First Point 24

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 service had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported incidents. Lessons were learnt to continually identify and embed good practice. The management shared learning with staff from incidents, accidents, complaints and safeguarding so that the service could continually improve and develop positive outcomes for people. Information was shared with staff through a secure messaging service, supervisions and meetings. A member of staff told us, “The manager keeps us up to date with any changes and we have regular communication through various different channels, and regular meetings.”

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. The registered manager told us, “A meeting takes place to carry out a full assessment before we commence a support package to determine if we are able to support the individual or not. We also look at what additional training our staff may need to ensure the person receives the best support. We get health professionals involved in the initial assessment and often invite them to meetings too.” Staff told us they read through the care plans to ensure they had all the information they needed to provide support safely. A relative told us, “We had the initial assessment completed with the care coordinator before we started the package. I have no complaints with the way the package was put together and the plan put in place. We have also had a review since then.”

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 service shared concerns quickly and appropriately. The registered manager had raised safeguarding concerns appropriately and had worked with the local authority to investigate these to ensure people were being safeguarded.  Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to local authority if I needed to”.

The service 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 had been assessed and risk assessments had been put in place to help mitigate risks as far as possible. These risks included areas such as supporting people with mobility equipment or with personal care. For example, the care plan for a person receiving percutaneous endoscopic gastrostomy (PEG) feed, a method of providing nutrition directly into the stomach when oral intake is not possible, included detailed and up-to-date information relevant to their nutritional needs and care requirements. Staff knew the risks to people well and told us they were kept up to date if there had been any changes to risk assessments and care plans. Staff said they always read the care plan and checked their phone app for care package changes or updates. A staff member told us, “I thoroughly read through everything about a person before supporting them and I always request additional training if I need it. I enjoy spending time with people and always try to get to know them better by talking to them.” A relative told us, “Staff are very quick to identify any concerns, and they always notice the smallest things and report it.”

People received personal care and support in their own homes. The registered manager told us, ''We involve families and health professionals when formulating and reviewing the care plans and work closely with them on a regular basis.'' Risk assessments had been completed to provide staff with guidance on how to keep people safe and minimise risks. For example, there was a risk assessment in place describing risks to people's home environment.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs. The registered manager had processes in place to ensure all staff received an extensive induction and staff we spoke to confirmed this. Appropriate checks were in place before staff started work including providing full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

However, not all references received had been verified in a timely manner and not all staff files contained 2 proofs of address. Office staff carried out a regular staff file audit however, the audits did not identify the shortfalls. The head of human resources (HR) told us they are currently in the process of organising and rearranging staff files to ensure the information is accurate and valid.

We recommend the provider ensures all the necessary recruitment checks are completed in line with regulatory requirements, to ensure that only individuals who are safe and suitable to work with people who use the service are employed.

We received positive feedback from a health professional. They told us, “Staff are sufficiently skilled and experienced to care and support people they a providing a service for. We have regular discussion around safe shadow periods and sign offs.” A relative told us, “The staff are wonderful people who are extremely respectful and kind. They are all very pleasant and know exactly what they are doing.”

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 had undertaken infection prevention and control training and were provided with personal protective equipment (PPE) which could be collected from the office. A member of staff told us, “I wear PPE when required, such as gloves and aprons during personal care and masks if needed. The registered manager completed a monthly infection prevention and control audit to identify any shortfalls.

The service 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. The registered manager told us, "Staff did not support people with medicines until they had completed the required training, and medicine competency assessments were completed.” Medicine competency assessments were seen. People had care plans and risk assessments in place which detailed what medicines they were prescribed and how they liked to be supported. Senior staff completed regular medicines audits which were signed off by the registered manager. There was a system in place to identify any shortfalls and to ensure people received their medicines safely.