Verity Healthcare - Haringey

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.

The service was in breach of legal regulation in relation tothe management of medicines.

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. Although, staff reported safety events, for instance, accidents or injuries experienced by people using the service to the domiciliary care service, lessons were not always learnt to continually identify and embed good practice. For example, supervision and spot visit records frequently recorded concerns about staff not checking support plans or notes, not always adhering to people’s support plan and plagiarising other colleague’s notes. There was no information recorded detailing how this was to be monitored and addressed in the longer term. The impact of this meant that without learning from incidents, staff may continue to lack the necessary skills and knowledge to prevent future recurrence and improper treatment for people using the service.

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 told us about their referral and assessment process. This involved an initial assessment being completed by the Local Authority and then forwarded to the domiciliary care service. The information together with an additional assessment completed by Verity Healthcare – Haringey was used to inform people’s individual support plan and associated risk assessments. Support plans implied people using the service and those acting on their behalf had been involved with the assessment process.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. 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.

People and their relatives generally considered themselves and their family member to be safe when staff came to provide support. Comments included, “All the care enhances [relative’s] safety. I’ve never had any concerns for their safety” and “I always feel safe with them [staff].”

The provider was aware of their responsibility to notify us and the Local Authority of any allegations or incidents of abuse. Staff had completed appropriate safeguarding training. Staff were able to tell us about the different types of abuse and what to do to make sure people were protected from harm. Staff told us they would escalate any concerns to the provider, care co-ordinator, Local Authority or Care Quality Commission. A member of staff told us, “If I had a concern, I would inform the office.”

The assessment reviewed the service's risk management processes, including feedback from people using the service and their relatives. The provider did not ensure all risks to people’s safety and wellbeing were being appropriately managed and mitigated. Staff are vital for keeping people safe by assessing risks, providing a vigilant presence and ensuring and maintaining a safe environment.

A relative indicated there had been occasions whereby staff had failed to use the right moving and handling equipment [slide sheet] with their family member. This can cause significant harm to people using the service, such as skin tears and friction burns. Concerns were raised that not all staff understood the risks associated with the wearing of pressure stockings for a person using the service. For example, staff not consistently assisting the person to wear them during the day and on occasions leaving them on overnight. The latter can restrict blood flow and circulation and lead to other medical complications.

Risks to people's health and wellbeing had been assessed and each person had tailored risk assessments, which identified the risks they could be exposed to, and the support needed to minimise these and to ensure their safety. The risks primarily related to people’s moving and handling needs, environmental hazards and medicines management, but also included the risks posed relating to specific healthcare conditions, such as Diabetes.

The provider did not always detect and control potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

A relative told us not all staff who visited their family member made sure the home environment was securely maintained for their security and protection. This referred to the key safe and front door being left open by some members of staff which could lead to unauthorised people gaining access to the property.

Environmental risk assessments were conducted. These are crucial to ensure the safety of people and staff by identifying, evaluating, and mitigating potential hazards in the home environment.

People’s and relatives’ comments relating to staffing levels were variable. Where comments were positive these included, “Most of the time we have the same staff, and they come the same time every day. Staff stay the full time required and do all we need them to do”, “Timekeeping is excellent, the regular member of staff is really conscientious and phones if they have been delayed” and “They [staff] are quite good at coming on time and will let us know if they are running late.”

Less positive comments indicated where an unfamiliar staff member was required to provide support due to staff sickness or annual leave, neither the person nor their relative was always forewarned in advance. The impact of this meant some people found this situation difficult, confusing to understand and adapt. A person told us, “Communication is not their [Verity Healthcare – Haringey] strong point. I don’t ever know who is coming to the house.” Some people indicated timekeeping by staff was poor and more challenging at weekends than during the week. A person using the service told us, “Staff can be a bit late, sometimes they call to say they are late, not always.” A relative told us, “Sunday calls can be quite late. I’ve often rung the office to ask where the member of staff is?” Another relative stated their family member had experienced missed calls and there had been occasions whereby they had had to contact the service to tell them not to come because of staffs’ lateness and having completed the care themselves. Following our assessment the provider wrote to us and told us people using the service had not experienced missed calls. No recurring patterns of staff lateness were identified for people's calls despite people's experience.

Staff recruitment records demonstrated relevant checks were completed before a new member of staff started working at the service. However, not all references were from a previous manager or HR department. This is important to verify the applicant’s employment history, and professional performance without bias. Where newly employed staff had received a letter detailing completion of their probation period, documentation providing a clear, verifiable record of performance, feedback, and any agreed-upon next steps was not recorded or available. The provider confirmed following our assessment that where an employee's most recent employer was unable to provide a reference an alternative reference was sought.

Staff had received mandatory training in line with the provider’s expectations using both face to face and eLearning methods. However, not all training was embedded in staff’s day-to-day practice. Staff competency assessments were not undertaken to ensure staff remained competent following training, for example, in relation to moving and handling and medication. Competency assessments are crucial for verifying staff’s skills and knowledge.

Newly employed staff received an induction and were given the opportunity to ‘shadow’ more experienced staff to ensure they understood their roles and responsibilities. Although staff spoken with confirmed they received 3 shifts; shadow shifts, a record was not routinely maintained to demonstrate their progress. The provider confirmed following our assessment that evidence of staff having completed shadow shifts was maintained.

Staff told us they felt supported by the organisation. Staff received formal supervision and ‘spot checks’ were completed at regular intervals. The latter is where the provider’s representative can observe a member of staff as they go about their duties to ensure they are meeting the organisation’s values, standards and expectations. Improvements were required to ensure where performance issues were highlighted, evidence of monitoring and actions taken to address this.

The provider assessed and managed the risk of infection to ensure people’s safety. A relative told us, “We are very pleased with hygiene practices and staff make full use of gloves and masks.” The relative stated their family member was prone to recurring infections and confirmed staffs’ infection control practices were suitable.

Staff told us they had access to a range of appropriate Personal Protective Equipment [PPE] to keep themselves and others safe. Staff had received appropriate infection, prevention and control training.

The provider did not always make sure that medicines management was safe and met people’s needs, capacities and preferences.

People’s and relatives’ comments relating to medicines management were variable. Where comments from people and relatives were positive these included, “They [staff] do their medication, no problems” and “They [staff] give family member their medication at the right time.” Less positive comments told us that inadequate time keeping by staff had resulted in a family member receiving their medication too close together, when there should have been a four-hour gap between individual doses. Concerns were expressed that not all prescribed medication had been administered by staff following a family member’s discharge from hospital. A person using the service told us they had to check their evening medication to ensure it was correct as on occasions they had found staffs’ practice to be careless. For example, medication dropped on the floor and staff not realising this had happened.

People had a support plan in place detailing the medicines support required and who was responsible for undertaking this task. However, the medicines support plan for 1 person was confusing as this referred to both self-administration and staff administering the person’s medicines, with no specific information recorded. A person told us staff prepared their morning medication by leaving this out the night before for them to take. There was no record to demonstrate this had been agreed with them and risk assessed. There were significant gaps in people’s MAR, where we could not be initially assured if the medicine had been given or not. In these instances, the MAR suggested this was completed retrospectively. We found at the time of this assessment; some members of staff were knowingly giving medication to 1 person without appropriate medical advice having been sought and opposed to the instructions recorded within the support plan.

Staff who administered medication had received training. However, not all staff had had their competency assessed or reassessed within the last 12 months or when poor practice had been highlighted, to ensure they remained competent to undertake this task safely.