LJM - Homecare Lincoln

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 always have a proactive and positive culture of safety where concerns were consistently acted on and learning was shared. The provider had systems for identifying safety concerns but these were not always effective in ensuring people and staff felt able to speak openly or could see that concerns resulted in learning and improvement.

Incidents, safeguarding concerns and medicines errors were investigated and there were examples where learning had been identified. Staff understood how to report concerns and identify risks. However, some staff said concerns they raised were not always followed up and they did not always receive feedback about what action had been taken. This reduced opportunities for shared learning and increased the risk of a closed culture developing. A closed culture is where poor practice can develop because people or staff do not feel able to speak up, concerns are not listened to or there is not enough openness and outside scrutiny.

This was also reflected in people’s experiences. Some people felt concerns had to be raised more than once before improvements were made. Which showed learning was not always applied in a timely manner. Other people described a more positive experience and said concerns had resulted in changes to their care.

The provider worked well with people and other services to support safe transitions and continuity of care. Systems supported people when they moved between services or returned home from hospital. Changes to people’s care and medicines were shared with relevant staff so they had current information about people’s needs.

People and relatives were involved in planning care following hospital discharge and when their support needs changed. Staff also worked with health and social care professionals when additional support was needed. One relative said, "I'm always kept informed."

There were examples where people’s independence was considered as their needs changed and support was adjusted accordingly. This helped people receive care that remained appropriate as their circumstances changed.

The provider worked with people to help protect them from abuse and avoidable harm while respecting their rights and choices. Safeguarding concerns were referred to relevant agencies and investigations were completed when concerns were identified. Staff understood different types of abuse and discrimination and knew how to report concerns.

Most people told us they felt safe. One person said, "Oh yes, I am safe.” Another person told us, “I do feel safe, they are helpful and I feel safe with them all.”

People were supported to make their own decisions about risk where they had the mental capacity to do so. People can only be deprived of their liberty to receive care and treatment when there is appropriate legal authority. In community services, this can include people receiving care in their own homes. We checked whether the service worked within the principles of the Mental Capacity Act 2005 and whether any restrictions on people’s liberty were identified and appropriately managed. Staff and management worked within the principles of the Mental Capacity Act. No one receiving support was subject to a community deprivation of liberty authorisation. People had choice, control and freedom over their lives and we found no evidence of unlawful or excessive restrictions.

The provider worked with people to understand and manage risks while supporting them to maintain choice and independence.

People’s risks were well assessed and care plans provided clear guidance about how their health conditions could affect them and what staff should do to reduce the risk of harm. People were involved in reviewing risks and staff understood how to support them safely without unnecessarily restricting their independence.

The registered managers used feedback and observations of staff practice to check agreed risk management approaches were followed. People generally felt confident staff supported them safely. One person said, "I use a hoist and feel safe when they are using it, I would say they are well trained."

People were supported to remain independent and take reasonable risks where possible. Risk management focused on enabling people to do what mattered to them safely rather than preventing them from making choices.

The provider identified and managed environmental risks and supported people to live safely in their own homes. Environmental risks were assessed and contingency arrangements were in place. Staff had guidance to follow and concerns were referred to relevant agencies where additional support was needed.

There was a particularly positive example where staff supported a person whose home environment had become unsafe and who other services had been unable to support. Staff worked at the person’s pace over several months, gaining their trust and agreement about changes to their home. The provider worked with the fire service, social workers and charities to reduce risks and source equipment. The person was supported to maintain the improvements and was able to have people visit and access their community which led directly to improvements in their wellbeing. A professional wrote to the provider and said, "That's amazing. Thank you so much for the outstanding amount of work you have all done to facilitate this all happening.”

People’s individual equipment needs were considered within their care and risk assessments.

The provider did not always ensure staff had the skills and support needed to consistently meet people’s individual needs. Staff completed induction, training and competency assessments. Detailed workbooks and competency checks supported staff undertaking clinical tasks and clinical accountability was held by one of the registered managers. Staff received supervision and appraisals. However, there was limited evidence staff received feedback about their performance or concerns they raised, reducing opportunities for reflection and improvement.

Some people described a variation in staff skills, particularly when unfamiliar staff provided their care. Concerns included staff not always understanding equipment, routines or how people preferred their care to be provided. One person said, "No, they don’t read the notes but they come in and do what they need to do. It is hit and miss." The provider was aware and taking action to improve this.

Recruitment systems were in place, although there were gaps in some employment histories which were rectified. Rotas were monitored and there was a live electronic system to identify late care visits in real time.

The provider assessed and managed infection risks and had systems to reduce the risk of infection spreading.

Policies and procedures supported safe infection control practice. Staff received infection control training and had access to appropriate personal protective equipment, which was used as required.

The provider monitored staff practice to gain assurance that infection control standards were maintained across the service. People did not raise concerns with us about infection control practices.

Medicines were managed safely and staff supported people to receive their medicines in line with their needs and preferences. Medicines systems were in place and staff received relevant training and competency checks. The provider monitored medicines practice and responded when concerns or changes were identified.

People were involved in their medicines support and care records described the assistance they required. One person said, "They give them to me and I know what most of them are for."