Princess Homecare

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 inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider continued to be in breach of the legal regulation related to safeguarding.

This service scored 56 (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 did not have a proactive and positive culture of safety based on openness and honesty. Lessons were not learnt to continually identify and embed good practice.

A volunteer had developed an action plan from the last inspection report. However, the provider could not describe the contents of the plan, what improvements had been made or who was responsible for further action. This did not demonstrate a learning culture or that the provider had the knowledge or understanding to improve the service in line with regulation.

The provider told us there had not been any accidents or incidents, so learning from such events was not possible. They had not however considered any learning from staff feedback which was provided at the last inspection.

Leaders had addressed the lapse in staff training. A health and social care professional told us they had found the provider to be good at identifying staff’s training needs and would request training where required. However, leaders had not ensured all staff had completed the government’s preferred and recommended training, or equivalent, for health and social care staff.

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.

People told us the provider would call the GP or other health care professionals if they were unwell or needed anything.

Staff knew how to escalate concerns with a person’s health. The provider confirmed this and told us they worked with a range of different health and social care professionals as needed. Recently this included a podiatrist and an occupational therapist. Health and social care professionals told us the provider would call them for advice if needed. They said any advice given, was always followed.

The provider did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

At the last inspection, the provider was in breach of the legal regulation related to safeguarding. Some improvement was found during this assessment, but the provider remained in breach of this regulation. ​

Leaders told us they were aware of safeguarding when providing people’s support, but they could not describe the main types of abuse. They were prompted by a member of staff to answer correctly. This lack of knowledge did not ensure potential abuse would be identified or appropriately reported and investigated.

A new system had been introduced to demonstrate any shopping leaders completed for a person. This had included taking a photograph of the shopping to correspond to the receipt. However, one receipt was missing, with no photograph to verify the transaction and there were loose photographs of purchased shopping, which were not accounted for. Although the service had introduced a complex system, this did not demonstrate an effective new financial governance framework. This meant people were at risk of financial abuse.

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.

At the last inspection, systems did not demonstrate risks had been identified or assessed and there was a lack of action to ensure safety. This was a breach of regulation in relation to safe care and treatment.

At this inspection, improvements had been made to care planning and risk management. For example, people had been assessed for risks such as skin damage, falls and health and safety and measures to enhance safety were identified. There was information to help staff minimise the risk of a person choking and how to use equipment safely.

One person told us any risks they faced were identified, which made them feel safe. They said they were only supported by the provider, so received a reliable service.

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

At the last inspection,risksassociated withaperson’s environment had not beenproperly assessed.This was becausethe providerhad purchased equipmentfor a personwithout the assessment of a qualified health professional.This did not ensure the equipment was safe to use or met the person’s needs.

At this inspection,the providertold us they no longer used the equipment as“CQC had told them off”.This meant the care intervention previously undertaken was no longerperformed. The provider told us ofothermeasures, which werebeingfollowedinstead.

Environmental risk assessments had been completed, and thevolunteer told usthey had helped the providerimprovedocumentation. This includedthe support people neededto vacate their propertyin the event of an emergency.

The provider told usthey were planning to implement anelectronic care planningsystem, but at present, people continued to have paper copiesof their care plan. The provider told usthese documents weresafelystored.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

The provider had not followed safe recruitment practice. This was because they had not gained an employment history for the most recent member of the team. The provider told us they had gained information about the staff member’s work performance but had not recorded their conversation. This did not provide evidence of the staff member’s suitability for their role. Whilst the staff member was known to the provider, the lack of formal processes did not ensure they were safe to be at the service.

Leaders told us there were enough staff to support existing care packages. However, 1 person was not supported with their preferences due to the staff member’s gender. This meant another staff member would be called upon when they needed support with their personal care. This did not ensure consistency and impacted on the person’s dignity and wellbeing.

At the last inspection, staff training had lapsed, and staff did not feel supported by the provider. At this inspection, focus had been given to staff training and communication between staff and the provider had improved.

One person told us they received consistency and had a good relationship with the provider. This was because the provider supported them with all their care.

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.

At the last inspection, staff had not undertaken training in infection prevention and control. At this inspection, records demonstrated online training had been completed.

The provider had an infection prevention and control policy, and staff’s practice was assessed within spot checks of their performance.

One person told us staff were always clean and helped them maintain cleanliness in their home. A health and social care professional confirmed this. They said staff were good at supporting people to wash and always observed their skin for signs of soreness or infection.

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.

At the last inspection, medicines were not safely managed. This was because written medicine instructions were not accurate, and risks associated with leaving medicines for a person to take later had not been assessed. There was no guidance for the management of transdermal patches and one person had regular ‘as required’ medicines without the GP being informed.

At this inspection, improvements had been made. There were clear instructions of the medicine’s prescription, and records showed medicines were administered as prescribed. Individualised guidance for staff regarding ‘as required’ medicines had been developed, and staff had recorded why the medicines had been given.

Guidance for staff was available to show when and where to apply topical creams, and these had been applied as prescribed. Records had been developed and showed staff rotated transdermal patches in line with the manufacturer’s guidelines. Staff had documented when they administered any ‘as required’ medicines. They included the time, reason for administering and the effectiveness of the medicine. This enabled more accurate monitoring.

Regular medicine audits were carried out to identify any shortfalls in practice and there was an up-to-date policy for staff to refer to as needed. Staff had completed online training in the safe administration of medicines.

The provider told us they helped people to order their medicines if needed and liaised with the pharmacy, to ensure they always had enough. One person confirmed this. They said the provider ordered their prescriptions and competently applied their topical creams.