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 requires improvement. At this inspection the rating has changed to 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. Where incidents occurred, lessons learnt had been identified by the management team, there was evidence the lessons learnt were embedded into the service in a timely way.

A staff member said, “Incidents are taken seriously and investigated appropriately… staff listen to what happened and try to understand why it happened so we can learn from it and keep people safe.”

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. They ensured transitions were meaningful and had people’s needs at the centre of the decisions being made.

People experienced smooth process when they are referred to a different service. Information is shared so people receive the care and support they need, in line with their individual plans.

A professional fed back to the service, ‘Your leadership and positive attitude instil a sense of reassurance and peace, not only for [person] but also for all the professionals involved in his care. It is truly a pleasure working with your team, and we will continue to support the team to ensure that [person] enjoys a happy and fulfilling life within the community.’

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 were supported in a way that promoted their safety, independence, and personal choice. People looked comfortable in their own home, where people were unable to verbally communicate their views, they used different communication such as signed and body gestures to show they were happy in their space with the staff that were supporting them. A person told us, “Staff are wonderful, I had problems in the past but that has been sorted. I am really happy now.”

Staff demonstrated a clear understanding of safeguarding procedures and acted promptly to address any concerns. Where a safeguarding issue occurred, the management team ensured this was investigated appropriately and immediate action was taken to keep people safe. A staff member said, “I remain vigilant for changes in behaviour, mood, or physical signs, and I report concerns immediately to my manager or safeguarding lead.”

At the last inspection, we identified that some restrictions in place were overly restrictive and lacked clear rationale. Since then, the leadership team had undertaken significant reflection and review. They had reassessed all restrictions to ensure they were proportionate, justified and in line with the principles of the Mental Capacity Act, and made changes where restrictions could not be evidenced as necessary. A staff member told us, “Restrictions are risk assessed, clearly documented, regularly reviewed, and always based on least restrictive practice.”

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

People’s risk assessments were person-centred and regularly reviewed, enabling people to live as independently as possible while remaining safe. These assessments considered both physical and emotional wellbeing.Where people’s needs changed the staff, management team and families worked together to get good outcomes for people. Staff received clear monitoring guidance, and the GP and family were involved promptly, demonstrating effective risk management and person-centred responsiveness.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People had individual risk assessment around fire risks and the provider ensured there were effective fire safety procedures. People had their own safe home that met their needs and was a safe environment for staff to work in. Where people required support with their housing needs, staff advocated for them. For example, staff took proactive action to identify and mitigate an environmental risk, ensuring they regularly contact the housing provider to request for maintenance.

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 were supported by staff who had the right skills. Staff received regular training and supervision to ensure they had the skills and knowledge to support people effectively. This included face to face training which considered the individual health and wellbeing needs of the people they supported to ensure staff were best skilled to support them. This included areas such as autism, learning disabilities, manual handling, safeguarding and health related training sessions. Staff felt they had the right skills to do their role.

A staff member said, “The training is helpful, relevant, and gives me the knowledge and skills I need to support people safely and confidently.”

The provider had 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 did not always assess or manage the risk of infection. During visits to people’s homes, we found that some of the areas of the home required attention in maintaining cleanliness. The registered manager acknowledged this and was going to put steps in to ensure this improved. We also found in on case where a staff member described a recent issue with mice in a person’s kitchen cupboard, which had been promptly addressed and treated to minimise health and infection risks.

When speaking with staff they confirmed they were provided with adequate appropriate personal protective equipment needed for their role.

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.

Medicines were managed safely, and people were supported to take their medicines in ways that reflected their individual needs and preferences. Staff demonstrated a good understanding of people’s medicine requirements and followed guidance to ensure these were met. Where people were prescribed emergency medicines for specific health conditions, staff were generally able to explain how these should be administered and when they were required. However, during discussions with 2 members of staff, there was some uncertainty, and they could not accurately describe when the emergency medicines should be administered. The provider responded appropriately to this by reviewing the guidance with staff and emphasised the importance of checking individual documentation if staff were ever unsure, to ensure medicines were administered safely and correctly