Persona Domiciliary Support 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 changed to 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.

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 had a proactive and positive culture of learning and 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.

People’s concerns were listened to by staff, reported to the provider, appropriately investigated and people were provided with an outcome. Lessons were learnt and shared to continually identify and embed good practice. The provider ensured thorough and timely responses, this enabled learning from incidents and promoted safe care. Senior management also had oversight through their electronic systems that ensured processes were followed and any themes or trends were identified and addressed.

Staff felt confident to report concerns both internally, and externally if required, and they knew processes and ways to make contact throughout the day and night. Staff told us they had raised concerns in the past which led to action and stated they “Would be listened to” and “Would be taken seriously” if they raised a concern.

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 an admissions policy, and we received good feedback from families about introductions to the service. Introductions were planned in line with the persons needs and at a pace that suited them. Careful consideration was given to where the person would be best supported, including the environment and their compatibility with others. This included families meeting each other too. People and their relatives were involved in transitions, and we received positive feedback about the process.One family told us “The transition was great. They knew who to put (person) in with. They listened to family. He wasn’t just placed anywhere”.

Staff recognised when needs changed and people could be transitioned to more suitable services or increased independent living and were supported to do so. One person was due to move to new accommodation that better suited their needs physically, financially and socially. This planned move had involved close work between the provider, the person, their family and a multi-agency team.

Relationships with health and social care professionals were established to promote and maintain people’s safety.

The provider worked with people and 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 shared concerns appropriately.

Staff were trained to recognise and report any signs of abuse or neglect. Staff felt confident to raise concerns to the provider, the Local Authority or the CQC. Staff told us they would be listened to, and the information would be acted upon.

People told us they felt safe, one person told us “I am safe, well looked after, I am happy”. One relative told us “Yes, he is hundred per cent safe… now he is with Persona, and I am so happy’ and another relative told us “He is extremely safe. The level of supervision is second to none, 24/7 care”.

Where people were being deprived of their liberty, for example, they were unable to access the community without staff support. The provider had submitted the necessary Deprivation of Liberty Safeguards to the local authority to ensure any deprivation was legal and, in the persons best interest.

The provider had updated policies and procedures in line with best practice which also ensured boundaries between staff and people were upheld.

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 and supportive.

The evidence we saw in care plans and risk assessments varied in quality. It was not clear if all the recommendations in one person’s epilepsy assessment had been fully incorporated into their care plan and improvements were required during the assessment. Other issues related to nighttime hourly monitoring checks not being completed or recorded, fluids not monitored and oral care support needed to improve. Another person’s care records did not consistently or accurately record information related to activity and health. A further person’s care plan required updating to ensure sections were clear and detailed on a transport risk assessment and their daily living skills. Shortfalls identified during the assessment were updated by the provider quickly. People and families told us they were involved in care planning, although this was not always recorded.

Most of the risk assessments we saw were person centred and reviewed at regular intervals or when needs changed and positive risk assessment and shared decision making was evident, and most risk assessments detailed potential triggers and strategies to support people.

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

We visited three properties where people lived. One of the properties had fire safety concerns. There was a flammable substance in the smoking area outside and one fire exit door was partially blocked by a chair. This had not been identified on safety checks completed by the provider. The provider immediately made the environment safe and introduced new safety checks for all properties to include outside checks. The provider also had plans in place to improve the smoking areas in all properties.

The provider had systems in place to check home environments were safe which were completed weekly and monthly by senior staff. There were some areas where checks had not always been completed. The registered manager updated the audits to ensure they were more rigorous.

Substances potentially hazardous to health need to be risk assessed and stored safely. We found that one person did not have a risk assessment, and these products were not stored safely. The provider assessed the risk and made the required changes and the learning from this was shared with other areas of the service.

Up to date certificates were in place for utilities such as gas and electric and fire checks were completed. People had evacuation plans personalised to them, and grab bags were in place. People told us they had fire drills.

The properties we viewed were clean and well maintained. The provider worked with housing associations to request repairs as necessary.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

We spoke to a random selection of staff, some raised concerns about the high use of agency staff and the negative impact this had on people and staff. One staff member told us the “Quality and amount of agency support affect’s the service and people we support”

Families also raised this as an issue, one relative told us “Agency don’t know what they are doing”, and another relative said “There is a lot of agency staff, and the quality of care is impacted. This was also raised by people who spoke with us, one person told us that “Agency staff don't come up to chat or to check on me”

The provider had identified staffing as an issue prior to the assessment; a recruitment drive had taken place with most vacancies filled by the end of the assessment. Evidence was provided to demonstrate the decrease in agency staff hours. This was important as over reliance on agency staff had impacted negatively on some people and increased the level of risk they were exposed to.

We checked staff files and found they had been recruited safely with the necessary pre-employment checks completed before employment commenced. Staff had an induction toolkit and plan which set out clear expectations and requirements. Staff told us they received the necessary training and had the skills they needed to do their jobs.

Staff were being trained in line with the Oliver McGowan code of practice on statutory learning disability and autism training. They also received training on Positive Behavioural Support where necessary and specialist training on communication where required.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

During the assessment it was noted red bags for any soiled laundry were not in use in one property. The provider took action to introduce these to all homes with a shared laundry facility to prevent any potential cross contamination.

In a second property an external company was responsible for cleaning communal areas. The cleaning cupboard was an infection control hazard as there was no system for safe storage and replacement of cleaning equipment for designated areas, such as mop heads. This had not been identified prior to the assessment. The provider was quick to escalate and resolve this issue during the assessment.

Some staff had been enrolled on to food hygiene training but had yet to complete this. This was being addressed by the provider.

There was evidence of up to date and ongoing infection prevention and control training and regular spot checks on staff to ensure compliance. There were cleaning schedules in each person’s home and people joined in cleaning their home where possible.

People, staff and families we spoke to were positive about how people and their environment were kept clean. One relative told us the “Home is sparkling clean. Spot checks are carried out. Bedding is always clean”.

The provider did not always make sure that medicine and treatments were safe and met people’s needs.

Systems and processes were in place to manage medicines safely, but they were not always followed. Room temperature checks had not been completed consistently in one medication room. This meant we could not be assured medicines had been stored at the correct temperature. One person’s documentation for covert medication was not up to date and did not include all the medicines being given covertly. Some of these concerns were related to an over reliance on agency staff. The manager was quick to respond, and improvements were made during the assessment.

Some medications are given as and when required, referred to as PRN medication. Guidance for staff on how to safely give some people’s PRN medicine was missing. The recording of some PRN medications required further attention to ensure that the reason it had been given was clear. The provider discussed this with staff immediately to ensure future compliance.

Care plans for people included clear risk assessments for medications and good guidance on how to provide medications safely. These was person centred and contained detailed descriptions on how staff should provide medications along with strategies and processes should people decline.

Assessments to establish capacity around medication were completed and best interest decisions were recorded. Some capacity assessments needed to be more specific.

People were supported by staff who had been trained and had regular updates, and competency checks to ensure procedures were followed. Staff confirmed this, one told us, “Yes, I have had the training that I needed, its regularly reviewed. The manager comes round often and just watches and makes sure you do it (medication administration) properly and record it all correctly and then will ask you questions. We have regularly review training too and online training”.

A sample of medication stocks were checked against peoples records and all were accurate.

The provider encouraged self-administration of medication where possible and one person told us they had been supported to administer their own medication which had increased their independence, and confidence and reduced their support needs.