My Homecare Crowborough

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 69 (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. Accidents and incidents were immediately reported and recorded by staff using a work mobile phone application to record all actions. Staff told us they were able to call the office, alert the registered manager and ask for further assistance if needed. Staff were trained to remain with people in the event of an ambulance being called to attend. A member of staff said, “We wait for a relative or an ambulance to come, would never leave alone.” A daily office meeting took place where the events, including any accidents, were discussed. Staff involved were invited to attend the meeting and a discussion took place about causes, action taken and steps that can be taken to minimise the recurrence if appropriate. Learning from accidents and incidents was shared across all staff. Accident, incidents and falls policies were in place to support staff with understanding about issues when things went wrong. Best practice was also highlighted and shared.

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 for the first time. A professional said, “I have worked closely with (registered manager) and the team from My Homecare who have provided care and support to clients leaving hospital. The team have always worked effectively, demonstrated great communication and have always shown flexibility and have been responsive.” A relative told us about their spouse who started being supported by the service after a long time in hospital. They told us they were impressed with the reception and support right from the start from staff who knew all they needed to about the person’s needs.

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 and were able to tell us about situations that they would report and could tell us the steps they would take to make people safe. A member of staff told us, “ I’d call in a safeguarding, make sure client and care staff are safe. Document and raise issue with manager as soon as possible and protocols put in place if needed.” 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 feel confident to use if needed,” “I wouldn’t think twice. Anything malicious or abusive” and “I know to inform and would do this if needed.” Safeguarding and whistleblowing policies were in place and were regularly updated.

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. 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.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Part of the pre-assessment process involved a home visit and risk review of the home environment. Aware of people’s vulnerabilities and for example, a risk in some cases of falls, trip and other hazards were identified and where possible removed. Access details including keycodes and domestic utilities for example, gas and electricity were all covered in assessments. Fire hazards and safe access and exit from people’s homes were documented. Some people’s homes had a lot of possessions and items that would make quick access in the event of an emergency more challenging but these were identified so that staff could do everything possible if needed.

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. There were enough staff to cover all care calls and contingencies were in place in the event of unexpected staff sickness or delays due to traffic or staff needing to stay with people longer than their scheduled time. The service covered a large geographic area and as far as was possible staff were split into teams to cover these areas with minimal travelling time. Similarly, staff were allocated the same people to enable them to get to know people well. Despite this, we received mixed reports from people and relatives about the consistency of care staff. Some told us they had regular staff but others said there had been recent inconsistencies. A person said, “There used to be regular carers, but now different staff members attend each day.” Another person told us, “I’m very happy with the service but the only thing is I would like is maybe having the same carers instead of different ones all the time.” Staff were allocated enough time for care calls but some people told us that staff seemed rushed at times and some did not always stay for the full allotted time. People were provided with a rota each week advising them of times of care calls and the staff expected. Staff received training and refresher modules in all key areas. A comprehensive induction for new staff was followed up with regular supervision and appraisal meetings as well as spot and competency checks. We looked at staff files and confirmed that staff had been recruited safely with all expected background checks having been completed and documents present.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. There were plentiful supplies of personal protective equipment (PPE) and staff had received appropriate training and refreshers in infection prevention and control. One staff member told us, “During the Induction, IPC, how do we wash our hands, it’s first thing we do when we enter, apron and gloves. Always wear full PPE.” Despite this several people told us that staff were inconsistent in wearing PPE and maintaining IPC standards when supporting them. Comments from people included, “Some staff but not all wear PPE,” “Most staff maintain cleanliness, washing hands and wearing gloves and aprons, but not all do so consistently” and “The carers don’t always wear PPE, I have complained about this to the service, this was resolved but now they have stopped wearing it again.” The registered manager acknowledged this and looked at refresher training for staff.

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 in 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 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.