Alina Homecare Walton on Thames

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.

People benefited from a service that learned from incidents, complaints and feedback. Regular reviews, audits and staff checks helped the provider identify improvements and reduce the risk of repeat incidents. Staff felt able to report concerns and knew what action to take to keep people safe.

Senior management showed us their electronic system for recording incidents and complaints.

Senior management told us they preferred to report all incidents, even when staff were not at fault, to ensure learning was identified. For example, incidents where people became unwell were still recorded and reviewed. Staff were reminded to contact emergency services first if a person needed urgent medical help and then notify the office.

All incidents were reviewed by managers before being closed. Monthly and quarterly audits were completed to identify any patterns or trends. We saw an example of a medication incident that was still being investigated. Appropriate action had been taken, including contacting NHS 111, the person's next of kin and the office

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.

People received a safe and planned start to their care because their needs were assessed before support began. This helped ensure the provider could meet people's needs and reduced the risk of people receiving unsuitable care. As a result, people experienced safe and consistent support from the beginning of their care journey. One relative told us, “Mum has been receiving care for almost 4 years now. They did a risk assessment to start with. The managers insisted on meeting her and having a look around her home.”

The provider had a clear referral and admission process. Management told us all new enquiries were recorded on an electronic system. Referrals came from social workers, healthcare professionals and recommendations.

Before care started, there was an assessment of the person's needs. This helped the provider decide whether they could provide the required care safely and effectively.

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.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the capacity to do so themselves.Staff demonstrated an understanding of the MCA and their responsibilities to support people to make decisions wherever possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes, an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. At the time of assessment, no one was deprived of their liberty or had any restrictions placed on them.

People were supported by staff who understood how to recognise and respond to potential abuse and neglect. Staff felt confident to raise concerns and appropriate action was taken when risks were identified. This helped to protect people from harm and promote their safety and wellbeing.

People told us they felt safe using the service. One person said, “I have always felt very safe, I have never had cause for complain.” A relative told us, “He is 100% safe. If I had any concerns, I would phone [the office].”

Care plans included information about any known safeguarding concerns and helped staff understand the risks people may face.

Staff were able to describe the signs they would look for that could indicate abuse or neglect. These included unexplained weight loss, bruising, flinching, or a person appearing unkempt. One staff member told us, "I would notice this with any of my clients as they're all very well."

Staff received safeguarding training as part of their induction and told us they used this learning in their daily roles. One staff member said, "I apply my learning in every task in my role. I assess safety for my client and for myself.

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 received care that helped keep them safe while meeting their individual needs. Risk assessments were developed with people and their relatives, helping staff understand how to manage risks effectively. This reduced the risk of avoidable harm and supported people to receive safe and consistent care.

People had personalised risk assessments that reflected their individual needs. These included guidance for staff on managing risks relating to mobility, falls, skin integrity, nutrition and healthcare needs.

For example, staff were instructed to monitor signs of infection for people with catheters and report any concerns. Where people were at risk of choking, care plans included clear instructions about eating and drinking. People at risk of pressure damage were supported with regular repositioning. Risk assessments also included guidance on using equipment to support safe transfers and reduce the risk of falls and skin tears.

People and relatives told us they were involved in risk assessments and care planning. One person said, "The risk assessment was done with my daughters present.” A relative told us, "They definitely did a risk assessment initially and that was how a few things were put into place.

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

People benefited from care and support that considered the risks within their home environment. Clear environmental and fire risk assessments helped staff provide care safely and respond appropriately in an emergency.

These covered both internal and external risks to people as well as staff.

The service had measures in place to protect people's homes and personal safety. Staff demonstrated a good understanding of fire safety procedures. One staff member told us, "Yes, I had my fire training. When I go to a client's home, I know where the fire blanket is, where the exit is and what to do in case of a fire.

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.

People received care from staff who had been safely recruited, trained and supported to carry out their roles. Staffing levels were sufficient to meet people's needs and staff had time to provide care in a person-centred way. This helped people feel supported, safe and respected, while ensuring care was delivered consistently and effectively.

New staff completed a comprehensive induction programme. This included online training, practical training and shadowing experienced staff before working independently. One staff member told us, "I've done shadowing before going to the clients house. I've done a lot of training. The induction training is online and face to face. I then started to shadow, first someone was with me whilst I completed the calls and since yesterday, I've been on my own. I feel confident."

Staff told us there were enough staff to meet people's needs and they had enough time to complete their visits safely. One staff member said, "I feel there's enough travel time between calls. I feel there's enough staff." Another staff member told us, "I have plenty of time between calls. I stay for the full duration of a call."

Staffing arrangements were planned to ensure people received the support they needed. Rotas showed additional staff were provided where required, including support for people needing 2 staff for transfers. Records also demonstrated that live-in care staff received regular breaks, with domiciliary care staff allocated to cover these periods.

People and relatives told us care was not rushed. One person said, "I have never felt rushed, but usually do ask them how much time we've got when they come to see me." A relative told us, "He has never felt rushed, he is very aware of what is going on." Another relative said, "They do everything at her pace."

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 were protected from the risk of infection because staff followed good infection prevention and control practices. Staff had access to appropriate personal protective equipment (PPE) and understood how to use and dispose of it safely.

People had care plans which included guidance to reduce the risk of infection where needed. For example, 1 person's care plan instructed staff to wear shoe covers, masks and full PPE to help protect them from infection following a hospital admission.

Staff demonstrated a good understanding of infection prevention and control procedures. One staff member told us, "I wear PPE no matter which client I go to visit. It's very easy to get hold of." They explained they regularly wore gloves, aprons and face masks when supporting people.

People and relatives told us staff followed good infection control practices. One person said, "They certainly do well with infection control and always come wearing gloves. I've had no problems." A relative told us, "They always wear gloves and plastic aprons."

Relatives also spoke positively about the cleanliness of people's homes. One relative said, "The house is always kept immaculate." Another relative told us, "I have always seen that they are extremely careful within my mother's home."

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.

People received support with their medicines safely and consistently. Clear recording and regular management oversight helped reduce the risk of medicines errors. Staff had the knowledge and training needed to administer medicines safely and took appropriate action when concerns about medicines arose.

Care plans clearly described people's medicine needs and identified whether staff were responsible for administering medicines or whether this was managed by family members. Where staff administered medicines, detailed guidance was available. This included information about where medicines were stored, how they should be administered.

Care records contained clear information about prescribed medicines, including the dose, frequency, administration times and whether medicines were prescribed on an 'as required' basis. There were body maps showing where prescribed creams should be applied to support staff.

The electronic medicines administration record (MAR) system supported safe practice. Staff were required to record medicines administration before they could end their visit. The system alerted management if a medicine was not given, helping to ensure omissions were reviewed promptly.

We reviewed a sample of MAR records and found they were completed correctly. Where medicines had not been administered, clear reasons were recorded. Staff told us they received medicines training during their induction and regular refresher training. One staff member said, "I had medicine administration training during my induction. We had another training session in the office last week." Another told us, "I always put on my gloves and make sure the client takes the right dose and on time. I give them water explain which medicine I am administering, and I know they have the right to refuse."