Northamptonshire Domiciliary Care Agency

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 inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to safe care and treatment and staffing. Risks to people were not being effectively assessed and medicines incidents were not managed effectively. People’s personal emergency evacuation plans were not up to date, and we identified shortfalls in staff supervision and training. We also found medicines were not being managed safely, and infection control practices were poor.

This service scored 34 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service had policies and procedures in place for recording, reporting, investigating and analysing accidents, incidents and critical incidents through their incident reporting systems, including a reporting and management dashboard.

There was evidence some accidents, incidents and critical incidents had been recorded, reported and investigated. However, the local implementation of the providers system had failed to ensure specific medicines discrepancies had been escalated, investigated and learnt from as these were recorded on a separate system, and relied upon staff to escalate the concern to a manager for review. The provider was unable to assure us during the assessment that medicines incidents and discrepancies had been escalated and investigated.

There was no evidence to assure us that lessons learnt were being shared with the teams, or that the provider’s reporting and management dashboard were being used to drive a learning culture across the service.

The provider told us during the assessment they had made changes to the local reporting processes and medicines incidents and discrepancies would now be reported on the incident management system. Although changes were made to the reporting procedures during our assessment, further work is required to be assured that the new process leads to sustained changes in practice and lessons learned are consistently shared with the team to improve outcomes for people.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services.

People’s care records did not identify all their current needs, meaning information could not be easily provided to other professionals or hospital should the person be admitted in an emergency. For example, people’s hospital passports had not all been fully completed and key information such as people’s medical history and how to communicate with them were not recorded.

Not all staff knew the resuscitation status of the people being supported by the service. We asked staff about people’s resuscitation status in 2 homes and staff were not able to demonstrate they would be able to share this information in an emergency.

This meant staff did not have all the information they would require to pass on to health professionals if people’s health deteriorated, or in an emergency.

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. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The provider had safeguarding policies and procedures in place. The registered manager shared the findings of several investigations carried out by the provider as part of their safeguarding practices.

We spoke with managers and staff during our assessment who were able to demonstrate knowledge of the recording and reporting processes and the different types of abuse that people accessing care may experience.

We could not be assured staff and leaders were applying the theory of safeguarding into practice and recognising potential safeguarding situations. For example, at one supported living home we identified people’s bank card PIN numbers were written on a label and accessible for all staff.

We also identified concerns in relation to medicines discrepancies not being escalated and investigated and could therefore not be assured that all concerns had been appropriately reported to health professionals, the local authority or CQC.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There were some risk assessments in place, however, these failed to adequately assess and mitigate known risks. We found that risk management plans for people’s specific health conditions such as constipation, continence, diabetes and Prader-Willi syndrome were either not in place or ineffective, as staff did not have adequate information to know how to mitigate known risks or meet people’s needs.

The provider’s approach to the local development of positive behaviour support plans for people experiencing distress was inconsistent. We found the plans in place did not contain adequate detail to provide staff with the guidance required to support people in line with the positive behaviour support policy. This meant people were placed at risk of harm as staff did not have enough information to know how to manage and alleviate people’s distress and anxieties to keep them and others safe.

There was no evidence people had been involved in the development of risk mitigation plans or that people had been supported to understand or manage risks.
 

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

People were supported by the provider in a supported living home with their own tenancy agreement from a landlord. We found people were not supported by the provider to keep their home safe. People's homes were unkempt and there were shortfalls in the provider’s health and safety checks. For example, where legionella checks were being completed, there were gaps, or no action if the temperature was falling outside of the correct range. We also found out-of-date items of first aid, and out-of-date COSHH risk assessments that did not reflect the chemical staff were using to support people to live in their own home.

People’s personal emergency evacuation plans were either not available or did not reflect their current needs. For example, in some homes we found personal emergency evacuation plans were only available on the electronic system and would not be easily accessible in an emergency, but in other homes they were paper based. However, the personal emergency evacuation plans we viewed did not all reflect the current needs of the people living in their homes. For example, at one home staff told us a person would not be able to use the recommended exit due to their decline in mobility. In another home, we found there were not enough staff deployed to be able to safely evacuate people during an emergency evacuation at night. We were not assured staff would be able to safely evacuate people from their homes in an emergency.

We found there was a lack of processes in place to support people to escalate concerns about the external living environment to the landlord to bring about a positive outcome. At one home the people living there had not been able to access their garden during the summer months as this was and continued to be significantly overgrown. A staff member told us the, “Garden makes us feel like we are doing a bad job.” The registered manager told us, “We now have a central team who we can escalate concerns, so things are getting better.”

The provider’s systems to support people to maintain a safe environment were not effective. This meant that people were not always being supported to live in an environment that was safe, with an external environment that was well maintained.

We raised our concerns with the provider during our assessment who took action to increase the staffing levels at one of the homes and arranged for a representative of their health and safety team to visit all the supported living homes to review people’s personal emergency evacuation plans.
 

