Helping at Home

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 good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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. We spoke with staff who were clear about how to report concerns, record on the electronic system the provider used, and had confidence that the provider would address any concerns and make improvements.

People and their relatives felt able to raise complaints if they needed to and felt they would be listened to and issues addressed. While a few people had raised concerns in the past, they said these were addressed promptly and effectively. One person said, “I wasn’t happy with something, so I called them, and they sorted it out right away."

The care manager had created an action plan to help continually improve the service after identifying areas where they wanted to make improvements. The provider shared feedback they had received after working with a partner organisation which said, “The information you shared is extremely useful to us and what we have learned from your 'lessons learned' will be critical to our success and the experience we are able to provide to our service users.”

Adopting a positive learning culture meant when things didn’t go well, they were reviewed by the management team and actions put in place to avoid the issue recurring, this improved people’s safety.

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.

We saw evidence of communication between the management and care staff team and other health care professionals to ensure continuity of care.

We reviewed documents that evidenced the provider had worked with people’s GP’s pharmacists, social workers and other professionals alongside people and their families to promote continuity of care in the person’s own home. When needed, the provider had referred people for mental health assessments, occupational therapy, district nurses and provided care in people’s best interests to maintain healthy skin integrity.

People told us that staff informed them of any problems they noticed. One person told us, “[staff] noticed I had pressure sores and has kept an eye on them. [Staff] told my [relative] who called a doctor. Anything [staff] spots that is untoward [they] will tell me”.

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 had received safeguarding training and were aware of signs to be alert to in cases of different types of abuse. Some staff were unaware of how to raise concerns outside of the service, for example, to the local authority. We discussed this with the provider who advised this would be discussed further with the staff to provide clarity on the external reporting process. However, staff had a good understanding of how to raise concerns internally and felt able to speak openly to the management team

One member of staff explained a situation where they raised a safeguarding concern, described the process they followed, and the next steps the manager took to safeguard the person in a timely way.

The provider had robust, detailed safeguarding policies in place which were up to date and clearly outlined their responsibilities.

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.

We saw that care plans identified risks which were discussed with people and relatives where appropriate when carrying out initial assessments and review processes. Information in care plans demonstrated people were involved in managing risk and felt risks were managed effectively. One relative told us, “[name] has never had a fall while they have been with the carers”.

This meant people were kept safe from potential harm and involved in conversations that considered their views in relation to managing risk.

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

We saw that care plans and assessments contained information which evidenced the safety of people’s home environment was considered and measures put in place to support people to live in a safe environment. Staff understood their responsibility to support people to maintain a safe environment.

One staff member talked about how they had recognised there was a person who struggles in the shower and thought they might be better if they were reassessed to have a rail in the shower. They raised these issues with the management team for referrals to be made to the appropriate professionals. People told us they felt the environment was managed safely.

This meant were protected from the risk of harm in their home environment.

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.

Prior to our assessment we had received a concern about staff turnover and changes in staffing, however they had also noted they didn’t feel this had impacted care provision. We reviewed staff files, training records, induction documents and supervision information. We found the provider followed safe recruitment processes and staff received ongoing training and support which ensured people received support from suitably skilled and experienced staff. Staff felt like there were enough staff to care for people safely. One staff member said “You know who has 4 calls or a day or 1 call a day. Call times are perfect for that individual, and I think it’s good really.” The provider told us, “We have got a policy to get everybody [staff] up to the highest level of qualification they can.”

Staff arrival and departure times at each call were electronically monitored. We asked for one month of call data which showed the average arrival and departure times of each call. We found call punctuality was good, with 92% of calls being delivered within 15 minutes of the planned start time. This helped to keep people safe and ensure they received the care the needed.

When asking people and their relatives about call times, most people felt there were enough staff to meet their needs safely. While one relative noted occasional staffing shortages, others said the service was reliable and consistent. People appreciated receiving rotas in advance and said staff were generally punctual. One person said, “They are exemplary at turning up, they have never missed an appointment”. Another person said, “[staff] is always on time, unless there is a problem with traffic, and [they] will make up the time at the end”.

The provider assessed and managed the risk of infection.

We spoke with people using the service and their family, there were no concerns highlighted for infection, prevention and control. People we spoke with told us staff wore appropriate personal protective equipment (PPE) for example gloves and aprons and followed hygiene protocols. People also said staff were attentive to health concerns and took appropriate action, such as informing family members or contacting healthcare professionals.

We found staff had received training regarding infection prevention and control and the use of PPE. The provider had comprehensive and up-to-date infection prevention and control policies in place, which clearly outlined roles, responsibilities, and procedures to minimise the risk of infection transmission.

The provider had accurate records of medicines and treatments and made sure they were managed safely and met people’s needs and preferences. Staff involved people in planning, including when changes happened.

Where staff supported with medicines, people said this was done reliably and on time. One relative said,“Meds has gone like clockwork.”Others noted staff monitored medicines being taken and communicated with families or health professionals when needed.

Staff were appropriately trained and aware of their responsibilities. The provider had up to date, clear and robust medicines policies and procedures in place. Staff were aware of how to give as required medicines and the checks they needed to make before giving this to someone. Where someone needed covert medicines, the provider had a clear policy and the appropriate documentation, including a mental capacity assessment and supporting documentation from medical professionals, family and the social worker was in place to support this. Covert means giving someone their medicine without them knowing, usually by hiding it in food or drink. This is only done when the person cannot make decisions about their care. It must follow legal rules and be in the person’s best interests.

We found risk associated with people using specific emollient creams had not been considered. Emollient creams help retain skin moisture, but some can pose a fire risk when absorbed into fabrics and exposed to heat or flames. The provider was responsive to our concerns and took prompt action to address the issues raised and evidenced involvement and communication with people and relatives as part of this.