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• 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 63 (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.

There were systems to learn lessons when things went wrong. Accidents and incidents, complaints and safeguarding allegations were reviewed to see what steps could be taken to reduce the risk of similar incidents re-occurring. Learning was shared with staff through team meetings. A staff member told us, “We hardly see each other and staff meeting gives us the opportunity to see each other face to face and discuss around the topic and reflect and learn.” Care plans were reviewed if necessary and this was communicated to the staff team. There were policies in place covering complaints, safeguarding and accidents and incidents to help guide practice in the areas.

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.
People’s needs were assessed before they started using the service to ensure the service was able to meet them. This helped to achieve a smooth transition from one setting to another. People and their relatives were involved in the assessment process so that their views and wishes were taken into account. The local authority was also involved where people were funded by the local authority. Staff told us how they first got to know people’s needs. One member of staff said, “I read the care plan, introduce myself to the person, have chat, get to know each other and make them at ease.”
 

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.

The provider had a safeguarding adults’ policy. This made clear their responsibility to report any allegations of abuse to the local authority and the Care Quality Commission. We saw allegations of abuse had been dealt with in line with the policy. Staff had undertaken training on safeguarding and understood their responsibility to report it to a senior member of staff. A member of staff said, “We would raise a safeguarding alert with the local authority.” Another member of staff said, “Safeguarding means keeping people safe. I watch out for something that is not quite right like bruises, people being fearful etc. I will pick up my phone and call my boss and pass the information to them.”

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.

Risk assessments were in place for people. For the most part these were of a satisfactory standard. However, we found a couple of examples of risks that had not been adequately assessed. A person was identified as having swallowing difficulties but did not have a chocking risk assessment in place. Following our visit the registered manager completed a risk assessment and also made referral to Speech and Language Therapy [SALT] team. Another care plan we reviewed indicated that the person required support with preparing meals and baking. However, no risk assessment was completed around this. This was addressed shortly after our inspection by the provider.

People told us that they felt safe using the service. A relative told us, “My relative is safe, and I trust the staff, all of them, implicitly. I am in the house as well and I also feel safe.”

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

As this was a domiciliary care agency where the service supported people who lived in their own homes, the provider did not have responsibility for the safe maintenance of the property or the equipment used. However, the provider had carried out environmental assessments of people’s homes to help ensure support was provided in a safe way.

There were enough staff to meet people’s needs. Staff punctuality was generally of a good standard. There were some instances where people did not have the same regular carers, but the registered manager said they were aware of this and were seeing to address it. Staff told us they had enough time to get from one visit to the next. A member of staff said, “They give us enough time. The clients are close to each other.” People told us staff were punctual. One person said, “Carers are always on time, stay and deliver their support and if finished early stay and chat.”

Checks were carried out on prospective staff before the commenced working at the service. These included proof of identification, right to work in the UK and criminal records checks. For one staff member we saw their criminal record check was not complete. We discussed this with the registered manager, and they sent us confirmation they had carried out a new complete check shortly after our inspection.

Staff undertook regular training to support them in their role. They also had 1:1 supervision meetings with a senior member of staff.

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.

The service provider did not have effective Infection Prevention Control (IPC) monitoring systems in place. For example, a recent inspection by NHS IPC was conducted and an action plan was put in place to improve IPC standards. The registered manager could not demonstrate to us how they were monitoring the progress of the action plan. Following our recommendations, the registered manager implemented a monitoring tool.

The provider had a policy on infection prevention and control to help guide practice in this area. Staff were expected to wear personal protective clothing when providing support with personal care to people.

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.

Medicines were mostly managed in a safe way. However, where people had been prescribed medicines on an ‘as required’ [PRN] basis, there were no guidelines for staff about when to administer these medicines. This included where people had been assessed as needing support from the provider with taking their medicines. This was contrary to the providers medicine policy which stated guidelines should be in place about when to support a person with taking an ‘as required’ medicine. The provider put in place PRN guidelines for people shortly after our inspection visit.

Medicines administration charts were maintained, we saw these had even competed accurately, and they were regularly audited by a senior member of staff. Where people were supported to take their medicines, they expressed satisfaction with this. A relative told us, “[Person] had their medication changed and there was no way I could collect it for the evening dose, so the manager sent the carers to collect it. This is over and above in my book.”