could meet peoples’ needs.

No concerns were shared by people, relatives or stakeholders in relation to any areas of staff training or knowledge. However, there was a lack of documentary evidence that all staff had been provided with regular supervision, competency assessments and spot checks. Not all staff who were administering medication had completed a medication competency assessment. We fed this back to the provider and local authority quality team who were now working with them to ensure this was addressed. The provider had safe recruitment practices. This included obtaining references and checks with the Disclosure and Barring Service (DBS). The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working in care services. We were assured there were sufficient staff to meet people’s needs and there were no concerns raised about visit timings or delays. Staff told us they had the information to meet peoples’ needs and people we spoke to had no concerns However, the rota did not include regular training and supervision time (see well led section).

People and relatives told us staff kept a safe environment in people’s homes to reduce the risk of infection. People told us staff wore gloves and aprons throughout their care. One relative told us, “They are good and very efficient.”

Staff acted on risks in the environment and protected people from risks of infections. There was plenty of personal protective equipment (PPE) available for staff.

The provider had policies and procedures to control and prevent the spread of infection. Most staff had received infection prevention and control training. People told us they had no complaints about this topic. People’s care plans included risk assessments relating to Control of Substances Hazardous to Health (COSHH). This provided guidance to staff to ensure safe storage, use and disposal of chemicals.

People told us they received their medication and relatives we spoke with confirmed this. We saw good record keeping in the 2 homes we visited.

Staff who administered medicines received medication training and records confirmed this. However, there were no records of staff completing medicines competency checks to ensure they were competent to administer medicines (see well led section). Despite this, there were no negative outcomes for people and feedback from health professionals was positive.

The provider had a medicines policy and staff said they knew what to do to manage medicines safely. Some people were prescribed medicines to be taken only when required known as (PRN) medicines. Guidance on PRN medication was available to help staff give these medicines consistently. Medicine care plans and risk assessments were detailed and provided good information to support staff to understand most people’s care needs such as diabetes.