Third Hand Care Also known as Third Hand 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 assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (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. Lessons were learnt to continually identify and embed good practice.

Lessons were learnt to continually identify and embed good practice. The registered manager understood their role under the Duty of Candour. They gave us an example whereby a care worker had left a person’s home 5 minutes early despite the person requiring personal care. Appropriate action had been taken in relation to the care worker’s action, and an apology was sent to the person and relatives.

The registered manager had procedures for dealing with incidents, accidents and complaints. They investigated these and developed plans for improvements. These were shared with the staff. The staff confirmed the registered manager discussed adverse events with them so they could learn together. Relatives we spoke with told us they were well informed when things went wrong, and they were confident improvements were made as a result.

The provider had a learning culture which was adopted by all staff. When things happened, there were discussions and meetings to explore what had happened. Effective changes in provider’s systems were put in place to make improvements.

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.

The provider carried out thorough assessments of people’s needs, consulting with the person, their representatives and other professionals involved in their care. The registered manager told us, “We liaise with social services, occupational therapists, district nurses, GPs and sometimes advocates. We have built a good relationship with them all. It works well.”

The service had up to date policies and procedures in place. Staff were required to read, understand and follow these.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They shared concerns quickly and appropriately. The 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 procedures to help safeguard people from the risk of abuse and people told us they felt safe. One person told us, “I have got lovely carers, I am really safe with them. I don’t want anyone to take them away from me.” Relatives agreed and said, “They are amazing. Their motto is, care first or don’t do the job” and “I think [family member] is safe with them.”

The provider worked with the local authority and other organisations to help investigate allegations of abuse and to keep people safe.

The provider 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. People said staff knew their needs and met these safely.

The management and staff worked well with people and professionals to manage risks. There were processes to help ensure risks to people were assessed and mitigated effectively. The registered manager reviewed each incident or accident to establish the cause and what actions were needed to reduce the risk of re-occurrence.

There were effective systems to review care plans and ensure they were sufficiently detailed and contained key information and guidance for staff.

People were protected from the risk of avoidable harm. Where risks were identified, we saw risk assessments were in place, and these were regularly reviewed and updated. For example, one person was at risk of developing pressure ulcers. Their care plan and risk assessment were clearly written and regularly reviewed. They contained instructions for staff to follow to ensure they met the person’s needs, for example, regular repositioning and application of cream to pressure areas.

Some people had specific dietary needs because of their health conditions. For example, one person, who was at risk of choking, had been recommended to be on a pureed diet. Their care plan clearly stated how to support the person to eat and drink and minimise the risk of choking. For example, ‘[Person] needs [their] head to be in an upright position when sitting up, to maintain airways, and [Person] needs support from the care staff to wipe away excess secretions and fluids from the mouth to minimise the risk of aspiration.’ The person’s care plan also clearly stated what to do in the event the person started choking.

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

The management team ensured they carried out a full assessment of people’s living environment to help ensure this was safe and if any adaptation was necessary. Where risks were identified, the registered manager took appropriate action, which included liaising with the relevant professionals and relatives.

Staff knew to report any concerns in relation to the safety of the environment so appropriate action could be taken.

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

However, although people confirmed the staff worked together to provide safe care that met their individual needs, some people and relatives told us they did not always get their visits at the agreed time. Their comments included, “I had to pull them up on timing” and “The timing isn’t good at night – we asked for 8.30 to 9pm and sometimes it is 9.45pm, that’s late and they don’t always let us know.”

Some people also told us the care workers did not always stay the full allocated time. One person said, “We pay for 45 minutes but they are in a rush and they are always gone in 35 minutes latest” and “They have a half hour, and they are usually here about 20-25 minutes.”

We fed this back to the registered manager who told us, “We are analysing our electronic call monitoring data to identify patterns of lateness and shorter visits, and adjusting rounds, travel time and staffing to address this. We are also reiterating to staff and office coordinators the requirement to inform people if carers are running significantly early or late.”

Although most people had regular care workers, some people reported they did not always have regular staff, and this meant they did not always build a rapport with them. Their comments included, “I know I have a lot of visits, but I see lots of different people coming in and out and I would prefer to have a few that I get to know well”, “Recently, over the last couple of months, I’ve had loads of different people. In a week I could see up to 15 different carers. I did ask what was going on but it just seems there are lots of changes” and “We have a lot of different carers. We will have one for 3 or 4 days and then someone different. The office keeps swapping the rotas for the carers.”

We raised this with the registered manager who told us, “We recognise that some of these issues may reflect the recent changes we have made to our rotasto comply with the local authority’s directive to adhere to the Working Time Regulations strictly, implement clearer shift patterns, and ensure carers receive appropriate rest breaks. Whilst these changes are essential for the safety and well-being of staff and, ultimately, for people using the service, we accept that the transition period may have had an unintended impact on continuity and timing, and we are working to stabilise this as quickly as possible.”

Further to this, the registered manager told us they had visited people to discuss the concerns to find a solution suitable for them.

People and relatives we spoke with said they were happy with the care workers who provided care and felt they were well trained. Their comments included, “I think they are trained well enough”, “The carers are very good, they do know not to rush me, and we do have a good laugh and a joke together” and “The carers do know what they are doing, I can ask them for help with anything really.” A relative agreed and said, “[Family member] has a ceiling track hoist, a profiling bed and air mattress because [they are] not mobile. The carers are competent at hoisting.”

Staff received enough training to meet the needs of people they supported. We saw evidence the staff were subject to regular spot checks of practice, supervision and had their competencies assessed to help ensure they were providing good, effective care to people who used the service.

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

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 staff received training in infection control and followed safe guidelines.

Almost everyone told us they felt safe from the risk of infection and cross contamination. They told us the staff followed safe infection control practices and wore their personal protective equipment (PPE) appropriately. The senior staff carried out regular spot checks to ensure this was the case. However, one person said, “One thing they are not good at is cross infection. They use the same flannel for different parts of the body even though it’s all set out for them.” We fed this back to the registered manager who told us they would provide refresher training and enhanced spot checks on infection prevention and control, and dignity in care.

The provider ensured the staff had access to PPE whenever they required this.

The provider 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.

Almost all the people we spoke with told us they received their medicines safely and as prescribed. However, one person said, “I have Parkinson’s and some of my medication is timed.They are not always on time and so if they are late, I just have to have my medication first thing when they come.” We raised this with the registered manager who told us, “Our clinical lead closely monitors [people living with Parkinson’s] because of their time-critical medication. I have scheduled a meeting with the clinical lead and the rota team regarding these service users, as this is a critical issue.” Delaying medicines by more than one hour, for example, can cause people with Parkinson's disease to experienceworsening tremors, increased rigidity, loss of balance, confusion, agitation, and difficulty communicating.

The provider’s electronic system enabled the care workers to sign for administration on their handset. The management were able to check medicines had been administered in real time. This meant they could take prompt action if they noticed somebody had not received their medicines on time and we saw evidence of this.

We viewed a range of electronic Medicines Administration Records (eMARs) and saw these were completed appropriately and in line with the prescriber’s instructions.

The senior staff undertook regular checks and observations of staff during medicines administration to help ensure this was done safely and in accordance with the person’s care plan.

Staff received training in the administration of medicines and had their competencies assessed regularly to ensure they maintained their skills and knowledge. There was a medicines policy and procedures in place and staff followed these.