Archived: Lancashire Domiciliary Care 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 66 (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 were learnt to continually identify and embed good practice.

Staff completed thorough incident forms outlining actions taken and agencies informed. These were reviewed by senior managers to identify themes and trends.

Relatives knew who to contact with safety concerns and felt confident appropriate action was taken. One relative told us, “[Staff] do lessons learnt and things are put in place to make sure they don’t happen again.”

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 developed an easy read admissions policy, and photos of the accommodation or staff were shared when needed to help people prepare for their move. Transitions were flexible, involving relatives and planned visits. One relative said, “We had lots of visits and meetings to address [person’s] needs (before they moved in).”

Staff assessed compatibility for people sharing a home, and if placements broke down, they supported individuals to move to alternative accommodation. Relatives and social workers were involved in these decisions, ensuring transitions were person centred.

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 shared concerns quickly and appropriately.

Staff received safeguarding training, with key information and local authority contacts clearly displayed on the staff noticeboard. A safeguarding lead was available to support the team, and concerns were investigated and well documented. There was an easy read safeguarding policy available, using pictorials to explain different types of abuse.

The service ensured people were only deprived of their liberty with the correct legal authority. Deprivation of Liberty Safeguards (DoLS) applications were completed for those who required them, in line with the Mental Capacity Act 2005 (MCA).

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.

Key information about risks to people was not always recorded in care plans and risk assessments, and some lacked enough detail to guide staff about preventative or reactive strategies. For example, 2 people used specialist mattresses to minimise the risk of pressure damage, but there was no guidance on required checks or required weight monitoring. Another person had a history of seizures. These were managed by medication, but there was no information on how the seizures presented or how staff should respond should they experience another.

Staff did not always manage risks in line with people’s assessed needs. Records indicated required 4 hourly repositioning was not consistently completed, fluid records showed persistently low intake for one person at risk of dehydration, and hourly night checks for another showed several gaps.

Staff were trained in positive behaviour support, but the agreed techniques were unsuitable for 1 person, and there was no evidence concerns had been escalated or alternative approaches explored.

Clear strategies were not always in place to guide staff to respond to behaviours that communicated a need or distress. One person’s positive behaviour support plan contained contradictory information, and it was not clear what worked well for them when their behaviour was heightened. Records evidenced the consistent, structured approach needed was not being consistently followed. Behaviours were not adequately recorded to help identify triggers or patterns.

Following feedback, the registered manager assured us behaviour support plans and related guidance would be reviewed.

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.

People’s homes were generally safe with appropriate aids and adaptations, though we identified maintenance issues such as damaged walls, worn paintwork and limited outdoor lighting.

Staff undertook regular safety checks to people’s homes and equipment, but airflow mattresses were not included. Two were set incorrectly, placing people at risk of pressure injuries. Systems were in place to monitor servicing and external checks, and report maintenance issues to the housing association; these were discussed at quarterly health and safety meetings.

Fire safety measures were not always robust. Risk assessments and evacuation plans were not signed by all staff to evidence they had been read and understood. Fire warden training was not provided to ensure staff were competent to lead an evacuation, and attendance at fire drills was not tracked to ensure all staff were captured. Several fire doors were found wedged open.

Following feedback, maintenance issues were addressed, airflow mattresses were added to weekly checks, and the registered manager assured us fire safety measures were being improved.

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 were recruited safely with the required pre employment checks in place. Agency profiles showed appropriate background checks had been carried out for temporary staff.

There was a robust induction and ongoing training. One staff member said, “During my induction, I did shadow shifts and all of my training. It was robust and I worked with some experienced staff. There was an induction checklist.” The registered manager confirmed staff without prior experience were supported to complete the ‘Care Certificate’. The Care Certificate is an agreed set standards that defines the skills, knowledge, and behaviours required for health and social care workers in the UK.

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 an infection prevention and control (IPC) policy, and staff were trained in IPC and food hygiene. Personal protective equipment (PPE) was available in each person’s home.

People’s homes were generally clean, and staff confirmed cleaning rotas were in place. While feedback on cleanliness was mostly positive, some relatives raised concerns about bedroom cleanliness. One relative said, “There is no evidence of problems in the common living areas, but in the past [person’s] bedroom has needed attention.”

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

The provider had systems for ordering, storing, recording and returning medication, but we found some thickener, laxatives and fortified drinks were not locked away as required.

Staff understood people’s medicines, and person centred information was available, though some care plans and protocols lacked details such as reasons for prescribing, signs and symptoms, or potential side effects. Risks linked to flammable creams were not always documented in people’s care plans, risk assessments or protocols.

Staff completed medication training and had their competencies assessed. Relatives generally felt medicines were managed safely. One relative told us, “Yes I am happy, [staff] manage (medicines) safely. In some instances when [person] has had a reaction to some of their tablets, they manage that very well too. They have taken [person] to the GP and been proactive.”

Following feedback, locked storage was organised and medication protocols were reviewed.