Homecare For You Dudley

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 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 regulations in relation to safeguarding and 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.

The provider had processes in place to enable staff to report incidents. Staff understood their responsibilities and incidents were recorded appropriately. However, governance and oversight systems were not sufficiently robust to ensure appropriate action was consistently taken following incidents.

During our assessment, we identified a number of incidents that met the threshold for a safeguarding referral. These incidents had not been referred to the local authority safeguarding team, which meant potential risks to people had not been escalated in line with safeguarding procedures.

Audits were in place but were not effective in identifying missed safeguarding referrals, recurring themes, trends, or emerging risks. This limited the provider's ability to learn from incidents, take preventative action, and drive continuous improvement. As a result, opportunities to reduce the risk of repeated incidents and improve the quality and safety of care were missed.

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.

Care plans were not always reviewed and updated following incidents. This meant changes in people's needs and risks were not consistently reflected in care records. We found some records lacked important information required to support the safe delivery of care. For example, 1 person had a diabetes risk assessment in place, however their care plan did not contain information about their diabetes or guidance for staff on how to support them safely. This increased the risk of staff not having access to all relevant information needed to provide appropriate care and support.

Regular spot checks of staff and supervisions were held, which provided opportunities for managers to observe care delivery, review practice and discuss any development needs.

People generally received care as planned. Records demonstrated there had been no missed care calls. Where visits were delayed, these were monitored by the provider and people were informed of the reasons for any lateness. Electronic monitoring records showed staff remained with people for the planned duration of their visits. People told us staff usually stayed for the full length of their calls and delays were uncommon and generally due to unavoidable circumstances.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff understood how to recognise and report concerns, the provider's systems were not always effective in ensuring safeguarding matters were appropriately escalated. During our assessment, we identified several incidents that met the threshold for safeguarding referral, but these had not been referred to the local authority safeguarding team. This meant opportunities to ensure concerns were independently reviewed and people fully protected had been missed.

The failure to consistently identify and escalate safeguarding concerns indicated weaknesses in management oversight and monitoring arrangements. Although policies, procedures and training were in place, these had not always translated into effective safeguarding practice.

We found where safeguarding referrals had been made to the local authority, corresponding notifications had not always been submitted to CQC. Providers are required to notify CQC, without delay, of safeguarding incidents and allegations involving people using the service. The failure to submit these notifications meant the provider had not consistently met its legal responsibilities and reduced external oversight of safeguarding 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.

People and, where appropriate, their relatives were involved in discussions about risks associated with their care and support. However, systems for assessing, reviewing and managing risks were not always effective. Risk assessments were not consistently reviewed and updated following incidents to ensure they reflected people's current needs and risks. This meant changes in people's circumstances were not always captured in care records. In addition, not all risk assessments clearly described the specific risks to people, or the actions staff should take to mitigate these risks. For example, one person used bed rails as part of their care; however, there was no bed rails risk assessment in place and no reference to the use of bed rails within their care plan. This meant staff did not have clear guidance about the risks associated with bed rails or the measures required to support the person safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risk assessments were in place and reflected the individual risks present within people's homes. These assessments provided staff with information about potential hazards and the measures required to reduce risks to people and staff.

Care plans contained guidance to help maintain safe home environments. This included information for staff about ensuring living areas were kept clean, tidy and free from hazards that could increase the risk of accidents or injuries. Staff had access to information about environmental risks and the actions required to support people safely within their own homes.

The provider's arrangements helped to ensure risks associated with people's living environments were identified and managed appropriately, supporting the delivery of safe care.

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.

New staff completed an induction programme designed to equip them with the knowledge and competencies required for their role before providing care independently. The provider ensured staff completed mandatory training and annual refresher courses to maintain their skills and knowledge.

Staff had access to training relevant to the needs of people using the service. This included topics such as dementia awareness and mental health awareness, enabling staff to better understand and respond to people's individual needs. Training records demonstrated staff were completing required training and keeping their knowledge up to date.

Staff spoke positively about the training provided. One staff member told us, “We have good training, refreshers always. Keeps us up to date and fresh.” Staff told us the training was relevant, accessible and helped them feel confident in carrying out their roles.

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

The provider had arrangements in place to support staff to follow safe infection control procedures and reduce the risk of the spread of infection.

We saw evidence staff had access to personal protective equipment (PPE), with systems in place to ensure supplies were available when required. Staff collected PPE from the office and spot checks were undertaken to monitor compliance with infection prevention and control practices, including the appropriate use of PPE.

People using the service told us staff consistently followed good infection control practices. They said staff wore gloves and aprons when providing personal care and changed PPE appropriately between tasks. One person told us, "They wear gloves, wash hands. They change them [gloves]. They have to change their gloves with every cream due to cross contamination and then they throw the gloves away and put fresh gloves on."

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

Medicine risk assessments were in place for people who required support with their medicine. However, these assessments did not always contain sufficient detail to fully assess and manage risks. For example, risk assessments did not clearly identify specific medicine-related risks, the likelihood of those risks occurring, the potential impact on the person, or the actions required to mitigate them. This meant staff did not always have access to comprehensive information to support a consistent approach to managing medicine risks.

However, we did not find evidence people had experienced harm as a result of medicine management practices, and medicine audits had not identified any administration errors. Systems were in place to monitor medicine management and reduce the risk of medicine-related incidents. Medicine audits were completed monthly to provide oversight of medicine administration and identify any concerns requiring action. Records showed audits were carried out consistently and supported the provider in monitoring medicines practice.