DICE Healthcare Limited

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 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.

People, relatives and staff were all aware of how to raise any safety concerns and were confident the management team would support and address any issues. Staff told us they felt confident with honestly sharing concerns, one staff member told us, “I used to be scared to say something [in previous job] but when I came here, I felt it was different, you don’t feel judged or undermined.”

We saw evidence of issues including incidents, concerns and near misses being discussed with staff and action being taken to support staff learning and improvement in people’s safety. For example, a person had raised a concern about a hoist and the battery not being charged. The registered manager told us, “Carers should have checked that they had put it back on charge, had it not been charged it could have potentially created an issue later on.” This was communicated with staff via email to reduce the likelihood of it happening again by raising staff awareness.

This open and honest approach and a proactive culture of safety meant people were less likely to experience harm as a result of safety concerns not being reported and lessons being learnt to improve practice.

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 a number of examples of the management team engaging with people, relatives and healthcare professionals as well as how safety was managed, monitored and concerns communicated to the appropriate healthcare partners.

The provider had checked all people’s weights on a regular basis so that any changes or concerns could be addressed. This included supporting a person with ensuring that their airflow mattress was set correctly to maintain the integrity of their skin by engaging with the occupational therapist, family and the GP.

When people joined the service, a thorough assessment was completed involving them and family where appropriate to ensure any safety concerns and the transition to receiving care from the provider were managed effectively. The registered manager also made contact with people’s GP when they started care and told us, “If we get a new client I write to GP to advise them and what care we are providing, and to get in touch.”

This meant people received consistent care from the provider and the wider team of professionals to ensure their health and care needs were monitored and met safely.

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 and knowledge checks around safeguarding, we also saw that there was information available at the office where staff met for meetings giving information on safeguarding including external agencies to contact.

Staff were knowledgeable about safeguarding practices and signs to be vigilant for that may indicate abuse. Staff and the management team were clear about their roles and responsibilities around safeguarding people and ensuring they lived in safety, free from abuse and avoidable harm.

People’s care plans provided information and instructions to ensure staff worked in a way that supported people to feel and be safe. One relative told us, “I have met the carers, and I am happy that [relative] is safe.”

We saw the registered manager shared concerns quickly and submitted safeguarding referrals to the local authority when concerns had arisen. One example of this also evidenced the involvement of the GP and a community psychiatric nurse supporting the person.

The provider and staff team had a good understanding of what made people feel safe, and what they needed staff to do to keep them safe. This meant they experienced care that protected them from risk of avoidable harm, and abuse and protected their right to live safely in their own home.

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.

The management team met with people, relatives and professionals to understand and manage people’s individual risks. We spoke with people and relatives about their involvement in this process who confirmed this happened. People also described ongoing contact with the team. One relative told us about a health concern the staff alerted them to, “They thought [relative] might have a urinary tract infection and they alerted me. [Relative] is happy and so are we.”

People knew how to contact the management team if there were any concerns. One person told us they could also contact an out of hours number if they needed to. They said, “Yes, I call them [management team] and the out of hours number. They always call me back.”

This supportive approach enabled people to maintain their autonomy, do the things that mattered to them, while receiving the care they needed to keep them safe and well.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The management team made a thorough assessment of people’s home environment before starting care to identify any potential risks and consider any ways of controlling the risk or empowering people to do this themselves. The registered manager showed us evidence of the assessments carried out, the information in the care plans and engagement with the local fire service to support people in their homes with fire safety. One person told us, “Yes, they did [carry out an assessment] and the fire brigade came to check fire alarms.”

Where people had specific equipment in place the provider ensured it was effective and met people’s needs safely. We saw evidence of the registered manager contacting an occupational therapist regarding equipment that staff had identified a potential concern about.

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 management team ensured staff had the right training to effectively carry out their role. We reviewed documents which evidenced staff received a thorough induction before starting work and opportunity to shadow with experienced staff. Spot checks and supervision meetings were carried out regularly to further support staff and improve ways of working. One staff member told us, “They [management team] come when we are at client’s house to see how we are doing, we get spot checks. They [management team] give us feedback. Regular supervision about once a month, sometimes we are asked questions to make sure we have an understanding for things like safeguarding.”

Staff were recruited safely. All staff had a disclosure and barring service (DBS) check completed. DBS check is a record of an individual’s criminal history used by employers to determine if a person is suitable for a job, particularly roles involving working with vulnerable adults or children. Checks on identity were carried out and the registered manager told us about a recent initiative they had undertaken to improve this process. They told us, “The Home Office are auditing all of the docs [documents] for overseas staff.”

Staff received the right training for their role, competency was assessed, and staff were supported to undertake additional training and qualifications. Staff had all been upskilled in relation to knowledge about supporting people living with dementia and were all registered “Dementia Friends”. One of the directors explained this, “It means they [staff] get additional training and have to answer multiple choice questions, and it gives them additional information and resources. [Care coordinator] has done a course on train the trainer for dementia face to face training for staff. It’s so important, quite a number of our clients have dementia and it’s important for carers to know what the triggers are, which part of brain may be affected and how in real terms this affects the person.”

The providers guiding policy and procedures, ensuring staff were well trained, supported and supervised meant people received care from skilled staff who were screened using a safe recruitment process, and were competent to provide safe care, keeping them safe and well.

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 provided staff with training on infection prevention and control (IPC), considered their use of personal protective equipment (PPE) during spot checks and had a clear policy in place to guide staff around IPC processes.

People and relatives told us staff used appropriate PPE and wore uniforms and people received the right level of support with personal care. One relative said, “I do think [relative] is well cared for [relative] is clean and dressed.”

People’s care plans and daily records evidenced that people were supported to maintain hygiene levels in their home environment, as well as being supported with their personal hygiene.

People receiving the right support from staff with maintaining their home environment and their personal hygiene meant they were protected from infection and disease.

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.

We reviewed people’s medicines care plans as well as the records of their support with taking medicines, including applying prescribed creams, and found the plans provided clear guidance for staff and records were completed in full. We found one person did not have a flammable creams risk assessment, but this was immediately corrected by the registered manager and was noted by the inspector on considering other factors to be a low risk.

People and relatives, we spoke with who were supported with medicines told us they felt happy and confident with the support they received from staff. One person said, “They take complete charge. No issues.” From the feedback we received it was evident that people were supported in a way that met their individual needs and preferences and promoted their choice on how they wished to be supported.

Safe support with medicines meant people were supported to take their required prescribed medicines and creams and remain well.