Selective Care

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 inspection this key question was rated good. At this assessment the rating remains good. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events Senior staff had systems to analyse incidents, share lessons learnt with staff and monitor staff performance. Senior staff promoted learning and improved practice in response to incidents. For example, the provider had implemented the use of an electronic care planning system. This helped to ensure staff kept contemporaneous care records that were securely stored and easily retrievable. Staff told us that senior staff were responsive and clearly communicated learning from incidents, which helped them reflect and make improvements. This included team meetings, individual supervisions and senior staff working alongside staff to embed good practice. This helped the provider investigate incidents and identify actions to reduce the risk of recurrence.

The provider had implemented innovative ways to work with healthcare partners to improve outcomes and significantly reduce risks related to people accessing different health and care services. The registered manager told us, “In our daily work, we faced ongoing challenges in accessing timely and accurate health information about our service users, predominately from GP surgeries and Hospitals.” This led to increased risks around, medicines updates being delayed due to communication issues with GP surgeries, the provider not always being informed about hospital discharges leading the risk of missed or delayed care, and lack of coordination with visiting professionals leading to duplicated visits or gaps in care.

The provider had worked with people and NHS partners to gain access to an electronic system that healthcare professionals used to record and update people’s health and medical treatment. This enabled the provider to access relevant health records securely in real time, which reflected accurate information to promote coordinated care.

The system has been particularly effective in supporting safe hospital discharges and coordinating care with other professionals, such as district nurses or GPs. This helped to promote positive outcomes for people when they had input across different healthcare professionals and services.

For example, one person discharged themselves from hospital, meaning the provider was not made aware care needed to recommence by the hospital discharge team. The registered manager had used the electronic system to flag the person had been discharged and quickly contacted the person to arrange for care visits to start. This helped to reduce the risks around failed hospital discharge as the person received the support they needed.

In another example, the registered manager used the electronic system to see that a person had been prescribed antibiotics for a chest infection after a GP visit. The provider responsively updated the person’s care plan and informed staff of the newly prescribed medicines. The provider would not have otherwise been informed about this change, posing a risk that the person may not have received their medicines to treat their illness.

In a further example, the provider used the electronic system to access updates from community nurses, after they visited a person in relation to their skin integrity. The registered manager used these notes to coordinate a plan of care in partnership with community nurses to monitor the person’s skin condition and share updates. The effective use of the electronic system meant the provider was quickly able to recognise changes and respond to a change in the person’s needs.

The provider also used the electronic system to improve the effectiveness of their daily audits, such as medicines. They accessed the system to routinely cross reference listed medicines with their records. The registered manager had identified instances where these records did not match and had taken appropriate action to update their medicines care plans and administration records in response. This meant care plans and medicines records reflected up to date prescriptions. This helped reduce risk around people not receiving their medicines as prescribed.

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 with professionals.

People told us they felt safe receiving care from staff. They told us they were happy with the quality of care they received. They told us they felt comfortable in raising concerns to senior staff and that staff helped them to remain safe in their own homes.

The provider had effective policies and procedures around safeguarding. This included supporting people to improve their home safety measures taken to promote people’s safety by investing in key safes and encouraging people to regularly change key safe numbers. This helped to promote their home security.

Staff had received training around safeguarding. They were confident in recognising and responding to safeguarding concerns. Senior staff ensured safeguarding concerns were investigated and reported to the appropriate authorities. The registered manager had used the outcome of safeguarding investigations to promote learning and improved practice. For example, they had developed policies around staff handling people’s money and training to ensure staff maintained appropriate professional boundaries with people. This helped to keep people and staff safe.

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People told us that staff provided safe care and were competent in their role. This included support in using equipment or helping them to mobilise around their home. They told us they received a reliable service and had not received missed or late care calls.

Staff had a good understanding of risks related to people’s care and the actions needed to reduce these. This included managing risks around falls, choking and skin integrity. People’s care plans detailed where externals professionals and other providers had input into people’s care. This included how respective parties had a role to play in helping people manage risks. For example, the provider had worked with health professionals to support a person with their mental health needs. This included submitting regular reports to mental health professionals about the person’s wellbeing and how they were managing risks in relation to their mental health.

The provider had effective systems to reduce risks related to monitoring care remotely. This is included, lone working policies, non-entry policies and electronic call monitoring, which helped assure senior staff that care was being carried out as planned.

The provider detected and controlled potential risks in the care environment. They made sure equipment supported the delivery of safe care.

People told us that staff helped to keep them safe in their own homes and that they had all the care related equipment they needed.

The provider completed assessments of people’s homes to help ensure there was a safe environment to deliver care. Where risks were identified, they supported people to make referrals to external professionals to help to improve safety. For example, in relation to fire risks, people were supported to make referrals to the fire and rescue service to seek home safety advice. Staff had a good awareness of how to identify and reduce risks, balancing people’s rights to live as they choose with the provider’s responsibilities in ensuring a safe working environment.

People had the equipment that they needed to support safe care and staff had a good understanding of how to use and maintain it. Where people were struggling to mobilise using existing equipment, staff reported concerns to professionals, such as occupational therapists, who made and assessments around the use of alternative equipment. People’s care plans reflected professionals’ guidance, which helped to keep people safe.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

People gave us positive feedback about staff. They told us they were well trained and competent in their role.

Staff told us they had received appropriate training in their role and that they were confident in delivering care that met people’s needs. They told us senior staff were very responsive and supportive. For example, by working alongside them if they were supporting people where there were complex issues.

The registered manager monitored staff’s competence and performance through observations of their working practice, supervision meetings and competency assessments. They had identified staff’s personal development needs and supported them to access additional training. This reflected a commitment from the provider to invest in staff’s skills and abilities.

There were sufficient staff in place to cover care calls and promote consistency in people’s care. The provider had contingencies in place to meet potential short term staff absence. For example, staff from the provider’s sister recruitment agency and senior staff completing care calls. The registered manager ensured agency staff had completed the same training as permanent staff. This helped to ensure there was no drop in the skill level of the staff provided.

The provider had safe staff recruitment processes in place. This helped to ensure that staff had appropriate skills, experience and were of suitable character to provide care to people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

People told us that staff always wore appropriate personal protective equipment, such as gloves and aprons. They told staff had a good understanding around infection control processes and that they helped them to keep their homes clean. The provider and infection prevention and control policies in place. This included how to minimise the risk of infections spreading if people were unwell. Staff had received training in infection prevention and control. Staff told us there were appropriate supplies of personal protective equipment available, which helped enable them to follow good hygiene practices.

The provider made sure that medicines and treatments were safe and met people’s needs.

People told us that staff supported them to take their medicines as prescribed. They said that staff were reliable and knowledgeable about their routines and preferences, which meant they had not experienced medicines errors or missed administrations.

The provider had effective systems in place to monitor medicines administration and update medicines care plans. This helped to ensure people received the right medicines at the right time. The provider’s electronic care planning system alerted senior staff if medicines were not administered at planned times. Senior staff monitored this alert system and took responsive action to help ensure people did not miss their medicines.

Staff had a good knowledge around best practice in medicines administration. They told us they were conscious to check medicines before administration, which helped ensure they matched the provider’s records. Any changes to prescriptions were reported to senior staff, who were able to update care plans in ‘real time.’ This helped to ensure the provider held accurate records around medicines administration.

People’s care plans reflected the support they required in the management of their medicines. This included their levels of independence around the administration and wider management of their medicines, such as arrangements around ordering repeat prescriptions. This helped to ensure staff were clear around the responsibilities in their role.