Amber Home Carers Surrey

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 legal regulation in relation to people’s safe care and treatment and the governance at the service.

This service scored 56 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events.

Whilst individual incidents and accidents were responded to, systems for identifying trends and systematically reporting to external professionals were not in place. This meant there was a risk that shared learning across the service would not be identified and external professionals would not be made aware of concerns. The registered manager acknowledged these processes needed to be reviewed and implemented. They assured us regular reviews would be completed going forward.

Individual concerns regarding accidents and incidents were recorded and addressed by the management team. This included where people’s needs had changed, additional equipment was required or difficulties with calls had been identified. Staff told us they felt the management team were responsive and any concerns they raised were responded to.

Following our assessment the provider informed us they had implemented additional processes to enhance how lessons were learnt from accidents and incidents.
 

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.

Systems were in place to support staff working together to meet people’s needs. Staff completed records regarding the care and support they provided. This ensured that the next staff members supporting the person were able to review any issues or requests prior to providing the person’s care. The electronic system used by the provider enabled messages to be shared with staff members to highlight any changes in people’s needs or issues to be aware of. Staff told us they felt they were informed of any important information which helped to keep people safe.

In addition, the provider worked with external agencies to help provide people’s care in a safe and effective way. These included, healthcare and social care professionals, equipment suppliers and the meals on wheels service.

Staff supporting people understood their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, there was not always a clear understanding from the management team and staff regarding how concerns should be reported externally.

People told us they felt safe with the support provided to them. One person told us, “I feel very safe. They are very kind and gentle and understanding of my needs.” A second person told us, “I trust them.”

Staff had received training in relation to safeguarding and were able to describe the different categories of potential abuse and signs of concerns they should be alert to. However, most staff were unable to tell us who they could share concerns with outside the organisation or why this would be important. A review of records showed that whilst there had not been any significant concerns, low level safeguarding concerns such as falls and near miss calls were not shared with the local authority in line with the provider’s processes. The registered manager assured us they would make contact with the local authority’s Quality Assurance team to gain further advice regarding their reporting requirements.

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

People and their relatives told us they felt staff understood their needs and supported them safely. One person told us, “Having the same carers the majority of the time makes a great difference, makes me feel safer because they know me.”

Despite these comments, we found guidance in relation to people’s needs did not always provide sufficient detail to enable staff to support them safely. These included details regarding how to prepare food safely, information regarding specific health care needs and how staff should respond to one person’s emotional needs. In addition, risk assessments were not completed in relation to people’s skin integrity or how this was monitored by staff. Whilst records showed people were generally supported by staff who knew them well, the lack of detailed information presented a risk as any new staff would not have the guidance they required to support people as safely as possible.

In other areas, we found risks to people’s safety had been recorded and guidance for staff provided. These included how people should be supported with their mobility, personal care and checks to complete before the end of a visit.

Following our assessment the provider gave assurances that processes to monitor people’s safety and well-being were being reviewed and monitored.

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 care plans contained guidance for staff regarding the environmental checks that were needed to keep people safe. These included ensuring equipment was in good working order, that lighting was appropriate for the person’s needs, the environment was clean and clutter free and the temperature was monitored. These measures helped to ensure people were supported in a safe environment in line with their needs.

The provider did not always make sure staff were fully competent in their roles and that there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support and supervision and development.

Most people and their relatives told us they received support from the same staff who were generally punctual and stayed the full duration of the visit. One relative told us, “They have a time to come (within an hour’s window). I’ve set in place that if they are going to be late, they will always call me. It’s very rare for them to be late. They always stay most of the duration.” However, we received feedback from some relatives that staff regularly arrived late and left early which meant their family member did not receive the full care they required. We read in meeting minutes that one person had complained of having repeatedly later calls. The staff member had commented this was due to the call being scheduled following a night shift in a different setting. The registered manager confirmed this was the case. They told us they would review this practice going forward.

We found records regarding staff visits were not always clear regarding what time people’s calls were scheduled, what time staff arrived and what time they left. The registered manager told us staff were allocated travel time between calls. However, we noted numerous calls where travel time was not scheduled, despite calls being between 3 and 5 miles apart. Staff did not always record their notes on the system at the time of the call and did not record the time they left. The provider did not routinely monitor the system or address these issues with staff. This meant the provider was unable to assure themselves people were receiving their care in line with their assessed needs. We reviewed call times for one person and found there were regular occurrences of staff arriving later than scheduled or not recording the time they had arrived or left the call.

Staff received mandatory training to support them in their roles. However, there was no systematic approach to ensuring staff competency assessments were completed in areas such as moving and handling, medicines management or the application of topical creams. The management team assured us they were in the process of these assessments being completed and we saw evidence assessments had been started.

Staff were not always recruited safely. Although references and recruitment checks were obtained, records showed these were frequently completed after staff had started work. There was no evidence that the risks associated with this practice had been assessed or mitigated. This placed people at risk of harm from being supported by staff who had not undergone up to date recruitment checks.

Subsequent to our assessment the provider told us they had reviewed the way in which staff competencies were monitored and implemented additional recruitment safeguards.

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

Records of spot checks of staff practice identified instances where staff had not washed their hands on arrival at someone’s home. There was no evidence within supervisions how this had been addressed or followed up on with the staff members concerned. Some relatives also confirmed that whilst staff wore gloves when supporting people with personal care, they did not wash their hands. This presented a risk of spreading infection, particularly as staff were visiting a number of people in the same day. Training records showed staff had completed infection prevention and control training although the comments were received suggest this may not have always been effective in ensuring staff followed safe procedures.

Staff had access to personal protective equipment (PPE) such as gloves and aprons. People told us staff carried a stock and stored some PPE at their homes.

Subsequent to the assessment the provider informed us they had implemented a more structured monitoring system in relation to infection prevention and control.
 

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

Staff competence was not assessed to ensure staff were able to administer people’s medicines safely. Staff completed online training in relation to medicines management but their competency in practice was not assessed to ensure they understood the safe systems to follow. This concern had not been identified when completing medicines audits. The registered manager acted promptly when this was identified and ensured competency assessments were being implemented. In addition, we found the content of the audit forms had not been designed for this type of service. This meant it was difficult for the provider to establish if safe medicines practices were consistently being followed.

People and their relatives told us staff supported them with their medicines safely. They described how they preferred to be supported with their medicines and told us staff followed this. Records showed people received their medicines in line with their care plan.