Home Instead Mid Cornwall

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

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 81 (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.

The provider ensured all accidents and incidents that occurred were fully investigated and areas of learning or improvement identified. Care staff felt they were valued and able to raise concerns, near misses, and that appropriate action would be taken and lessons would be learned. One person told us, “I can phone the manager and they listen, If I have a query or a concern or a complaint it is dealt with straight away and they always get back to you with a follow up and tell you what happened.”

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

We viewed records which demonstrated the provider’s consistent and highly effective approach ensured people had excellent continuity of care. Healthcare partners told us, “Their process of arranging introductions with new patients, documentation and high standards of care is to be commended.” “The Home Instead (Mid Cornwall) team also support any identified needs with the patients they are involved with and will seek advice, support, and equipment from us appropriately. They will also contact the GP practice direct for any acute health needs.” The provider continually demonstrated exceptional practice in their holistic and proactive approach for people transitioning into their service ensuring they had highly positive experiences. One relative told us “I met the owner at [my relative’s]home when he introduced himself and the company and how it worked. He completed a risk assessment and included [my relative] in the process. By the end of the appointment, he had a good picture of [my relative’s] needs, and a care plan had been put together. He explained that it might have to change as the care went on but pointed out it was all decided together. The owner was very good in working to include companionship on the task list as [my relative] was still grieving badly at the time.”

The provider prioritised safety and continuity of care throughout people’s care journeys. For example, a person was supported to attend the “Forget Me Not Church Choir” in St Austell. Staff told us, although this person did not say much they really enjoyed singing and enthusiastically took part. During a recent hospital admission, the care staff visited the person in hospital and sung with them. Due to this, the hospital staff sung to the person to help keep them calm when carrying out procedures.

Staff and leaders knew people exceptionally well and recognised when their health needs changed. They were highly responsive in seeking advice from healthcare staff which reduced hospital admissions for people. For example, one person told us their relative had been prescribed medication to help with grief. However, the carer noted the person was getting dizzy and falls had increased since taking it. This was reported and the medication changed. This reduced the risk of falls, which could have resulted in a hospital admission and the medication was being correctly supplied from the pharmacy. This had an extremely positive impact on people’s emotional wellbeing and supported their personal goals to remain at home.

Professionals spoke highly of the provider. Comments included “We often utilise Home Instead, they have always worked to identify the right carer with the right person, this is to be commended.” and “They have always been a proactive positive care provider who communicates well with the frailty team.”

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.

People consistently reported and demonstrated through their actions they felt safe with their care staff. We observed people were comfortable requesting support and reassurance from staff. Comments from people included, “They look after me very well,” “They always get here and I feel safe,” “Suits me down to the ground,” “Care staff work well together and get everything done to keep me safely living at home.” A relative told us, “[staff member] is very sharp and asks lots of questions if she is noticing something happening with [relative]. [My relative] has said they feel particularly safe with [staff member].”

Health care professionals were confident the service provided safe care. They told us, “I have always found the team to be professional, person centred and caring.”

Staff had a good understanding of local safeguarding procedures and were confident any safety issues they raised would be investigated and resolved. Staff said, “They would deal with it straight away and would get back to you” and “At each supervision [they are] reminded what to look for and the process and who to speak to if it arose.”

The provider demonstrated learning from safety events, and this was embedded into staff practice. They ensured safety incidents were investigated, and risks dealt with and not left. People were supported to have maximum choice and control of their lives.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that staff supported people in the least restrictive way to ensure people and their families felt in control of their care. One professional said, “The owner works directly with myself for any identifiable governance led information alongside more complex patient situations we can come across and has been in Multi-Disciplinary Teams (MDT) and Best Interest meetings with myself and other MDT members to achieve a good outcome for a patient.”

There were processes to ensure people were protected from financial abuse, where the service provided support with shopping tasks, care staff were provided with an ‘equals card.’ This was like a debit card where care staff uploaded the receipt the person and carer signed and the office them invoiced the person.

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.

Staff were confident people were safe, risks had been identified and during home, and external visits, risks were mitigated effectively.

The provider actively supported people to take positive risks to improve their emotional wellbeing and reduce isolation. We saw evidence people were actively supported to take positive risks. This worked exceptionally well for people who lived with dementia, physical difficulties, or sight impairment. Opportunities included supporting people to swap books at the book shed, going to church, taking picnics overlooking the Fowey, trips to the Eden Project and Heligan to have coffee. The provider demonstrated how they actively supported people to take risks to enhance their quality of life and reduce their social isolation.

