St Elizabeth's Domiciliary Care 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 inspection we rated this key question requires improvement. At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last inspection the provider had failed to robustly assess the risks relating to the health safety and welfare of people. This was a breach of regulation 12(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was not in breach of regulation 12.

This service scored 75 (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, for example, where incidents relating to medicines occurred the management identified these, took immediate action and shared lessons learnt with the wider team.

The registered manager had a clear overview on all safety aspects of the service. They had a clear overview of incidents, accidents and safeguarding concern, that then translated into looking at themes and trends relating to the safety of the service. Where particular themes were identified, action was taken to improve the service. For example, the provider set closed culture training up, which included learning for staff, but also the management team assessing the culture of the service, making sure it was an honest and open culture.

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.

Staff gave examples, where they met new people, they were starting to support and how they started to build positive relationships. Staff described how information was shared appropriately with them and where people moved to other support services.

Professionals felt people were supported by staff who knew them well and was able to support them to share information when they needed to. One professional said, “I feel that the staff are very knowledgeable and there seem to be sufficient staff members when I visit the residential settings or when residents are brought to the dental clinic.”

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.

People were supported in a way that promoted their safety, independence, and personal choice. People and relatives told us they felt safe and comfortable in their homes. One person told us,“The staff are kind, we do a lot and hang out with my friends. I have lived here for a long time. I like this as my home.” A relative shared, “Yes, absolutely [relative] feels safe and is treated with respect. The staff are very responsive to [relatives] needs and listen to them. They have been great in handling [relatives] care and getting the appropriate medical help that is needed.”

Staff demonstrated a clear understanding of safeguarding procedures and acted promptly to address any concerns. Where safeguarding occurred the management team ensured this was a robust investigation and immediate action was taken to keep people safe.

Where people had restrictions in place, these were reviewed by the appropriate people and were the least restrictive measure. Applications to the court of protection were completed highlighting the rational for these restrictions.

Risk assessments were person-centred and regularly reviewed, enabling people to live as independently as possible while remaining safe. These assessments considered both physical and emotional wellbeing.

People and relatives were involved in developing their care. Staff spoke about how people take positive risks; we saw evidence of this where people were taking part in things they enjoyed doing. People and relatives, we spoke to also confirmed this.

Where people were anxious or may be distressed at times, staff knew how to support people to make sure they felt safe to express their emotions and staff felt they had the skills and to support people to be 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.

People had detailed fire risk assessments in place, staff felt confident in knowing how to support individuals to evacuate if there was a need to.

Fire drills and fire risk assessments were in place to ensure people were living in a safe environment.

Staff were recruited safely, with appropriate checks in place, and there were enough staff to meet people’s needs without unnecessary delays or rushed care.

Staff recruitment processes were robust and individual staff circumstances were considered taking into account their wellbeing and employment needs. The team management staff recruitment had excellent systems in place, to not only make sure there was safe recruitment for people but also that staff were safe in their roles.

The team had been proactive in ensuring they were up to date with recruitment law in relating to sponsorship. They had requested an independent review into their processes to ensure they were in line with best practice and meeting regulations.

Staff received regular training and supervision to ensure they had the skills and knowledge to support people effectively. This included training in areas such as autism, learning disabilities, and epilepsy. Staff felt they had the right skills to do their role, however some felt they would benefit from more face-to-face training. One staff member said, “We have all online training, and I think I have all the training I need to do my role. I have the face-to-face training. If I need some support or different training, I will always ask.”

We observed there to be enough staff to support people’s individual needs. People did not need to wait for support. One person said, “I shout out to staff. They come quickly if I am in trouble. I am happy here. I feel safe here.”

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. This was evidence through audit completed by the management team.

The staff and management identified where areas of people’s homes needed maintenance, they supported people to speak with the housing provider to identify the works that were required.

Medicines were managed safely, and people were supported to take their medication in a way that suited them, promoting independence where possible. Staff understood people’s needs and preferences with medicines and ensured these were followed. The medicines administration record showed that people received their medicines in line with the prescribers’ instructions.

People received their medicines safely and as prescribed. There was a policy in place to support the safe and effective use of medicines. The service made effective use of an electronic medicines administration (e-MAR) system to record how and when medicines were given.

There was a robust process in place to ensure medicines which needed to be given at the same time each day were. People’s medicines were given to them in a way which met their individual needs, and this was clearly recorded for staff, so they understood each person’s preferences. ‘When required’ (PRN) medicines were used safely and effectively.

There were PRN protocols in place which supported the use of medicines and provided staff with information to understand when and how to use them. All staff were trained and were able to make use of emergency medicines and devices for the treatment of prolonged seizures. Where protocols were in place to manage complex healthcare conditions, information wasn’t always clear which protocol staff should be following. This meant there was a risk of people may not always receive care and treatment in a timely manner. We raised this during the inspection and the service was responsive to make the required changes to ensure this was resolved and staff knew what action to take if a person’s condition deteriorated.