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 Inadequate, and the provider was in breach of regulation in relation to safe care and treatment and staffing.

At this assessment the rating has changed to Requires Improvement. Enough improvement had been made, and the provider was no longer in breach of regulation.

This meant some aspects of the service were not always safe and there was limited assurance about safety.

There was an increased risk that people could be harmed, and further work was needed to ensure improvements were fully embedded and sustained into working practices.

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 and processes in place to support a positive learning culture and encourage the reporting and review of safety events.

Safety incidents were recorded, reported and investigated appropriately, with records demonstrating that relevant learning and actions were identified following incidents.

Staff understood their responsibilities for reporting safety concerns and were able to clearly describe the processes they would follow to raise and record a safety event.

We saw evidence that learning was shared following safety events through a range of mechanisms, including staff debriefs, medicines error interviews and discussions at team meetings.

The provider demonstrated an understanding of its responsibilities under the Duty of Candour regulation and shared evidence showing how people were informed and supported when things went wrong.

The provider had systems to monitor safety events and maintained a reporting dashboard intended to support the identification of themes and trends.

While systems were in place to monitor incidents, we found a repeat finding that the provider was unable to fully demonstrate how information from the reporting dashboard was being used to analyse individual or service-wide themes and trends to drive improvement across the service.

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

The provider had made changes to its hospital passport since our last assessment. However, we found that several records were not consistently accurate, complete or up to date. For example, at one service, hospital passports did not reflect the medicines people were prescribed, and at another service, sections of the hospital passport had not been completed.

The provider shared updated hospital passports with us during the assessment and told us they intended to remove medicines information from hospital passports and provide a current medicines administration record (MAR) sheet instead.

While improvement had been made, the processes of continuously updating records to aid safe pathways and transitions required embedding. The provider assured us this work was in progress, and all hospital passports were in the process of being updated to reflect the provider’s new approach.

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 had systems and processes in place to safeguard people from abuse and improper treatment, including safeguarding and People in Positions of Trust (PiPoT) policies.

Safeguarding concerns were recorded, reported and investigated appropriately, with records demonstrating that learning was identified and acted upon where required.

We reviewed examples of safeguarding investigations, including a concern raised through whistleblowing, and saw that appropriate enquiries had been undertaken and actions taken in response.

Staff demonstrated a good understanding of safeguarding processes and were able to describe the signs of abuse and how they would report concerns.

People using the service consistently told us they felt safe. Relatives expressed confidence in the care provided, with one relative telling us, “Yes, I think [relative] is safe,” and another saying, “They keep [relative] safe, yes.”

The provider had risk management policies and processes in place, and we found improvements had been made to the quality of risk assessments since our previous assessment.

The oversight of restrictive practice had increased since our last assessment, with restrictive practice audits having been completed at some supported living services and further audits planned.

However, we found one example where restrictions that had previously been removed had been reintroduced by the staff team. This had not been identified through the provider’s governance and oversight processes, which demonstrated that improvements in the oversight of restrictive practices were not yet consistently embedded across services.

We shared our feedback with the provider who responded appropriately by undertaking an investigation and completing a restrictive practice audit. They shared the findings, actions and learning from this work.

While people told us and the provider they felt safe and oversight of risk mitigation and restrictive practices had improved, further work was required to ensure these improvements were fully embedded and consistently applied in practice.

The provider had health and safety policies and procedures in place to support the safe management of the environments where people lived.

People were supported in supported living services under their own tenancy agreements from external landlords.

Since our last assessment, we found people had been supported to make improvements to both the internal and external environments, and the supported living services we visited were more personalised and felt like people’s homes.

Health and safety checks were being completed in line with the provider’s requirements.

We also found improvements in the review of fire evacuation plans and personal emergency evacuation plans (PEEPs) to support people to be evacuated safely in an emergency. However, we found one example where the plan had not been updated to reflect changes to a person’s living environment.

The provider had systems in place to support the recruitment, training and supervision of staff.

We found staff had been recruited safely and in line with the provider’s recruitment procedures and there was evidence that agency staff had received appropriate pre-employment checks and training relevant to supporting people with a learning disability and autistic people.

People and staff consistently told us there were enough staff available to meet people's needs. The provider told us some supported living services continued to be staffed above commissioned levels due to the complexity of people's needs while discussions regarding funding arrangements remained ongoing.

Staff told us, and records confirmed, they received regular supervision. New staff described receiving training and being assessed as competent in key areas, such as medicines administration, before working independently. A new staff member told us, “Its been a really good start.”

The provider maintained oversight of mandatory training compliance, and records demonstrated good completion rates across the service.

The provider's systems for monitoring service-specific training and competencies required further development. For example, while training had been carried out, there were no competency assessments for catheter care.

We also found further consideration was required in relation to competencies for new starters before staff attended formal training for complex medical conditions such as Prader-Willi Syndrome.

The provider told us the actions they were taking to address our findings during the assessment and assured us further improvements would be made.
 

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.

The provider had infection prevention and control policies and procedures in place to support safe practice. There was an adequate supply of Personal Protective Equipment (PPE) available, and staff were able to describe the actions they would take in the event of an infectious disease outbreak.

We found improvements had been made to cleaning standards in supported living homes where concerns had previously been identified. Although there were some gaps in the cleaning records we reviewed, all of the homes we visited were clean, tidy and well maintained, and provided a homely environment for people.

We also observed safe food hygiene practices, including the appropriate labelling of opened food items with the date they had been opened.

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

There had been improvements in medicines management since our last assessment, including better oversight of medicine storage temperatures. Although some gaps remained in temperature recording, we saw evidence that leaders had taken action during periods of extreme heat to reduce temperatures within medicines storage areas.

Medicines competency assessments had been completed for staff and were refreshed where required. Regular medicines audits were undertaken, and all stock checks we reviewed matched the recorded balances.

We identified some concerns relating to medicines administration and documentation. For example, at one supported living service, an ‘as required’ (PRN) medicine had been administered after its expiry date. While a manager told us this issue had been identified through a recent audit, there was no recorded evidence of this or of action being taken to remove the medicine.

We also found some PRN protocols required further development to ensure they provided clear, person-centred guidance for staff. For example, in relation to bowel health.

We shared our feedback with the registered manager who outlined the actions they planned to take to address the issues we identified, including the introduction of new local medicines protocols.

While there was evidence that medicines oversight and auditing arrangements had improved, further work was required to ensure these improvements were fully embedded in practice.