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

There was not a systematic approach to determine the range of skills required in order to meet the needs of people using the service and keep them safe at all times. We identified shortfalls in the evidence and delivery of training to meet people’s specific health needs, including diabetes, Prader-Willi syndrome, dementia, epilepsy, communication, positive behaviour support, and caring for people with a catheter.

The service did not ensure staff were supervised until they demonstrated acceptable levels of competence to carry out their role unsupervised. For example, at one of the homes we identified a staff member administering medicines without the required training or competencies in medicines, epilepsy and caring for people with a catheter. The registered manager took immediate action to remove this staff member from administering medicines until their competencies were completed.

The service was not able to evidence that agency workers that had been deployed in the service had learning disability and autism training, had a criminal records check, and had received an induction to the individual supported living homes. This meant people were at risk of receiving poor care from agency workers as they had not received the required induction to carry out their roles safely and effectively.

Staff had not received appropriate ongoing or periodic supervision, or appraisals in their roles. One member of staff told us, “I’ve not had one [supervision] for a very long time, I’m not able to recall when I had one in the last 5 years.” Another staff member told us, “We don’t get regular supervision.” We were also told, “I can’t recall getting one [supervision] in the last couple of years.” The registered manager told us there was no supervision and appraisal matrix available, and they did not provide us with any evidence during the assessment that staff had received appropriate supervision and appraisals.

The providers’ systems and processes did not make sure staff were suitably skilled and experienced to support people’s individual health needs, and that staff had the required supervision and support to carry out their roles safely and effectively. This meant people were exposed to the risk of receiving poor care and not having their needs met.

We raised our concerns with the provider during our assessment who took action to assure us agency workers did have learning disability and autism training as well as the required safer recruitment checks. The provider also introduced an agency induction process, arranged diabetes training, and were in the process of sourcing several other training courses.

The provider did not assess or manage the risk of infection. They did not detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

People were not always supported to keep their homes clean. We observed people’s homes to be unkept, cluttered and dirty. For example, at one of the supported living homes we observed the home to be visibly dirty, full of clutter and there was a collection of cigarette ends from staff, and a collection of rubbish in the garden. There were no cleaning records to view for this home and staff told us they did not have enough time to carry out the required cleaning.

The cleaning records we viewed in several other homes were either not completed or highlighted shortfalls in the completion of cleaning, and we identified some bathroom items that were rusty.

We raised our concerns with the provider during our assessment who took action and arranged for a contractor to spend 2-days cleaning the home. We returned to the home to check on the standard of cleanliness and found improvements had been made. Staff told us several journeys had been required to the recycling centre to declutter the home.

We viewed the newly introduced cleaning record and found this had not been completed, and there was no record to complete until the new month commenced. This meant there continued to be obvious signs there were not adequate oversight arrangements of homes to ensure they were clean, tidy and hygienic, and we were not assured on the return visit that the improvement would be maintained.

The poor cleaning standards affected service users’ dignity and placed them at risk of ill health from poor cleanliness practices.
 

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

People’s medicines were not managed safely. There was a medicines policy in place, however, we found staff competencies for medicine administration had not all been completed or refreshed in a timely way. This meant people were not being supported by staff who had received adequate medicines management training.

Medicines were not stored securely, and we were concerned people were able to access other people’s medicines. For example, we observed a broken medicines cabinet, an unlocked medicines cabinet and keys to medicines cabinets on key hooks, worktops and unlocked draws.

People’s ‘when required’ protocols (PRN) for some medicines were ambiguous. This meant staff did not always have the appropriate guidance to know when PRN medicines should be administered. For example, we found PRN medicines for Zopiclone, Diazepam, Lorazepam and people’s constipation medicines that did not have adequate guidance for staff to be able to administer these medicines safely.

At one home we identified a medicine for managing bowel health that had been administered although the staff told us the person was under the GP for investigation due to loose bowels, and they were not currently administering Lactulose for this reason.

We completed stock checks on people’s medicines and were unable to balance the actual medicines balance against the stock recorded on the medicines system. We found stock checks were not being routinely completed by staff or a manager as part of routine assurance checks to ensure medicines were being managed safely.

We found medicines that had expired and had not been returned to the pharmacy, and the recording and monitoring of medicines temperatures was either not taking place, recorded only periodically, or where the temperature had exceeded the recommended maximum, there was no evidence of action being taken to mitigate the risk of medicines becoming spoiled or ineffective.

There was a lack of adequate oversight from leaders in relation to medicine optimisation. This meant people were being placed at risk of harm from poor medicines management.

We raised our concerns with the provider during our assessment who took action to make improvements to the management of people’s medicines. Although changes were made to medicine management during our assessment, further work is required to be assured that the new processes lead to sustained changes in practice.