Help at Home (Danbury Gardens)

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 we spoke with were confident to raise safety concerns. A person we spoke with was clear any concerns relating to safety and care were to be raised with the Help at Home service. The person told us, “I’ve never had to raise a concern. However, I would speak with [registered manager] as they are the manager of Help at Home”.

Systems and processes were in place to learn from incidents to prevent reoccurrence and promote safety. Incidents were recorded by a member of the staff team, who documented a summary of the incident or event and any immediate action taken. Incident forms were reviewed by the registered manager, and any additional information as to any actions taken to mitigate risk were documented. All incidents were referred to the regional manager or member of the quality governance group for final review and sign off.

An event analysis was undertaken monthly, which considered all safety events including medication errors, accidents and complaints. This enabled the registered manager to identify any themes or trends. For example, it was identified a person had frequent falls over a short period, the person was referred to the GP and falls team, and a referral made to an occupational therapist, who advised the use of additional equipment to mitigate risk.

Information as to any changes in people’s care resulting from an incident was shared with staff. Staff were clear about accident and incident reporting and escalation and spoke of shared learning following any incidents. A member of staff told us, “Learning from incidents is shared with staff on online learning, after an incident, staff are encouraged to do training in the relevant area. Seniors will speak soon after the incident with staff and assure them. It is about talking and good communication and where they can be helped. If there is learning to be done as a result, this is rolled out.”

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.

Referrals to the service came from the local authority. Referrals included an assessment of the person’s needs, and information as to any known safety concerns and measures required to promote their safety.

People’s care and support needs were documented within a personalised ‘passport’, which provided information as to their needs, including areas of risk, medication needs, health conditions, including known allergies. Information about a person’s needs was shared with other services where appropriate, for example if they transferred from their home to hospital or into a care home.

Staff told us they had access to information as to people’s needs when they commenced the service. A member of staff told us, “Before I support a new person, I read their care plan. It is really important to understand what their needs are, how I can access their flat, how they like to be supported.”

Care professional team meeting minutes included information for staff on how to facilitate and support people transferring from hospital back to their home. For example, monitoring health and well-being, identifying any changes in prescribed medicine, or changes to mobility.

The providers’ systems and processes supported a collaborative approach between health and social care partners, people and where appropriate family members, this facilitated the delivery of safe care and was kept under review through ongoing monitoring.

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 told us they felt safe with the staff. A person told us, “The staff make me feel safe, as I know they are here when I need them, and they are kind and caring.”

Staff undertook training in safeguarding and had a good understanding of their role in identifying, reporting and escalating concerns. A member of staff told us, “It is our duty to keep people safe from abuse and harm, physical, domestic, psychological and sexual abuse. We report to the team leaders, but mostly the registered manager. Other agencies to report to include the safeguarding lead in Leicester City Council. I would report to the CQC (Care Quality Commission) if I think that it is not safe to tell anyone else or if I felt I was not being listened to and no action was being taken.”

Safe and effective systems, processes and practices were in place and implemented to protect people from abuse and neglect and formed part of the monthly event analysis undertaken by the registered manager. Safeguarding alerts and concerns were recorded and monitored, and actions taken to safeguard people. For example, staff had identified potential financial exploitation of a person, following local authority involvement and discussions with the person, changes were made as to how the person managed their finances with staff support.

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 were fully involved in all decisions related to their care, which included identifying risks and how they could be minimised. People’s views were respected, which included circumstances where people chose not to follow the guidance provided by external professionals. For example, a person’s records documented they understood the potential safety implications of not using equipment as advised.

People’s needs were kept under review and where changes were noted, timely referrals were made to external health and social care professionals to promote and maintain their safety. Records highlighted areas where people were at specific risk, including poor skin integrity. Staff documented if they noted any redness to people’s skin, and ensured equipment and measures were adopted to mitigate risk. For example, the use of pressure relieving equipment, such as mattresses and cushions, and supporting people to regularly change their position who were unable to do so without the support of staff.

Risks associated with medical conditions, such as diabetes were documented within people’s records. For example, information for staff as to the signs and symptoms a person may display if they were experiencing a hypo and hyperglycaemia attack, and the action required by staff.

Staff had undertaken training to promote people’s safety in several key safety areas and had their competency regularly assessed.Training topics included moving and handling people, health and safety and first aid.

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 we spoke with were aware concerns relating to the environment, including their individual accommodation and shared facilities were not the responsibility of Help at Home (Danbury Gardens), and should be reported to the extra care housing manager. A person told us, “If my concern was about the environment, I would speak to [person’s name] who manages the complex.”

Risk related to people’s care and support within their environment were assessed and kept under review. Measures were taken to mitigate risk, which included the use of equipment to promote people’s independence and safety. For example, walking frames, shower chairs and perching stools. Information as to how equipment was to be used was documented within people’s records. A person told us, “I have to use a banana board to transfer from bed to wheelchair, the carers know how to support me with that.”

Records detailed the location of electrical and water supplies within people’s homes so as staff were able to respond in the event of an emergency such as a flood, by turning off the water supply.

People had a Personal Emergency Evacuation Plan (PEEP) outlining personalised information as to the support they would require in the event of an emergency. The PEEP had been developed in collaboration with the Help at Home (Danbury Gardens) staff and the extra care housing provider to ensure safe systems were in place in the event of an emergency.

The registered manager sought the guidance and involvement of external professionals to mitigate identified risks, which included the local fire service, occupational therapists and local authority staff. Help at Home staff, supported by the local fire service had taken part in a phased evacuation of several flats within Danbury Gardens. The registered manager advised any concerns relating to the premises would be shared with the on-site housing team of the extra care facility for action.

