Naidcare

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 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.

The service was in breach of regulations in relation to staffing and fit and proper persons employed. The nominated individual had not completed the appropriate checks to ensure that staff were recruited safely into the service.
 

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 did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice. The field supervisor shared knowledge and information with staff during supervisions and meetings and records confirmed this. However, there were no action plans completed to evidence how issues raised were to be addressed, dates to be achieved, if actions had been resolved, remained outstanding or whether there was a formal record of lessons learnt. This limited the ability to learn from incidents and feedback, which meant learning from good practice was not always identified or embedded across the service. A member of staff told us, “The manager keeps us up to date with any changes to the persons care package.”
 

The service 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. The field supervisor told us, “A meeting takes place to carry out a full assessment before we commence a support package to determine if we are able to support the individual or not. We also look at what additional training our staff may need to ensure the person receives the best support.” Staff told us they read through the care plans to ensure they had all the information they needed to provide support safely. A relative told us, “I was with [relative] when they did their first assessment. They looked around the home and involved me throughout the assessment.”

The service did not always work with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The staff training matrix did not include all staff members or show when all staff had completed their safeguarding training. The service relied heavily on the Care Certificate as evidence of staff competence. While the Care Certificate provides a useful foundation for induction, it does not replace the need for ongoing, service specific safeguarding training and refreshing of staff skills. The lack of a clear training record, combined with an over reliance on the Care Certificate meant we could not be assured staff were trained and skilled in supporting people safely with the relevant training required.
Most staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people. This action included informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to local authority if I needed to.”

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 Mental Capacity Act (MCA) 2005. 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. We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. We found staff practice reflected the principles of the MCA. People were encouraged to make their own decisions, while still minimising risk. Staff understood their roles and responsibilities in relation to the MCA framework.
 

The service 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. Risks to people had been assessed and risk assessments had been put in place to help mitigate risks as far as possible. These risks included areas such as supporting people with mobility equipment or with personal care. Staff knew the risks to people well and told us they were kept up to date if there had been any changes to risk assessments. Staff told us they always read the care plan and checked the care planning application they used on their phone to see if there had been any changes to the care package.

People received personal care and support in their own homes. The service detected and controlled potential risks in the environment. They made sure equipment, facilities and technology supported the delivery of safe care. The field supervisor told us, ''We involve families and health professionals when formulating and reviewing the care plans and work closely with them on a regular basis.'' Risk assessments had been completed to provide staff with guidance on how to keep people safe and minimise risks. For example, there was a risk assessment in place describing risks to people's home environment.

The service had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as staff not having a completed application form containing a full employment history. Staff files held incomplete documentation in relation to their interview and not all references received had been verified or dated correctly. There was no evidence a regular staff file audit was being completed. This meant the nominated individual provider could not be assured that staff were suitably skilled, qualified and safely recruited to meet people’s needs.
Staff were subject to Disclosure and Barings checks (DBS) when they first applied to work at the service. These checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. The service had received and reviewed all DBS certificates as part of its safe recruitment processes.

Staff told us they were supported with an induction when they first started working. However, records showed induction for newly employed staff comprised of 1 day and did not demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. Not all staff received regular support in the form of a supervision. Staff told us they did have regular supervisions; however, this information did not concur with the supervision records see on staff files. This meant there were no effective arrangements in place to monitor staffs' practice, performance and professional practice.

There were multiple gaps across the staff training matrix, with several different mandatory training areas incomplete or missing for a number of staff. The service continued to rely heavily on the Care Certificate as evidence of staff competence; however, while the Care Certificate provides a useful foundation for induction, it does not replace the need for ongoing, service specific training and regular refreshers. This meant the training records were incomplete and lacked evidence of required updates, we could not be assured that staff had the full range of skills and up to date knowledge needed to support people safely.
 

The service did not always assess and manage the risk of infection. It was unclear from the training matrix if all staff had completed their infection prevention and control training. This meant we could not be assured that all staff had the necessary and up to date knowledge to minimise the risk of infection and safely implement effective infection prevention and control measures.
However, staff were provided with personal protective equipment (PPE) which could be collected from the office. A member of staff told us, “I wear PPE when required, such as gloves and aprons during personal care and masks if needed.” A person told us, “All staff wear PPE, and I feel very safe when they are here.”
 

The service 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 field supervisor told us, "Staff did not support people with medicines until they had completed the required training, and medicine competency assessments were completed." Medicine competency assessments were seen on staff files. A person told us, “They give me my medication. I don’t have to do anything. I have never had any problems with my medicines.” People had care plans and risk assessments in place which detailed what medicines they were prescribed and how they liked to be supported. The field supervisor told us they completed weekly audits.