Raynsford Domiciliary Care

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 62 (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 which focused on empowering people but also considered people’s safety. The registered managers told us they nurtured a culture of openness and honesty. Accidents and incidents were reported and investigated. There was evidence of lessons learnt from incidents and amendments to practices. For example, financial protocols relating to the management of people’s money had been reviewed to help prevent further incidents and embed good practice. The registered and service managers met regularly and worked closely together to share any lessons learnt or good practices.

Staff felt supported and told us they were able to raise any concerns with the registered and service managers and were confident action would be taken. All staff spoke about the positive impact on people as result of the improvements made by the managers to enhance people’s lives. One staff member explained the culture of the service in the past had been restrictive and provided examples of the changes in staff approach which had resulted in positive outcomes for people.

The provider worked with people, their relatives and healthcare partners to ensure there was a continuous and safe transition of care when people moved in and out of the service. People and their relatives had been involved in decisions about moving into the service.

An initial assessment was carried out with any potential new people who wished to move into the service. This enabled the registered manager to determine the person’s needs and their level of independence and support requirements as well as their compatibility with other people who used the service. A transition plan was then developed with people depending on their needs and confidence. The registered manager said, “We won’t move people into the service unless it is safe to do so, we want ensure people are happy living together.”

People had been supported to attend specialised medical appointments to ensure their care and treatment remained continuous. Additional support and consideration had been made for those people who found attending appointments stressful. Feedback shared from health and social care professionals was positive. They told us communication to and from the service was good and staff followed their recommendations to ensure people’s health needs were met and monitored.
 

The provider and staff worked with people to help them understand what being safe meant to them. For example, information about bullying and safety concerns was provided to people in a clear and understandable format to help them understand different types of abuse and harm. We observed people actively engaging with staff without fear or anxiety. People and their relatives raised no concerns about people's safety. People said they would talk to their key workers if they had any concerns. One person said, “I am happy and safe here.” When asked about people’s safety, we received comments from relatives such as, “Yes, 100% absolutely. Because she’s not able to go out of her home by herself and is fully supported. There are good interactions, as I see it”; “Yes, yes I do think there’s a positive culture” and “I believe so there’s no reason to believe she isn’t safe.”

The registered managers and staff had received safeguarding training appropriate to their role. They had a good understanding of their responsibility to recognise and report abuse to the relevant authorities.

Staff told us they concentrated on improving people’s lives whilst also protecting people’s rights and help them live a life free from bullying and harassment. The provider shared safeguarding concerns promptly to the relevant safeguarding agencies.

The provider did not consistently work well with people to accurately document the management of their risks. Whilst we found no impact on people as staff knew people well; we did, however, find a small number of inconsistencies in the management of people’s risks in some people’s care records. This meant staff may not have had clear information about how to support people. Every person had a personal emergency evacuation plan in place; however, these plans would benefit from more detail when assessing people’s nighttime evacuations based on their support needs, staffing levels, and the specific fire safety plan for each house. We fed this back to the service managers who took immediate action to address this.

People had been involved in developing their care and risk management plans. Staff were aware of people’s risks and the support they needed to help mitigate risks. Systems were in place to manage, review and monitor people’s needs such as epilepsy and dietary risks.

Staff provided safe care that fully met people’s needs and enabled people to do the things that mattered to them. People were supported and empowered to take positive risks in areas they wanted to and to enhance their lives.

People were supported to attend routine and specialist health care appointments. When required, staff acted on any concerns and made appropriate referrals to health care professionals as needed. Effective systems were in place within each house to communicate any changes in people’s health and support needs.

The provider did not always detect and control potential risks in the care environment. Staff acted as people’s advocate or supported them to maintain their tenancies and report any individual concerns or maintenance issues to their relevant landlords. However, people had not always been supported to report concerns to their landlords about the shared indoor and outdoor communal areas. We found some communal areas in some of the houses were ‘tired’ and required remedial work.

