LANH

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 changed to requires improvement. This meant people were safe and protected from avoidable harm.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 59 (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 systems in place to ensure action was taken following incidents, however the process needed to be improved to ensure incidents are consistently reported to the relevant professionals. For example, notifiable incidents, including police incidents, had not been reported to the Care Quality Commission. After we raised this with the provider, they had started to submit notifications when applicable.

Staff listened to concerns about safety and investigated safety events. Lessons were learnt to continually identify and embed good practice. For example, an incident occurred that involved cigarettes and the provider sought advice from the local fire service and implemented a plan to support the person in managing the risks associated with smoking safely, including fire safety equipment.

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. One relative told us the provider had ensured the transition between LANH and another care provider went smoothly. Before LANH took over the care package they worked alongside staff from the other care provider to ensure all information, preferences and details were handed over.

People, their relatives, and other professionals were involved in planning people’s care and support needs. We saw records of multi-disciplinary meetings, held to discuss safe care and treatment pathways for people, and staff knew when to refer to specialist services to support and manage people’s care safely.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately to the relevant professionals.

The provider had not always informed the local safeguarding team of incidents of self-neglect. For example, one person would often refuse their care calls or not respond when contacted by staff. The provider had raised this with social workers; however they had not always raised a safeguarding alert to the local authority.

The provider did not always ensure the systems and practices were effective where restrictions were placed upon people. The provider had not ensured restrictions that were considered and implemented, were in line with the requirements of The Mental Capacity Act 2005. One person’s care plan detailed a restriction that was in place for when they become distressed and anxious. Whilst the restriction had been discussed with family and other health professionals, a mental capacity assessment had not been completed to ensure the decision was the least restrictive.

Whilst safeguarding processes needed improvements, people and their relatives told us they felt safe. One relative told us “[relative] feels very safe, the lights go on in [relative] when the carers arrives. [Relative] smiles at them they have a great relationship.” Another person told us “Oh yes [person] absolutely feels safe.”

The provider did not always work well with people to understand and manage risks. The provider had not consistently ensured that people’s health risks were well managed. For example, one person who was able to move around their home independently was prescribed a blood thinning medicine. This significantly increased their risk of internal bleeding if they were to have a fall or injury. There was no guidance in place for staff to follow relating to this risk.

Constipation risks were not always well managed for all service users that were identified as at risk. People at risk of constipation did always not have risk assessments, or bowel charts in place to inform staff if the person was constipated. Staff documented some people opening their bowels only intermittently meaning their bowel health could not be effectively monitored.However, other service users’ constipation risks were well managed and there was evidence of health care being sought in line with guidance.

Staff did not always have a good understanding of people’s health risks. Some staff did not have a good understanding of the risks around choking. One person was at risk of choking, however when we spoke to a staff member that supported that person, they did not know the person was at risk of choking. This meant that the person’s choking risk was not well managed.

Some staff did not have a good understanding of epilepsy, specifically when to give emergency medicines if the person was prescribed it. This meant we could not be assured that if a person were to have a seizure, staff would be able to respond promptly and in line with guidance to ensure their safety.

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 provider implemented risk assessments to ensure staff understood the environmental risks that impacted them and the people they support. People’s care plans included information about any equipment or technology that was used. The provider also ensured that when a person needed additional support regarding their environment, referrals were made to relevant authorities, for example the local fire service and occupational therapists.

The provider had not always ensured there were enough qualified, skilled and experienced staff to provide safe care that met people’s individual needs. Whilst staff had completed training that was relevant to their role, they were not always able to demonstrate their knowledge around people’s risks. For example, some staff we spoke with did not fully understand how to manage and support people with some of their health risks, including epilepsy and choking.

People and their relatives gave mixed reviews in relation to staff’s knowledge and understanding. One relative told us, “They tend to be overqualified. They’re educated, friendly and understanding.” However, another person we spoke with told us, “They [staff] are very slap dash, they sit around on their phones a lot.”

The provider ensured that the majority of care calls were carried out within the allocated time frame. People also told us that their calls were generally on time and that if they were late there was normally a reason such as heavy traffic.

Staff were recruited safely. This included staff having a disclosure and barring check (DBS). A Disclosure and Barring Service (DBS) check isa record of a person's criminal convictions and cautions. A DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable groups.

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. Staff had completed infection prevention training and implemented this during their care visits. People and their relatives told us staff practice safe infection control measures, such as using personal protective equipment (PPE). One person told us, “They [staff] wear gloves if they’re having to assist [person] with their toilet and shower.”

Staff we spoke with understood their role in relation to preventing infections, one staff member told us, “We have PPE reserves in cars, if we run out we will call manager, or get from colleagues. We wear apron and gloves during personal care. We have never any issues accessing PPE supplies.”

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. The provider kept accurate medicine records. We reviewed medicine administration records and we found them to be up to date and complete, if there were gaps, this was escalated to management and actioned accordingly.

Staff had completed training in relation to medicines management and the provider carried out competency assessments with staff so they provider could be assured they were competent to administer medicines and put their training into practise.

People and their relatives told us they were happy with the support they received in relation to their medicines. One relative told us “There has never been any issues with medicines.”