Bells Home Care Limited

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 requires improvement. At this assessment the rating has remained 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 a legal regulation in relation to governance at 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.

Staff listened to concerns about safety and the service always investigated and reported safety events. However, lessons were not always learnt to continually identify and embed good practice.

Staff were encouraged to raise concerns and felt supported by the registered manager to do so. However, learning from incidents was not consistently embedded in practice. While safety incidents were investigated, there was no clear evidence that actions taken were shared with staff or used to drive improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. However, they did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Pre-assessments were completed and used to inform care planning. However, one person had been receiving care for over a month without a care plan or risk assessments in place. This posed a risk to safe and consistent care delivery. Daily notes for this person were also unavailable, despite the provider stating notes were always collected monthly for review. While staff were introduced to new people, the absence of written guidance in this instance compromised continuity and safety.

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.

There were clear systems in place to report safeguarding concerns, which were tracked and monitored effectively. Staff had received safeguarding training and demonstrated awareness of their responsibilities. People and relatives told us they felt safe with the care provided. One family member said, “[Name] is very safe with them.”

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.

Risk assessments were in place for some aspects of care. However, there were significant gaps. For example, there were no risk assessments for the use of flammable creams, body maps for topical creams were not in place. One person’s care plan lacked clarity on the use of prescribed thickener. This limited staff’s ability to manage risks effectively. While people and families were involved in care planning, the lack of documentation undermined safe risk management.

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’s home environments were assessed to ensure they received care in settings that were safe, and any equipment was well maintained. Staff ensured equipment such as hoists and specialist beds were used safely and appropriately. Relatives told us that staff were confident and competent in using equipment. People and their relatives consistently told us their homes were left clean, tidy, and safe following staff visits.

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.

Recruitment processes were robust, with improvements made since the last inspection. Gaps in employment history were explored, and appropriate checks were in place for overseas recruitment. Staff received training, regular competency checks, and support through supervision and appraisals. People and their relatives consistently praised staff reliability and familiarity. One person said, “They (staff) are on time and I know them all now.”

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 service had effective infection prevention and control (IPC) measures in place. Staff consistently used personal protective equipment (PPE), including gloves, aprons, and masks when required. People and their relatives described staff as “meticulous” and “very clean”. Care plans included IPC information, and there were good stocks of PPE available. One family member said, “They (staff) wore their masks when [relative] came out of hospital. They are always very clean and tidy.”

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

Staff had regular competency checks to ensure they were safe to administer medicines. However, there were key shortfalls in documentation and protocols. ‘As and when required’ medicines and topical creams lacked clear protocols, and body maps were not used to guide application. Some prescribed creams and skin washes were not included in medicine care plans, and information about thickener use was inconsistent. This posed a risk of unsafe administration. We discussed this with the registered manager who confirmed they had taken action to ensure these omissions were put in place. One family member told us, “They fetch [Name’s] meds from the doctors and sort it all out, that’s good.” However, the lack of supporting documentation limited assurances in medicines administration safety.