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

Care plans included environmental checklists, highlighting potential hazards such as gas, electric and water and where these could be located should they need to be shut down, as well as poor lighting, steps, and any difficulties in finding the property. Keys to windows and doors were highlighted and doorbells were checked to ensure they were working. Care staff completed lone working training, and all care staff used an App on their phone, so their location was known when they arrived and left a care call. One carer said, “Care plans are up to date and pretty thorough; they include information on where to park and to get in, all their background information, it’s all in there.”

The provider made sure there were always enough qualified, skilled, and experienced staff, who received thorough support, supervision, and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

The provider actively recruited a diverse workforce that reflected the demographics of the people they supported. Focusing on role specific competencies, including technical skills, empathy, cultural competence, and adaptability. Care staff were recruited safely, and necessary pre-employment checks had been completed. The provider had a ‘Smart Recruiters System’ which kept candidates engaged throughout the hiring journey offering staff clear visibility of their progress.

The provider had excellent induction and training ensuring they employed the right care staff at the right time. The induction and shadowing procedures meant care staff possessed the necessary skills and experience. Care staff described the induction as being “Lots of training for the first two months before you are let loose.” and “Very hot on the training before you are left alone.” We saw records of training provided during induction with records of observations and assessments. Care staff had completed the Care Certificate, a qualification that ensured all care workers had the same introductory skills, knowledge, and behaviours to provide compassionate, safe, and high-quality care.

We saw rotas were well organised and care staff were given 15 minutes paid travel time between each call; travel time was increased when longer journeys were completed. All care staff stated they never went alone to care for a person they had not met, no matter how long they had worked there. All care staff were introduced to people they had not met and shadowed so they knew how a person liked their tea, or where things were. We saw evidence care staff had support visits, spot checks, and competency assessments to monitor their skills and values.

The provider had an extremely positive culture where care staff were actively encouraged to develop their skills. One carer was completing a City and Guilds Certificate in dementia care; this was something they had requested in addition to the dementia training. One staff member told us, “Anything you want to learn they will look into ways to make that happen.” Care staff also completed additional training in relation to specific needs, for example Motor Neurone Disease training for care staff was available to provide support for people living with the condition. At the time of the assessment the provider was not supporting anyone with Learning Disabilities however all staff had completed Learning Disabilities training.

The provider had excellent monitoring procedures to oversee staff daily attendance and time keeping. The manager was very keen to ensure staff did not shorten visits unless something unusual happened. People and relatives told us, “The carers are very good at being on time and if they were delayed, they would be kept informed.” No one we spoke with could recall ever having had a missed visit, but one person was contacted when the carer became stranded in recent floods. One relative said, “The care staff arrived on time unless they got caught up somewhere and then they let me know, but the time they leave is then adjusted accordingly.”

Supervision and appraisals were carried out regularly and included people and carer’s needs. Appraisals included goals and aspirations.

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.

Staff had access to Personal Protective Equipment (PPE) and received training in Infection Prevention and Control. We observed care staff conducting welfare checks during calls to identify any changes, such as persistent cough or fever. This task was also included on their task listed on their App to be completed.

During our observations care staff managed infection control risks and PPE was effectively used. One person told us “They [care staff] are very good about infection control as they support all my personal care…The care staff are always changing their gloves when they do different things…all the care staff wear PPE (gloves and aprons). I have jokes with them that they must get through a lot of pairs a day.” The provider included Infection Prevention and Control as a standing agenda item in team meetings.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened.

People and relatives told us medicines were given safely. Comments included “The care staff do all medication, and it is written in the book.” and “I self-administer my medication, but sometimes a carer will check that I have taken them if they are not sure. I am ok with this as sometimes I get distracted.” Care staff had received training and competency checks were completed. Care staff removed previous medication patches and documented on a body map where the next patch was to be applied.

The provider had an electronic system to record medication. Medicine records were personalised to detail how people liked to be supported to take their medicines and if they had allergies,

Medication training consisted of a 3-hour practical session where all competencies were included. For example, administering eye drops and applying medicated creams and ointments. Senior care staff observed medication administration before signing care staff off as competent.