Daisychain Homecare Services

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.

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

This service scored 50 (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. The provider did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. The provider had systems and processes for staff, people and their relatives to report any concerns, incidents, accidents and complaints. However, lessons were not always learnt to continually identify and embed good practice. Whilst the service recorded this information, they had not always completed an analysis or reviewed this information for themes, patterns or lessons that could be learned and used to drive improvements in 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, however important information on how staff should safely support people was not always included in people's care plans. We found the service worked well with external agencies, such as community nurses and occupational therapists who confirmed people received safe care, however we found important guidance provided by external agencies was not always included in people’s care plans. This meant that staff did not have guidance to refer to on people's specific needs such as catheter care or moving and handling plans.

The provider did not always work well with people and partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately. Accidents and incidents had not always been recognised as potential safeguarding concerns. We found that action had been taken to protect people from immediate harm, however, investigations were not thorough, and referrals to the local safeguarding team or CQC had not always been made when required. The provider had systems in place to monitor safeguarding events, the systems did not demonstrate any analysis of emerging themes or evidence of learning to inform practice. Staff had received safeguarding training and were aware of how to report concerns internally, however, these concerns were not always managed appropriately by the staff responsible for oversight and escalation.

The provider did not always work well with people to understand and manage risks. People’s care plans did not provide sufficient guidance on how staff should safely support them with known risks such as moving, handling, repositioning, skin care or support with skin integrity. For example, where people needed equipment to support their mobility, we found no information available to staff on the safety checks required for the equipment or any instructions on how to safely meet people’s specific needs when supporting them with moving and repositioning. We also found where people were identified as at risk of a fall, there was not enough information to demonstrate how this risk had been assessed, the likelihood or potential severity or the control measures staff should follow. This placed people at risk of avoidable harm.

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 ensured staff were recruited safely and received training appropriate for their roles. We received mixed feedback from people and their relatives about staff punctuality. One person told us, “Their timekeeping is absolutely awful. I’ve complained a few times. I’m given the rota, but they don’t follow it.” Another person told us, “The staff are reliable, they’re usually on time, unless something unusual happens, to hold them up.” And a relative commented “They come four times a day, they turn up when they should and they get in touch with me if there’s a delay.” Staff also provided us with mixed opinion on the staffing levels, some staff shared they were regularly asked to work extra hours due to the provider been short staffed. The provider used an electronic call monitoring system to monitor the visits staff made. We analysed this data during our inspection and found some concerns with how calls were organised. The data evidenced that staff travel time was not always scheduled and this meant staff were then late for their subsequent visits. The provider was aware of these concerns and was taking steps to improve their monitoring of visits and recruiting additional staff.

The provider did not always assess or manage the risk of infection. Staff had undertaken training in infection, prevention and control and understood the importance of wearing personal protective equipment when delivering personal care, however the care plans in place for people did not provide enough guidance on how staff should manage the risk of infection. For example, we found people’s catheter care plans did not provide any information on the hygiene measures staff should follow or how staff should monitor the person for signs of infection, this posed a risk to people of infection and avoidable harm.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were safely managed and were administered by trained staff who received regular checks and direct observation of their practice. People and their relatives provided us with positive feedback on how staff supported them. One relative told us, “There haven’t been any problems with medicines, they’re very careful. They make sure [person] takes them safely”. And another person told us, “There is a medication record in the house, and they give paracetamol as needed. It’s well organised.”The provider ensured regular audits of medicines were carried out and where errors had occurred, we found appropriate action had been taken to reduce the risk of reoccurrence.