Help at Home Care Service

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

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 72 (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.

Records showed that accidents and incidents were documented, and staff understood the importance of reporting concerns. Investigations included sufficient analysis and/or follow-up to understand underlying causes. Staff told us they felt comfortable raising concerns and were confident these would be addressed by management. Relatives told us, “I feel safe from risks with carers” and “The carers change but there is no difference in quality.”

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.

External professionals told us the service worked effectively with them and was responsive when concerns or changes in people’s needs were identified. Comments included, “They [manager and coordinator] take time to listen, respond promptly to concerns or requests, and consistently demonstrate professionalism and compassion in their work.”

Summary information about people’s specific needs, risks and preferences was available to be shared with health professionals to support safe transitions of care if hospital admission became necessary.

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.

People consistently reported and demonstrated through their actions they felt safe with their support staff. We observed people were comfortable requesting support and reassurance from staff. People and relatives told us, “I feel very safe with them, safeguarding is strictly followed in my opinion”, “I’m very safe and sound with the carers, they are the best I have had” and “They keep my relative very safe from risk at all times.”

Involved health care professionals were confident the service provided safe care. They told us, “They feed back any concerns and request reviews of care as appropriate and will go above and beyond their care to keep a person safe until the review has been completed.”

Staff had a good understanding of local safeguarding procedures and were confident any safety issues they raised would be investigated and resolved. Staff said, “Do safeguarding reports all the time, report anything to the office.” and “Emails come from the office around safeguarding, with what and when to be vigilant.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. We checked whether the service was working within the principles of the Mental Capacity Act. We found staff supported people in the least restrictive way to ensure people and their families felt in control of their care.

There were processes to ensure people were protected from financial abuse. Where the service provided support with shopping tasks, people had pre-loaded shopping cards or were able to use their own cards.

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.

Staff were confident people were safe; risks had been assessed and were mitigated effectively. Care plans included guidance on how to support people if they became upset or anxious. Care staff said the office made sure they were aware of any updates to risk. A relative told us, “The carers are very patient with my [relative] because [my relative] has progressive dementia” and “They will listen and point things out they may be unsure of and inform the district nurse.”

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

Care plans included environmental checklists, highlighting potential hazards such as gas, electric and water and where these supplies could be located should they need to be shut down. This supported staff to respond appropriately and safely when working in people’s homes.

The provider did not always 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 always work together well to provide safe care that met people’s individual needs.

The provider had enough experienced staff to meet people’s needs safely though a small number of staff were working excessive hours which was being monitored. Staffing levels were planned to ensure people received continuity of care and visits were delivered as scheduled. People told us staff mostly arrived on time and stayed for the full duration of visits. Comments included, “I get different carers, but I am happy with the continuity”, “They do personal care very well” and “The punctuality is not always exact; they get held up in traffic or with a previous client.”

Induction training helped ensure new staff had appropriate skills and knowledge to support people in line with their needs and preferences. Care staff told us, “The induction was ok, we had training, supervisions and were given a handbook.”

Staff completed core training modules as required by the provider, however this did not meet all mandatory requirements for adult social care providers. For example, there was no training for supporting autistic people or people with a learning disability. This has been a legal requirement for all CQC registered providers since 2022. The provider immediately added it to their training matrix.

Staff were recruited safely and necessary pre-employment checks had been completed. Staff files contained photographic identification and full employment histories.Arrangements for interviewing prospective employees was not well structured, interview notes had not always been kept, so we were unable to see if the questions asked explored candidate’s previous experience and knowledge. This can help employers make decisions about candidates. The provider said this would be implemented to use in the future.

Supervisions and appraisals were carried out regularly although some appraisals had very similar wording and did not seem personalised. However, staff told us they felt supported and able to raise concerns or seek advice when needed.

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.

Staff had access to good stocks of Personal Protective Equipment (PPE), including gloves, aprons, and hand sanitiser. Staff told us PPE was readily available and could be replenished when needed. We noted during home visits that PPE was used and people and their relatives told us, “They all take hygiene very seriously and they follow the rules with PPE.” Another told us, “I’ve only reported one hiccup like not always changing gloves, any issues are addressed straight away when I report it.”

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.

Staff understood how to manage people’s medicines safely and had access to guidance. At the time of the assessment Medication Administration Records (MARs) were kept on paper, and these were available in people’s home for care staff to complete. The provider had plans to introduce a digital care planning app which included MARs. The paper MARs had facilities to record why ‘as required’ medicines were used and there were protocols to guide staff on when to offer these medicines.

Missed medicines were reported by care staff to the office. Where medicines had been missed an incident form was raised with lessons learnt captured. MARs were audited monthly.

Staff told us, “The MAR chart is clear with ‘as required’ medicine, we always check whether it is needed and not just administered.”