Lancaster & Morecambe Domiciliary Service

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 remained Good. This meant people were safe and protected from avoidable harm.

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.

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 had been learnt to continually identify and embed good practice. However, we found there could be some improvement to ensure lessons were learnt in a timely manner.

The provider had policies and procedures in place to promote safety and to understand and respond to any safety incidents to avoid reoccurrence. Though we saw these had been understood and followed by leaders and staff, in one tenancy we found this could be improved. We discussed this with the registered manager and were assured this had now been addressed.

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 systems in place which helped ensure people were able to transition between services safely. The registered managers reviewed new referrals and ensured preadmission assessments were accurate. This helped staff understand what support people needed to transition into the service.

All people supported by the service had a hospital passport in place which provided up to date information about people’s needs, medical conditions and communication and support needs to provide guidance to other professionals and services. People were supported by staff to make and attend appointments and shared up to date information with a range of healthcare partners, including consultants, learning disability nurses and community health care services.

People who were considering moving into one of the tenancies were supported to transition in the best way for them. New tenants were able to meet people and staff and to get to know each other in less formal settings, before making any decision.

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.

The provider had policies and procedures in place to identify and respond to safeguarding concerns. However, the provider had not always raised concerns with the local authority safeguarding team. We discussed this with the registered manager who acknowledged this had happened in one tenancy and provided assurance all concerns had been raised before this assessment and that further safeguarding training was planned across the team. The safeguarding log was robust and clearly identified the actions of the provider and the outcomes for the person.

Staff we spoke with were confident they could raise concerns with leaders, and they would be responded to properly. Most relatives were confident people were safe, comments included, “[Name] is safe, they couldn’t be any safer.” And “[Name] is safe because they have carers there all the time. We have met them, and they are decent folk.” However, some feedback we received expressed concerns about safety which though now addressed the relative felt had not been resolved in a timely manner. We discussed this with the registered manager and were assured appropriate steps had been taken to avoid a reoccurrence.

People’s rights were safeguarded because staff and leaders followed best practice guidance and the legal processes detailed in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards. Where people were deprived of their liberty any conditions included in the legal authorisations were followed by staff and leaders.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People had been supported to manage risks to their safety, health and wellbeing. Staff and leaders followed the providers’ risk management policies and procedures. Risk assessments had been completed, reviewed, and updated in response to incidents and events. Some recording would benefit from being more detailed and systematic.

People were supported to stay safe in their home and when accessing the community. Staff and leaders promoted people’s rights and ensured any interventions which were needed for their safety had been properly assessed and represented the least restrictive option. Where people experienced increased risks due to any distress they may feel, detailed positive behaviour support plans were in place. Staff and leaders were knowledgeable, compassionate and skilled in this area.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

The providers robust recruitment policies meant people were supported by staff who had been recruited safely. Staff had access to a broad range of training opportunities. Staff received training appropriate to their roles with some bespoke training related to people’s specific needs and conditions.

One tenancy, we visited, leaders had developed their own additional induction programme. Staff we met were skilled and knowledgeable about their roles and the people they supported.

Staff received regular formal and informal supervision. Staff said they felt well supported by team leaders/managers and could ask for support at any time.

The provider assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly.

People were protected from the risk of infection because staff understood and followed effective infection prevention control policies and procedures. People and staff had access to personal protective equipment, including gloves, aprons and hand gel.

Some people we visited showed us their bedrooms. These were all well maintained and clean.

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.

People received their medicines as prescribed, from staff who were trained and had their competencies checked regularly. Medicines were securely stored; medicine administration records were completed accurately. Where people needed medicines only when required, we saw there were clear protocols in place to guide staff about when, and what dose, to offer. This included medicines such as pain relief, rescue medicines for people who had seizures and medicines people might need to help them manage their feelings. People’s medicines were regularly reviewed in partnership with other professionals.