Look Ahead Domiciliary Care (Hertfordshire)

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 inspection we rated this key question good. At this assessment the rating has changed to inadequate. This meant the service was not safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and safeguarding.

This service scored 34 (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 always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

There was not always consideration when mitigating risks of closed cultures. For example, we found in some homes restrictions that had been imposed by the staff team, there was no rationale as to why this was in place. People were not able to move around their home freely.

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.

The provider did not consider the restrictive practices that were in place when supporting people. This meant people had restrictions imposed on them without legal justification or any discussion as to why it was necessary to restrict the person.

People were not being supported in line with their positive behaviour support plans. Where incidents occurred, documents did not detail the strategies they used before administering medicines which affected people’s mood. We also found one example where staff had used physical restraint which was not in line with their care plan.

In some circumstances people had restrictions with moving around their home. We found one person enjoyed playing with the lighting, however staff made the decision as to when the person could not do this anymore and removed access to this. This does not promote respect to the person or their human rights.

People’s needs and feelings were not always considered by some staff when they provided support to people.

People were not supported to help understand and manage risks. Staff did not provide care to meet people’s needs that was safe and supportive.

Risk assessments were not always detailed, we found examples where risk assessments needed further development or were not present. For example, epilepsy plans did not detail how to support the individual if they were to have a seizure and where epilepsy equipment was in place to help keep the person safe, we found was not in working order. Where people had a risk of choking, there was not appropriate detail in care plans and risk assessments to reduce risk and tell staff what action to take if a choking incident happened. Daily records showed that staff were not following the guidance in place.

Incident and accidents were not looked into appropriately. Although there was a trend analysis for the forms for some incidents, there was a lack of information that showed what steps were taken to mitigate the risks. For example, we found what was described as unauthorised holds being used as well as chemical restraint being used without clear rationale as to why this occurred. Staff confirmed they had discussions and debriefs when incidents occurred.

People were not always supported by staff who had the right skills and knowledge. Staff training records showed that staff were supporting people without the training required to support them safely. We found examples where staff did not have appropriate training when people became physically aggressive towards staff and how to deal with this safely. In addition, where people must have rescue medicines, not all staff had the correct training in the event they needed to administer the medicine. The provider took immediate action to ensure the staff had the right skills to support people safely.

People were supported to ensure they lived in an environment that met their needs.People were supported to raise any concerns with their living environment with the appropriate agencies, however we found examples of some equipment was not in working order and this had not been identified by staff.

Staff felt they had the right training to support people. However, records reviewed found that the provider did not make sure there were enough qualified, skilled and experienced staff. For example, we found staff had supported individuals without up-to-date training for manual handling, epilepsy and training in how to deescalate situation where people become physically aggressive.

The provider did not always make sure staff received effective support, supervision and development. Staff said that although they were able to speak with management, some staff said they had not received regular supervisions, and they found this important to them.

The provider operated a safe recruitment process; appropriate checks were undertaken to help ensure staff were suitable to work at the service. A disclosure and barring service (DBS) check and satisfactory references had been obtained for all staff before they worked with people. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider assessed and managed the risk of infection. They detected and controlled the risk of any infections spreading and shared concerns with appropriate agencies promptly. We found that people were supported with maintaining a clean home and environment..

People were receiving their medicines as prescribed; However, we found that on several occasions a person had been administered medicine which changed their mood, without documents detailing the rationale as to why this was administered.

People said they were encouraged to be as independent as they can with their medicines and staff supported them when required. Staff spoke about how they would identify if someone was in discomfort and may require medicine.