Internal monitoring systems had not always been effective in identifying all environmental issues and records did not always show ongoing maintenance issues had been followed up with the landlord. Regular cleaning and health and safety checks, including fire safety checks, were completed by the service manager at each house. However, it was not always clear when actions had been taken to address shortfalls in their findings or links to the provider’s health and safety audits.

We brought our concerns to the attention of the provider and management team of the relevant houses who had recognised improvements were needed. Managers took action to follow up on our concerns during the assessment and contacted the relevant landlords. The provider implemented new maintenance logs to help service managers monitor and drive forward these improvements. However, further time was needed to ensure these processes were fully embedded and sustained.

We observed, and people told us, they had been supported to personalise their own bedrooms, and they found communal areas were homely. People had been assessed for equipment to help them overcome barriers and be more independent including rails, and alarm bracelets to alert staff. However, one person shared they were concerned about how they would alert staff if they became unwell while they were in their bedroom. This was raised with the service manager who took immediate action to try and find a solution to ease the person’s fears.

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

People praised the staff and felt there was enough staff to support them. Each supported living house was supported by a core daytime staff team. The staffing levels for each house was continually monitored and determined by the needs of people and their funded hours. Where possible, a senior staff member, deputy manager or service manager was part of each shift to provide leadership and guidance. The level and role of night staff at each household was determined by people’s nighttime support requirements.

Each supported living house was supported by an on-call system which provided out of hours assistance, managed emerging risks and unexpected staff shortages.

Safe and values-based recruitment practices were used. People were supported by staff who had been vetted and recruited based on robust employment and criminal checks. The provider planned to implement additional safety measures when they had not been able to obtain sufficient information about staff conduct at previous jobs.

Records showed, and staff confirmed, they had received sufficient training and support to carry out their role. Most staff had received specialised training in how to support people with a learning disability, and or autistic people, to meet their assessed needs.

Whilst we found some gaps in staff training; we were told this was being addressed with individual staff members and progress was being made to train internal trainers to compliment staff online training. We reviewed and discussed a sample of staff supervision records with the registered managers, who recognised the need for further training to ensure senior staff conducted and recorded effective staff supervisions.

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.

We found most of the supported living houses were generally clean and tidy. However, we found people had not been supported to maintain the cleanliness of parts of their home in a small number of the houses we visited. We raised this with the relevant service manager who took prompt action.

People were supported to clean their rooms and communal areas according to their needs and levels of independence. People told us they were supported to complete their own chores such as managing their laundry and contributed towards shared household tasks, such as, washing up and vacuuming. Relatives raised no concerns about the cleanliness of people’s homes. One relative said, “I’ve seen them make sandwiches, and the kitchen is spotless. It really is.”

Staff were clear about the importance of using personal protective equipment when supporting people with their personal care or managing soiled items.
 

People’s medicines were generally managed safely; however, we found a small number of inconsistencies in the management of people’s medicines in some of the houses.

People’s medicines were stored in locked cabinets in their bedrooms. Whilst most people understood their prescribed medications and when they should be taken, one person we spoke with was uncertain about the purpose of their medicine. The service manager agreed to review the person's medications with them in an understandable format.

Senior staff at each house had the overall responsibility for daily medicines management, administration and checking people’s medication administration records. We found a small number of gaps in people’s medicines administration charts and gaps in the recording of medicines cabinet temperature charts in some of the houses. We fed this back to the service managers who agreed to review their medicines monitoring systems to ensure there was a consistent approach in the management of people’s medicines.

Medicines care plans provided staff with the guidance they needed to support people with their medicines. Staff had received training on how to administer people’s prescribed medicines safely. Staff were knowledgeable about people’s medicines and felt trained and competent to safely administer people’s medicines.

The provider was committed to ensure people had regular medicine reviews with health professionals. Staff were mindful of administering antipsychotic medicines in line with national best practice guidance called STOMP (‘stopping the over-medication of people’ with a learning disability and or autistic people when distressed).