Right at Home Eastbourne

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 Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

There was a system for reporting accidents and incidents. These were both paper and computerised. The paper records were completed by staff who then gave them to the office team where the registered manager read them and signed them off before entering them on to their computer system. These documents described what had happened, any investigations that had taken place and actions taken. Staff understood how to identify and report safety concerns. Some incidents were related to staff whilst at people’s homes. There was evidence of measures that had been implemented to reduce the risks. Staff were updated when any risks or concerns were identified.

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.

Transitions between services ran smoothly with people and their loved ones being supported throughout the process. Within care plans there was a summary sheet that provided the key information about people, their health details, allergies and any preferences to treatment and notice of advanced decisions about care. These helped inform other services when receiving people into their care.

A health professional said, “This is practice and transparency that facilitates working in equal partnership with [name], placing their rights and dignity at the centre of practice."

A relative told us about their loved one who was being supported by the service after 6 weeks in hospital. They told us they were really happy with the care and she was improving. In hospital she had been so withdrawn and poorly, but was now talking and laughing again.

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 safely and were protected from avoidable harm. Staff had been trained in safeguarding procedures and were able to tell us about situations that they would report and told us the steps they would take to make people safe. A member of staff told us, “I’d immediately report it to the manager, who would call in a safeguarding, and make sure the client was safe.”

The registered manager told us of a positive and well established professional relationship between the service and the local authority. They knew how and what to report and this was always done in a timely way. Similarly, staff knew about the whistleblowing process and told us they were confident to use the process if needed. Whistleblowing allows staff to raise concerns anonymously. Comments included, “I wouldn’t hesitate to raise issues,” “I have done it before at my previous job” and “All the procedures are easy to access. When I am on call, I make sure they are nearby, just in case.” Safeguarding and whistleblowing policies were in place and were regularly updated.

Whilst the provider worked with people to understand and manage risks by thinking holistically, this had not always been reflected in peoples individual care plans and risk assessments. For example, there was no risk assessment for people’s safe bathing temperature or how staff ensured they were not scalded. This was immediately discussed with the care team and updated by the registered manager on the care plan and risk assessments. This had low impact on people at this time due to staff knowledge. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments supported staff to manage identified risks whilst ensuring people's rights and independence was promoted and respected.

The registered manger and wider staff team understood the importance of managing and reducing risks to people. Assessments were in place covering people’s needs, and these were updated regularly and more frequently following any incident, changes to people’s needs, or following a hospital stay. Staff knew about risks and were able to tell us about specific concerns relating to vulnerability to falls or pressure sores and the actions they would take if needed. Staff told us they had time to re-read risk assessments to bring themselves up to date following days off. Some people lived with complex needs and risks associated with for example, Parkinson’s disease, and people living with epilepsy or dementia. The service liaised closely with other professionals in these cases to make sure people received the safest care and support possible. The management of risk allowed people to carry on with their daily routines with minimal restrictions to their lives.

Positive risk taking was supported and encouraged in line with the principles of Registering the Right support, Right care, Right culture to support people with managing their physical risks whilst promoting independence and enjoying going out in the community. The registered manager had identified on the recent audit that people and families voice was missing from care plans and risk management and was taking this forward as a priority.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff visited the person’s home and completed an environmental risk assessment before care and support was provided. This ensured that all potential risks were identified and people’s homes were a safe place in which to provide care for both the person and staff. The assessment included checking external access to the home and how staff would gain entry. Checks were made externally and internally for any hazards, such as trip hazards or any animals that staff would need to be aware of. Where possible changes were implemented to mitigate risks as much as possible whilst also respecting people’s and their families’ individual preferences. Discussions took place with families should changes need to be made. Checks were also made to ensure smoke detectors were in place and people were offered the opportunity for a referral for fire safety checks.

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.

Most people told us they received the support at the times they needed it. Comments included, “Always on time, if they are delayed, they let us know,” “Never let down, we get regular carers, so they know us well,” and “Can’t fault them, usually on time and stay for the allocated time.” However we were also told, “[Name] loves the carers, but there are times they are late, and then they don’t stay for the full allocated time, I understand there may be traffic but a phone call would be appreciated,” and “There is little consistency in the staff, lots of different faces, which does affect efficiency but I can’t fault the carers they are excellent. ” This was discussed with the registered manager and assessed that at the time of the inspection there were enough staff to support people safely. The service had a system that tracked the visits which showed the times of arrival, the times of departure and it was evident that these were monitored closely. We were able to track people’s care alongside visit logs and could evidence that suitably qualified staff were deployed to meet people’s needs.

There were processes to ensure staff were recruited safely. This included references, employment history, appropriate checks for staff from overseas to ensure they had the right to work at the service and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

When staff started work at the service, they completed a period of induction, and they commenced their training. This included a period of shadowing where they worked with more senior staff to understand the day to day running of the service and meet people who they would be supporting.

There was a training program which staff completed. There was a combination of face to face training and on-line training and refreshers. Staff told us they valued the face-to-face training as they were able to discuss how they used it in practice. This included moving and assistance, medicines, and basic life support. This was provided as a group or one to one as required. In addition to the providers mandatory training staff received further training that was relevant to the people they supported. This included stoma and catheter care. All staff were supported with regular supervision meetings, spot and competency checks. Comments from staff included, “Staff training is great. There are beginners training and then annual like meds, first aid and moving and handling online. Certain courses we have to do. They alert if we have not done and it has moved to amber; it never gets to red,” and “Training is sufficient, annual training and other bits and bobs. The learning disability and autistic training is compulsory. Training was an eye opener.”

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 protected them from the risk of cross infection. One person said, “They don’t wear uniforms but always use the aprons and gloves.”

Staff received infection prevention control training and had access to essential personal protective equipment (PPE). Staff told us there was always plenty of PPE available. Observation of staff practice, such as hand hygiene took place regularly, which included the use of PPE.

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. Processes were in place for the safe management and administration of people’s medicines. Not everyone needed help with their medicines, but this was assessed as part of the initial assessment and where needed, medicine risk assessments and electronic medicine administration records (eMAR) were created. The service worked efficiently with local pharmacies and GP surgeries to make sure prescriptions were collected or delivered on time and that reviews of people’s medicines took place.

Families or advocates were involved with reviews of medicines. Medicines were stored in safe and secure locations within people’s homes. The eMAR system allowed for immediate management oversight of when medicines were being administered and any concerns could be identified straight away. Staff had training in giving medicines and received competency checks to make sure their knowledge and practice was up to date.

Staff were able to tell us the steps they would take in the event of people refusing their medicines or where medicines were lost or spoilt. Protocols were in place for as and when required (PRN) medicines for when staff were at care calls and staff knew the steps to follow and who to contact if needed.