Care at Home Services (South East) Limited – Eastbourne, Hailsham and the Weald

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 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 manager 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. When accidents or incidents occurred, staff would record details on a mobile telephone application. These details were then immediately available to the manager and office staff for support, follow up if needed. Staff were confident in identifying concerns that needed reporting. A staff member told us, “Depending on the severity I would call the office for advice and support. I’d report and maybe call in other support if needed.” A spreadsheet was kept by the manager so that any trends or themes could quickly be identified and addressed. However, only 9 accidents or incidents had been reported in the past 12 months and there were no identifiable patterns or repeat incidents. The manager held meetings with staff following incidents to identify and share any learning. The manager told us that depending on the nature of the incident some meetings would be held 1 to 1, other in small focus groups and where there was a potential impact on all staff, messages would be sent out to everyone.

The manager 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. People’s support needs were regularly reviewed with the support from other health and social care professionals. If it became necessary for a person to have to move from their home because of increasing support needs, then this process ran smoothly and people received all the professional support they needed. Most people wanted to remain in their homes, but for some it became necessary for them to move to residential or nursing homes or to a hospice. The service had a separate, nurse-led team as well as staff trained in complex cases. Every effort was made to ensure people remained safe within their homes, but safety was never compromised and moves to other care settings were made when it became necessary.

The manager 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 manager shared concerns quickly and appropriately. People were supported by staff who knew them well and had received training in safeguarding and mental capacity. People were protected from avoidable harm and everyone told us they felt safe when supported. Comments included, “I`m safe as I`ve had the same ones for 4 years now,” “Very safe, they are all lovely, they announce who they are and I know them anyway. Of course, I trust them” and “I feel very safe with the carer`s, we trust them.” Staff were confident in reporting safeguarding concerns and were able to describe to us situations that they would report. The service had a whistleblowing policy which staff were confident to use if needed. Whistleblowing gives legal protection to staff raising concerns whilst protecting their identity. The service kept a register of safeguarding matters raised and these had been raised appropriately and dealt with in a timely way. Decision specific mental capacity assessments were in place for some people who needed support with making some decisions. These assessments had mainly been completed by other professionals for example, GP’s and they provided guidance to staff about how best to support people.

The manager did not always work well with people to understand and manage risks. Staff were not always aware of the risks to people and the care needed to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Most areas of risk to people had been identified and risk assessments completed to advise staff in the event of something going wrong. However, some areas had not been identified. A person lived with a large piece of essential medical equipment that presented potential trip hazards to the person, visitors or staff. The equipment was sensitive to heat and was routinely kept next to a radiator. In some care plans there were references to people that had a history of anxiety, low mood and depression. Although referenced within care plans, none of these issues had a risk assessment in place to support staff with what actions to take in an emergency. All these concerns were raised with the manager who took steps to address the gaps. These would, however, take some time to be written and to be fully embedded within people’s care plans. Other risks to people were documented and people told us they felt confident when supported by staff with one saying, “They use a hoist and they are well versed in safety with it.” Some people were at risk of falling and the service used a falls assessment program that considered all aspects that may lead to a fall for example, medicines, sensory needs, footwear and support needed when transferring. Consequently, falls risk assessments were thorough. Some people had complex support needs and risks relating to choking for example. Care plans showed how other professionals, speech and language therapists (SALT) were involved in risk assessment management.

The manager detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. A thorough environmental risk assessment formed part of people’s initial home visit. As well as noting any trip or other obvious hazards, the assessment included points of access to people’s homes, key safe details and essential domestic appliance information and location of gas and electric points. The assessment extended to the outside of the person’s home and included descriptions of steps and pathways and any fittings to help with people’s mobility. The assessments were regularly reviewed to reflect any changes to people’s living environment, including the addition of any supportive equipment.

The manager 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. Staff had been recruited safety with reference checks, photographic identification and Disclosure and Barring Service (DBS) records and other key information, held on staff files. DBS checks help managers make safer recruitment choices. Staff completed a comprehensive induction program where initial training modules were completed and they were given opportunities to shadow more experienced staff. There was some dependency on agency staff, but the same agency staff were used so they too got to know people well. Regular training refreshers took place and this was monitored by the manager with prompts sent to staff when modules were due. Training was up to date. Staff were supported with regular spot checks, unannounced visits by supervisors when out supporting people and medicine competency checks. Staff had regular supervision meetings and they told us these were supportive and provided them with opportunities to speak up and raise concerns if needed. A member of staff said, “Have regular training every 6 months and supervisions.” Another added, “I have the skills to do my job.” People told us they were confident in the staff and the training and skills they had. A person told us, “Yes, they are very well trained. They have got to know me well.” Consequently, people were supported by staff that knew them well and had the skills and training to meet their needs.

The manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Infection prevention and control was managed well. A policy was in place, regularly reviewed, that provided guidance and up to date information about infection control processes. Staff had received training and told us they were confident in the appropriate use of personal protective equipment (PPE). People and their relatives all told us that staff adhered to safe practice and wore PPE when carrying out personal care or other tasks that involved handling medicines or food for example. A person said, “Yes, they wear gloves and aprons which they put in the waste bin and then the outside bin after use.” A relative added, “They wear a uniform. They use plastic aprons, gloves and masks which they put in the bin afterwards.”

The manager 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. Most people either managed their own medicines or were supported by relatives. However, some people did require support from staff and all staff were trained in medicine administration. A person told us, “Yes, they do my meds and never miss and make sure that I have it with tea and biscuits. I used to order them but now the office does and it`s a great relief as they come every month.” Care plans had a medicines section which listed people’s medicines and their current regime, that is if they required support from staff. Staff recorded on their mobile telephone applications, all details of the date, time, dose of the medicines they administered. Care plans described protocols for as and when required (PRN) medicines, so staff knew exactly when to administer. Staff knew the correct procedure to follow if medicines were spoilt or if a person refused to take their medicines. A staff member said, “There is a refusal button on the app (application) which we click but also would refer back to the manager for advice.” Medicines were stored safely within people’s homes.