Enchanting 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 69 (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.

People and staff felt confident in raising issues and told us they were confident senior staff would address their concerns and follow up with staff. One staff member told us, “They [office staff] are good at giving feedback which I like.” The provider had good oversight of incidents, accidents and complaints. They used concerns raised through their online system to record and resolve issues raised by staff about people. The provider had used feedback to implement lessons learnt to continually make improvements and embed good practice. Staff were informed of these through an online chat group or updates via their care app.
 

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.

This provider assessed people in the hospital before a person came home to start the package of care. The provider ensured care was organised flexibly, with adjustments made to meet people’s changing needs. This included when people attended appointments, when their health needs changed or when they were admitted to or discharged from hospital. Staff told us they were always informed when people started with the service, or people came out of hospital with different needs. Information was available on people’s care plan via the app as well as online messaging. One staff member told us, “Information such as medicines can be accessed via the app. It is usually pretty thorough.” They told us the office staff also call them to keep them informed to ensure people’s care met their needs.
 

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 with external agencies. However, there had been a delay in notifying CQC, for 1 allegation of abuse, until the provider had thoroughly investigated the claim, which they found to be unfounded. We discussed the importance of timely reporting of all allegations of abuse with the provider who sent the notification retrospectively during the assessment.

People and relatives told us they felt safe receiving support from the staff. Staff had a good understanding of safeguarding procedures and understood how to recognise the signs of abuse. The provider had effective safeguarding policies and procedures in place. Senior staff demonstrated a thorough approach to investigating safeguarding concerns, to help reduce the risk of people suffering abuse or coming to avoidable harm.

All staff were trained in safeguarding adults and children and knew what signs to look out for and who to report this to. One staff member told us, “If [person] tells you anything untoward, you have to tell them you need to speak to someone else. Follow up the concerns.”
 

Although the provider worked with people to understand and manage risks, they did not always consider all of the risks to ensure staff would have comprehensive guidance when supporting people to remain safe.

The provider considered risk to people as part of their assessment, however, how staff were to support people to reduce the risk of harm was not always considered and clearly documented in people’s care plans. For example, people did not have a risk assessment for using flammable emollients which posed additional risks to people in the event of a fire. However, the provider worked to put this in place during the assessment.

Although some risks identified such as skin breakdown were not always comprehensively assessed by the service; they had alerted health care professionals. There were good risk management plans in place created in partnership with the district nurse team for example in relation to monitoring people’s skin health and preventing pressure ulcers. This gave appropriate guidance to staff to provide good quality care. Staff we spoke with were clear about these risks and how to mitigate them. One staff member told us, “Yes, we also have the district nurses who give us a plan as to where to put the cream and what to do.” People we spoke with were happy with the quality of care provided.
 

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

The provider carried out assessments of people’s home environments to identify and reduce any risks related to the delivery of care. This included checking when hoists were last serviced and arranging for hoists to be inspected to make sure they were safe to use. The provider had invested in technological solutions to aid the delivery of safe care. This included electronic care planning systems and telephone systems, which helped to improve safety and the provider’s ability to monitor how care was delivered.
 

The provider made sure there were enough qualified, skilled and experienced staff. However, some recruitment practices needed to improve. We reviewed 4 recruitment records during the inspection. These included Disclosure and Barring Service (DBS) checks. Recruitment records did not always record all the required pre-employment checks completed to show how the provider ensured only suitable staff would support people. A suitable recruitment policy was in place.

People and relatives told us consistency of staff was important to them. Although people generally received care from regular staff, they found changes of staff challenging at times. One person told us, “I am absolutely thrilled with the various carers who are really lovely.” One relative gave us mixed feedback saying, “There are too many carers and no continuity.” People told us staff were on time and stayed for the full duration of their calls. They also told us they thought staff were well trained.

The provider made sure staff received effective support, supervision and development. Records evidenced staff received an appropriate induction including training and shadowing. Training for staff across all mandatory subjects was up to date and complied with best practice guidance. Staff training was a combination of in-house or external face to face and online.
 

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 effective infection control policies and procedures in place. Staff told us there were adequate supplies of personal protective equipment PPE, but some people raised concerns some staff had to be prompted at times to use this equipment appropriately. The provider was aware of this and had addressed concerns with regular spot checks. This helped to ensure staff were following effective infection control procedures.
 

The provider made sure that people received their medicines as prescribed and medicines management met people’s needs, capacities and preferences.

The provider had policies and procedures developed in line with national guidance, to help ensure staff were following best practice when supporting people with their medicines. People’s care plans detailed the support people needed to manage their medicines, and levels of independence people wished to maintain. Staff and management had a good understanding of best practice in medicines administration, including National Institute for Health and Care Excellence (NICE) guidelines for medication management. Staff were trained to administer medicines and their competency to do so safely was assessed via spot checks. However, the level of detail for competency assessments was less than would be expected to provide assurance. The provider produced appropriate forms during the assessment to use in future to complete more comprehensive competency checks.

Staff completed an electronic medicine administration record when they administered people’s medicine. This was monitored by the provider and medicine records were promptly updated when people’s prescriptions changed. During the inspection the provider altered their weekly medicine alert checks to daily to ensure any missed medicines would be followed up in a timely manner.

The provider was aware when people required strict time-specific care calls to ensure they received their time specific medicines as prescribed.