KMX Nursing Agency

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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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. Incidents including where people may display behaviours of emotions were documented and immediately escalated to the management team. Incident reports were analysed and debrief meetings were held to discuss what had gone wrong and where improvements could be made. Following incidents, action was taken, for example, referrals to professionals or a review of support plans. A staff member told us, “Feedback was initially provided via a telephone call, after which a meeting was scheduled to further discuss the incident in detail. Meeting notes were circulated afterwards to ensure everyone was clear on what had been discussed and the actions agreed upon. During these reflective sessions, we explored what had happened and how it affected me. At the end of this process, we were able to identify any underlying triggers for the situation, such as, the service user’s preference for certain individuals and tailored our support accordingly. Engaging in reflective practice with management not only supported my wellbeing but also strengthened ongoing learning and safety within our team.”

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. Hospital passports were developed with people to enable others to understand them. The hospital passports included important information about people to promote a smooth transition and a continuity of care when using other services. Relatives gave examples of when staff supported their family members to appointments to help them feel safe and relaxed. We identified 1 hospital passport required updating to reflect a person’s current needs, we fed this back to the management team who reviewed it immediately.

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. Relatives told us they felt their family members were safe with staff. Staff received safeguarding training and followed the provider’s safeguarding policy; they knew what steps to take if they had concerns about a person. A staff member told us, “I look for signs such as bruises, unexplained injuries, changes inbehaviour, or signs of neglect. I would report immediately to my manager or safeguarding lead. If necessary, I know how to escalate externally to local authorities, or CQC.” The registered manager shared examples where concerns had been identified which they had referred to the local authority safeguarding team. Some people had a community Deprivation of Liberty Safeguard (DoLS) authorisations, this meant there were some restrictions in place which were deemed in their best interest. Staff supported these people in the least restrictive way and promoted a full life within the guidelines.

The provider mostly 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’s health were assessed and managed well, for example, some people lived with epilepsy. Each person’s support plan outlined specific seizure triggers, ensuring staff could recognise and respond to early signs effectively. Where some people displayed behaviours of emotions, Positive Behaviours Support (PBS) plans were developed to guide staff on how to support them in a person-centred way and to avoid what may be the cause of anxiety. Other risk assessments and associated care plans were in place, for example, for catheter care and using equipment to support mobility. These risk assessments contained information, however, we fedback more detail would be helpful to promote safe support. The management team responded by reviewing the risk assessments immediately. Staff had received practical training in these areas and relatives told us they felt their family members were supported safely by staff.

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 undertook assessments of people’s environment to mitigate risks to them and staff when delivering care. Environmental assessments considered hazards, such as, clutter or whether there were pets within the home. The registered manager gave examples where they had made referrals to the outreach service to promote the safety of people. Risk assessments were conducted for people who wished to remain independent whilst cooking and undertaking household chores. A staff member described how they ensured people’s environmental safety and said, “I follow cleaning schedules, check for trip hazards, and ensure equipment is safe and tidy, reporting any maintenance concerns.”

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. Relatives told us they were happy with staff’s timekeeping, a relative commented, “Staff turn up on time and stay for the amount of time.” Staff told us they had enough travel time between support visits and did not feel rushed. Staff were recruited safely; checks were in place prior to deployment, this included DBS checks, references and the right to work in the UK. Staff underwent a programme of training before commencing duties and refresher courses to ensure their knowledge was up to date. The training was both theory and practical, courses included, epilepsy, learning disabilities and PBS. New staff spent a period of shadow training with experienced staff until they were assessed as competent to work unsupervised. Staff spoke of the training and said, “The company provide us both online training and face to face training which I found helpful to enhance my knowledge and understanding of my job role. The practical aspect of training encourages group work and discussion of real scenarios of care needs. If I ever feel I need more training, I can speak to my manager, and they’re very supportive in arranging refresher courses or additional learning.”

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. Staff encouraged people to keep their homes clean and tidy, where people needed assistance staff helped them whilst promoting their independence. Staff completed infection prevention and control training and had access to personal protective equipment (PPE). A relative told us how they had requested specific PPE to be worn when staff supported their family member and said this had been adhered to.

The provider made sure that medicines and treatments were safe and met people’s needs, and preferences. Staff involved people in planning, including when changes happened. Medicines were managed safely. Members of the management team and team leaders conducted audits to ensure medicines were administered, documented and stored safely. Staff counted medicines daily and recorded amounts to minimise the risk of people running out of stock. PRN (when required) protocols were in place to guide staff when people may require additional medicines. Where people required PRN medicines to help calm them, we saw they were not routinely used and only administered as the last resort.