Victoria Home Care Solutions

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 did not have a consistently proactive and positive culture of safety. Staff listened to concerns about safety and investigated and reported safety events. The team approached issues with openness and honesty, but lessons were not always learnt to continually identify and embed good practice.

The provider relied on the staff to report concerns and when they did, this was followed up robustly. However, there was not a proactive approach to identifying safety concerns, for example the regular review of daily records, reporting on themes and trends, addressing any issues before they became critical and learning from this. This was identified as an area for improvement during assessment and the provider was keen to improve ways of working and adopt a more proactive safety culture.

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.

We saw evidence of communication and engagement with external healthcare professionals to support people receiving the continuing care they needed. The registered manager and team did not always effectively document in people’s care records, when they had contacted other healthcare colleagues and services. This needed to be improved to better evidence the approach they took with continuity of care and safe care pathways.

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 can only be deprived of their liberty to receive care and treatment with appropriate legal authority. Where people receive support in their own homes, this can be done through The Court of Protection which is defined as part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed deprivation of liberty within the service. We found that the principles of the MCA were being met and issues were identified quickly. Staff followed the organisation’s procedures correctly and informed the registered manager without delay. The registered manager demonstrated strong oversight of safeguarding. They assessed concerns promptly, took proportionate action based on level of risk, and made timely referrals to the relevant external agencies, including the local authority safeguarding team and the Care Quality Commission

The staff understood what made people feel safe and took steps to address this, for example, being supported by a consistent staff team. One person told us, “The team that come in the morning will tell me who is visiting in the afternoon, it’s a small team so seen most of them, so I know who’s coming, which gives you more confidence and you feel safe, absolutely.”

The registered manager and team demonstrated a strong understanding of safeguarding procedures and fully understood their responsibilities to report and address concerns and protect people’s right to live in safety. Staff spoke with us about a complex and sensitive safeguarding issue they had addressed involving the police. They spoke about supporting the person through this. One staff member said, “[Person] seems like they are just part of the family, and we stepped up even more to show them they’ve got us to support and trust, and we will look after them no matter what.”

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.

People and relatives were involved in reviewing care plans and risk matters. We saw the registered manager had updated a care plan after a person’s hospital admission and change in needs. One person told us, “Quite recently we have had to provide a hospital bed and slings as getting to stage [relative] can’t stand or walk. [Staff now] use a hoist to get them out of bed. Big changes in last month or so, registered manager contacted the OT (occupational therapist) and liaised with them as things were getting worse.”

The registered manager and team understood the value of supporting people to do the things that mattered to them not just what tasks were required, this included flexibility to accommodate things that the person wished to prioritise. One staff member told us, “We [team] are flexible, if someone’s got an appointment we can work around them, if they are going out with family and wish for an earlier call registered manager will put that in place. It means a lot.”

This approach meant people had balanced support that ensured they received the safe care they required but could still prioritise things that were meaningful to them and support their overall wellbeing.

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

The registered manager carried out an assessment of the environment before people commenced care, but this was not effectively documented. However, staff knew people well and understood the risks in the environment. For example, a staff member explained about doing spot checks at the home of a person living with dementia, as they placed items in appliances which created a risk of harm from fire and property damage. We saw the registered manager had made a referral to the fire service, for someone who smoked, to support them to maintain a safe home environment.

The registered manager assured us that improvements to the assessment process and how environmental issues would be documented and assessed in the future would be implemented.

The provider made sure there were enough skilled and experienced staff, who received effective support. They worked together well to provide safe care that met people’s individual needs.

However, the provider failed to ensure all staff were recruited following a robust, safe recruitment process. They did not always make sure staff received effective support with development, including maintaining safe compliance levels with mandatory training.

We found gaps in recruitment documentation; this was addressed promptly by the registered manager who introduced a clear check list for documentation required prior to staff commencing work. We had received a concern from a member of the public regarding staff working without a Disclosure and Barring Service (DBS) check. These checks are important in ensuring suitable staff were employed to support people safely. At the time of the assessment there were no staff currently providing care, who did not have a DBS and the provider assured us there would be no recurrence of this issue going forward.

There were gaps in staff training, most notably in relation to fire safety. The registered manager had sent a reminder message to staff to prompt them to complete it just prior to the assessment and understood the importance of maintaining compliance with all mandatory and person specific training and would ensure this was overseen.

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.

We had no concerns about infection prevention and control (IPC) and people and relatives did not communicate any issues with this.

Staff had access to appropriate personal protective equipment, for example gloves, and there was effective guidance for staff around IPC.

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, however, documentation was not always completed robustly.

We saw there were gaps in medicines administration records and staff did not consistently record why people were administered as required medicines. We found that medicines had not been missed but had not been thoroughly documented when given, which the registered manager addressed with staff.

Staff confirmed they had received training in medicines and their competency to administer medicines was assessed. We spoke with people and relatives about support with medicines, one person told us, “I feel quite safe with them [staff supporting with medicines]”. A relative said, “[Medicines] No errors at all.”