Home Instead Wembley

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• 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. The rating has improved from requires improvement to good during this assessment. This meant people were safe and protected from avoidable harm.

Our previous inspection found that improvements were required to medicines management. This assessment found that the provider had made appropriate improvements to this area.

This service scored 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

An effective system was in place to report, record and monitor incidents and accidents to help support people safely. There was a detailed and comprehensive record of lessons learnt to help reduce reoccurrence. Lessons learnt were discussed in regular meetings and staff were encouraged to openly discuss and learn from one another.

Senior staff promoted a positive learning culture at the service through their monitoring and engagement with staff. There was a focus on learning and improving the service wherever possible. Staff were able to raise concerns outside of the management team to help prevent the development of a closed culture. A member of staff said, “The minute we put in a concern, the manager deals with it immediately. There is also good follow up about any changes.”

The provider worked with people, relatives 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.

People and relatives told us the provider was flexible around changing care hours and care arrangements if required. This included being flexible if people had medical appointments or if they were unwell. The provider ensured people’s needs were reassessed after significant events, such as hospital admissions or injuries. This helped to ensure care arrangements were suitable and reflective of people’s current needs.

Staff spoke confidently about the processes to report concerns and raise issues about people’s safety. They were also confident their concerns would be listened to and acted upon by management.

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 professionals.

Procedures were in place to help safeguard people from abuse and improper treatment. Staff knew how to recognise signs and symptoms of abuse and received training to help ensure they were up to date with best practice guidance. Staff knew how to report concerns and said that they wouldn’t hesitate to do so. Senior staff had a clear oversight of safeguarding concerns and alerts received.

People told us they felt safe in the presence of care staff. They said that staff were kind, reliable and they trusted them. A relative told us, “The carer is wonderful and look after [my family member] well. [They] feel safe in their care.”

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.

Individual support plans included risk assessments that considered people’s environment, health, medicines and activities. Risk assessments contained comprehensive, detailed and clear instructions for staff about how to support people to minimise and manage risks to help keep people safe. These informed staff of what actions they needed to take to help keep people safe and help reduce the risk of harm.

Staff worked with specialist advisors to respond to risks effectively. For example, a Speech and Language Therapist (SALT) was involved in the management of a person with a swallowing risk and this was clearly documented in the care records.

Staff completed training in areas of potential risk such as first aid, moving and handling and health and safety.

The provider assessed, detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People told us they were supported to remain safe in their own home.

Environmental risk assessments were completed during initial assessments in people’s homes to ensure staff could deliver care safely. Where risks were identified, appropriate detailed risk assessments were put in place and documented in care plans.

The provider had systems in place to monitor environmental safety on an ongoing basis. Spot checks and audits were carried out to ensure compliance with safety standards, and any issues identified were addressed promptly. Relatives told us they felt reassured. A relative said, “I can’t fault their responsiveness to any request or concern. They aim to resolve any and all issues and do so successfully.”

Staff had a clear understanding of when to raise concerns to senior staff in relation to environmental safety. The provider used technology to help promote the safe delivery of care. For example, senior staff monitored electronic care planning systems both within and outside of office hours. This helped to promote safety for both people and staff as the provider was assured care visits were completed as planned.

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.

People and relatives told us they were happy with the staffing arrangements in place. They told us they received care and support from consistent care staff, who understood their needs. They were confident staff were competent and trained to a good standard.

Staff spoke positively about the training and ongoing support they received in their role. They had received training around people’s specific medical conditions and care related equipment. The provider had a number of staff who have been trained in specific topics so they can deliver in-house training to staff (train the trainer initiative).

Senior staff regularly reviewed staff’s working performance through supervisions and spot checks. Management met regularly with staff to share feedback, identify training needs and set objectives to help staff develop and improve.

There were sufficient numbers of staff in place to cover care calls and meet people’s needs. The provider had an electronic homecare monitoring system in place to monitor care staff’s timekeeping and punctuality in real time. The system would flag up if care staff had not logged a call to indicate they had arrived at the person's home and were running late.

The provider had safe staff recruitment processes in place. Thorough checks on the suitability of potential staff were completed which helped to ensure staff were of good character and were suitably qualified for their role.

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.

People told us staff followed good infection control and hygiene practices. They told us staff helped to keep their homes clean and wore appropriate PPE when supporting them with their personal care.

Staff had good knowledge of infection prevention and control. They said there were adequate supplies of PPE in place for them to use whilst supporting people with their personal care. There were effective infection prevention and control policies in place and the provider had taken measures to improve processes to reduce the risk of infections spreading.

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.

Since the previous inspection, the provider had made improvements to the recording of medicines administration. They had implemented an electronic medicine recording system to document medicines administration. This provided office staff with real time details of medicines administration so that they were able to closely monitor when medicines were administered. This helped promote proactive monitoring of administration and reduce risks related to medicine errors.

We looked at a sample of Medicines Administration Records (MARs) and found they were completed fully indicating medicines were administered as prescribed.

Some people were prescribed PRN (as required) medicines. There were appropriate protocols for staff on when and how to administer PRN medicines. PRN medicines were administered as prescribed.

Staff who handled medicines had completed training and had a competency assessment.