Support at Home

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 newly registered 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

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 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.

We were not assured that the learning culture was fully effective or embedded. The provider's approach to safety was not always effective in identifying and managing risks. During the assessment, we identified gaps in care planning, risk assessments and oversight processes that had not been recognised by the provider. Known risks were not always reflected within care records and there was limited evidence to demonstrate that risks associated with the person's health, wellbeing and living environment had been fully assessed and managed. This meant opportunities for learning and improvement were not always proactively recognised or acted upon.

However, staff we spoke with demonstrated an understanding of how incidents should be reported and escalated. One staff member told us, “Management investigates incidents, and feedback is shared with staff so lessons can be learned.” There were processes in place to support what staff told us. The registered manager told us wider sharing of the learning was completed through staff meetings, supervisions and other communications with staff.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We were not always assured that safe systems, pathways, and transitions were consistently managed. Care plans and risk assessments did not always reflect the person’s current needs or risks, which meant there was limited guidance available to support safe and consistent care. In addition, gaps in recording meant it was not always clear how risks were being monitored or managed over time.

However, there were systems in place to assess people’s needs before they began using the service, including both face-to-face and record-based assessments. The person had a transition plan to support a safe move into the service. Staff demonstrated an understanding of the person’s needs and how to escalate concerns when required. One staff member told us, “Staff like to be involved so they can see the person’s needs directly and assess if they can meet them,” indicating that information was shared with the wider team prior to admission.

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

The person felt safe being supported by staff. They told us, “I feel safe with ‘staff members names”.

There were systems in place to ensure safeguarding concerns were identified, reviewed and investigated when needed. Staff told us they had received training in this area and records we viewed confirmed this. They were aware what action they should take if there were concerns.

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.

We were not always assured that the person was consistently involved in managing identified risks. While staff were aware of risks relating to the person's health and wellbeing needs, care records did not always clearly demonstrate how these risks were assessed and managed to support the person safely. For example, care plans and risk assessments did not clearly demonstrate how environmental risks were identified, assessed and managed. As a result, we could not be assured that staff had clear and consistent guidance to support the person safely.

However, we found that care plans and risk assessments were regularly reviewed. Staff spoken with demonstrated an understanding of the person’s needs and told us, “We sit down and talk about their needs and any concerns”.

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

We were not always assured that environmental risks were consistently assessed and managed. While the person lived in their own home and had the right to make choices about how they maintained their living environment, we identified potential environmental risks that had not been clearly assessed or recorded. We found there was limited evidence to demonstrate how these risks had been formally assessed, balanced with the person's rights and preferences, or how staff should support the person to manage them safely and consistently.

However, the person had access to well-maintained outdoor space, which was clean, tidy and provided areas for seating and spending time outdoors.

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.

Staff had been safely recruited, and records confirmed appropriate recruitment checks were carried out to ensure they were suitable to work with the person. Staff told us, and records confirmed, they had undertaken training relevant to the person’s needs. Training records showed staff had completed training to equip them with the knowledge and skills to support the person, including understanding their individual needs and diagnoses.

The provider did not consistently assessed and managed the risk of infection. Risks were not always detected and controlled to prevent the risk of cross infection.

We observed items stored within a wet room which presented a potential risk of cross infection. Whilst staff were aware of the circumstances, care records and risk assessments did not demonstrate how the associated infection prevention and control risks had been considered or managed. Improvements were needed to ensure infection prevention and control risks were identified, assessed and mitigated. However, the person told us staff wore Personal Protective Equipment (PPE). Staff confirmed PPE was available when they needed it, and they had received training in this area. There were processes in place to ensure staff protected people from the risk of cross infection.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

The service was not supporting anyone with medicines at the time of the assessment. However, we found there were processes in place should support be required. Staff responsible for administering medicines had received relevant training to ensure they could do so safely.