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 told us they were cared for and supported by staff and received a reliable service. A person told us, “The carers are good at sticking to the call times, the staff team are flexible, but usually work to the care plan, and know what they are doing.”

Schedules of care calls were developed each week and shared with people using the service and staff. A person told us, each Sunday, they were hand delivered a schedule of care calls detailing the time of the call and the member of staff who would be attending. People and family members told us; changes could be made to their scheduled care call times if requested. A person told us, “I have changed my call times on occasion, I just go to the office and speak with them.”

Staff told us there were sufficient staff to meet people’s needs. A member of staff said, “I think the staff levels are perfect, the right level to support people safely. We try to keep the same staff for individuals, as it is reassuring for the person, especially if they have specific needs”.

Help at Home (Danbury Gardens) had a contract with the local authority, which incorporated individual hours to meet people’s assessed needs, as well as a ‘block contract’. The block contract included 4 hours at lunchtime, and an out of hours on-call service operating from 10pm to 7am, to respond to emergencies, such as a fall, for all residents of Danbury Gardens. A record was kept of all calls made, including the time, the person involved, the reason for the call and the action taken, and was shared with the local authority. A person told us, “I have had a couple of instances where I have fallen out of my wheelchair through overreaching. It has been comforting to know Help at Home are in the office and will rescue me, or at the very least, put the wheels in motion by calling for assistance.” The registered manager and staff requested the assistance of external professionals in the event of an emergency, who helped in assisting people from the floor in the event of a fall.

The registered manager kept a record of all requests for additional support, not covered through the block contract arrangement. For example, people requesting additional support during the day in addition to their agreed contracted hours. This enabled the registered manager to evidence to the local authority any requests to increase funding to enable them to provide additional hours of support and care for individuals.

The provider understood their responsibilities under the Equality Act with regards to protected characteristics in supporting people who use the service, for example people being supported by staff who understood their language and culture. A member of staff told us, how they spoke in Gujarati with a person, which facilitated and enabled them to make clear their decisions and choices.

Staff were recruited in a safe way. Appropriate checks were carried out prior to people commencing work. This enabled the provider to be confident suitable staff with the right skills and experience were employed. Staff received the support they needed to deliver safe care; this included supervisions, appraisals and support to develop and learn.

Staff had undertaken training specific to people’s needs which included training on improving skills and understanding the needs of people with a learning disability or those living with dementia as well as training areas related to people’s health, such as stroke awareness, diabetes, Parkinson's Disease and catheter care. A member of staff told us, “I had training specific to supporting a person learning disability.” Another member of staff said, “Training specific to certain needs is available to staff and the manager has oversight of this any training needs are identified.”

The registered manager told us there was a comprehensive induction programme in place. Staff worked alongside experienced staff and completed training in a range of topics, including the Oliver McGowan training. A member of staff told us, “When I joined, I did all the online training and had 3 days in person training. I shadowed for 3 days before I started attending to the people on my own. It was very helpful because I got to know nearly everyone, and they got used to me.” Staff had the opportunity to undertake vocation qualifications in care as part of the provider’s apprenticeship programme.

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 and family members confirmed staff wore Personal Protective Equipment (PPE), gloves and aprons. A family member said, “I have seen staff wearing gloves.”

Staff received annual training on infection prevention and control (IPC), and had their competency assessed in the use of PPE. People in some instances in additional to personal care and support received a domestic call. People’s care records detailed the support required, which included, assistance with laundry, vacuuming, polishing and mopping.

People’s care records highlighted specific areas where there was an increased risk of infection, which included people who had a catheter. Information included how personal care was to be provided, along with information as to the signs and symptoms which may indicate a person had a urine infection.

The provider had a policy for IPC in line with good practice guidance. Potential risks related to infection were assessed, and any concerns were shared with the appropriate agency.

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 were supported to maintain their independence and manage all aspects of medicine including ordering and administering where they were able to do so. A person told us, “My medicine is on repeat prescription, and is delivered. I take my medicine without any support from staff.” Where people required support, this was provided. A family member told us, “The staff give [relative] their medication from the locked box and record they have done so.”

Assessments identified whether people required support with their medicines, and records included information about a person’s prescribed medicines and the role of staff in providing support. Records included information as to where medicines were stored within people’s homes. Medicine Administration Records (MARs) detailed the name of the medication, the dosage, and time it was to be taken, and any specific instructions given by the prescriber. For example, whether the medicine should be taken before or after food.

Staff signed MARs, including the time the medicine was administered. A member of staff told us, “I give people’s medicines and we have clear instructions about how to do this, most people take their medicines with water, and most are independent. We sometimes give medicine, which is prescribed as and when required, for example for pain, we record why, and where the person told us they were experiencing pain.”

People in some instances chose not to take their medicine as prescribed, in these circumstances the registered manager informed the prescriber, recorded the person’s wishes, and documented they understood the potential implications for not taking their medicine as prescribed. This showed people were involved and supported in decisions relating to their care.

Staff received training, which was regularly updated and included checks to determine staff’s competence to support people with their medicines. A member of staff told us, “Medicines competencies are checked very frequently, this is usually part of our regular spot checks which happen 3 times a year.”

Auditing of medicine records enabled the registered manager to maintain oversight and ensure safe working practices. The frequency of auditing was specific to the needs of the person determined by the level of risk, for example by considering the number of medicines a person was prescribed.