Comforting Healthcare

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 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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 had not been any incidents or accidents involving people using the service since it started operating. However, there were comprehensive systems in place to report, record and investigate any concerns that arose to ensure they were acted upon and learnt from. A staff member said, “I would report this straight away.”

The service 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.

Staff actively involved people and their families in decisions about care and transitions. With consent, they also liaised with individuals’ GPs to gain a comprehensive understanding of health needs, ensuring care was well-informed and tailored.

The service 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.

People and their relatives felt safe receiving care. Staff had received safeguarding adult’s training, and a safeguarding policy was in place.Staff said, “I would let the office know and manage as the first line of action. If it was something urgent, I would call professionals.”

The service 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. For example, 1 person was identified as being at risk of choking. The assessment instructed staff to follow the SALT recommendations; however, the guidance was ambiguous, referencing both level 5 and level 4 meal consistencies, which differ significantly. Whilst no harm had been caused, this lack of clarity could have resulted in staff errors. Additionally, another person with epilepsy did not have a risk assessment in place. After we provided feedback, all risk assessments were reviewed and updated prior to our second visit to the service.

All other risk assessments were in place and provided detailed information to reflect people’s individual needs. There was no negative impact on care, and people told us they felt risks were well managed. Feedback included comments such as, “Oh yes, [person] is safe. [person] gets on really well with the staff. Staff go above and beyond.”

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.Staff carried out safety assessments in people’s homes and removed any potential trip hazards. They were trained to use equipment safely and had been given fire safety training to ensure they could respond appropriately in the event of a fire. The service also maintained records of equipment checks to confirm they were carried out and kept up to date.

There were enough trained staff in place to ensure people’s care calls were completed. We reviewed the provider’s scheduling system and staff were provided with time to travel between calls. However, while some people were happy with their scheduled calls, other people told us they experienced late calls and an inconsistent approach from some staff that supported them.

Comments from people included, “Some carers don’t let you know they are going to be late. One staff member is meant to come at 7am but came in at 7.45. If this happens staff are then rushing and then [person’s] independence is taken away from them like putting their own shoes on, getting ready as staff are rushing” and “It’s the same staff who come" and, "I have two different staff, as I have a few calls. Yes, I asked for girls and the girls came to see me." “Yes, staff arrive on time, if running late they let [person] know.”

Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

New staff completed an induction and probationary period, including shadowing experienced colleagues before working alone. Training records showed several gaps in staff training. The service reported that it had introduced disciplinary measures to encourage staff to complete their training.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff understood how to protect people from the spread of infection. Staff had access to personal protective equipment such as aprons and gloves (PPE).A staff member said, “Yes, I have had infection control training. We wear gloves and aprons where needed.”

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

Medication administration records (MARs) were not consistently completed with accurate codes or clear reasons for omitted doses. For example, 1 MAR showed Levetiracetam (used to treat epilepsy) recorded as “Not required” on 5 occasions, while the code “Other” was used 3 times with notes stating, “Not applicable.” Additionally, Medi Derma barrier cream, which should have been applied after each pad change, was not always documented. The registered manager and records showed no people had missed their medicines however, incorrect codes were being used by staff.

Instructions for administering medicines were also unclear. For instance, a person was prescribed a topical cream, but both the MAR and topical chart stated, “use as directed,” and the specific directions were unavailable in the office because the bottle was kept in the person’s home. The registered manager immediately addressed this issue.

No person or their relative expressed any concerns regarding medication administration, and no medicine related incidents had occurred within the service. Staff reported that they had received medication training and felt confident in their ability to administer medicines safely. One staff member stated, “I have completed this training and am competent in this area.”