Graceful Care - Wandsworth

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 improved to good.

This meant people were safe and protected from avoidable harm.

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 service had a culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People using the service told us that were able to raise any concerns with the provider and were confident that the managers would take these seriously. Managers and staff understood the importance of reporting safety concerns and learning lessons when things went wrong.

Care workers completed incident reports if they were witness to any safety concerns which were then investigated by managers. Service concerns were investigated thoroughly and where appropriate, were shared with the local authority or other professionals. This demonstrated an open culture based on honesty. There was evidence that the provider used incidents to learn lessons, for example following an incident around medicines, the provider arranged a medication forum for care workers to learn from.

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 provider completed assessments of people’s needs when they received a referral or an enquiry. Information was obtained from people, and others involved in their care, about people’s individual needs and risks they might face.

This information was used to develop an initial care plan which then further developed into a more comprehensive, individualised care and risk management plans. This helped to ensure people received safe and appropriate care and support based on people’s assessed needs.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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.

Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to tell us how they would spot potential signs of abuse.

Care workers were aware of safeguarding, what it meant and how they would act in response to concerns. Comments included, “Safeguarding is avoiding harm to clients, making sure that I’m aware of any changes in behaviour or unexplained bruising, I would tell the office” and “Safeguarding is to prevent harm from occurring such as emotional, physical abuse. I can report straight away to emergency services if people are in danger or If I suspect anything else, I would call the office.”

People using the service, and their relatives, told us they felt safe. They said, “The carer is very accommodating to [family member’s] needs. I am able to go on holiday without having to worry” and “If I need to go out, I am confident to leave [family member] with the carers. She has dementia, they understand her body language.”

Managers worked with the relevant external health and social care professionals and bodies when a concern was raised and took appropriate action to safeguard people from harm.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People, and their relatives, told us that any safety concerns or risk were managed by care workers who were trained and competent in their role. They said, “They understand [family member’s] choking risks and feed her small spoonfuls. They know how to use the hoist and how to transfer”, “They know I need two people to assist me. They have enough training” and “They tuck [family member] into bed so she doesn’t fall out. They make sure her frame is there and the cat is out of the way.”

Care records included risk assessments which contained details on how to reduce identified risks so people could lead independent lives, knowing their safety was considered.

Staff had access to people’s care records and told us they always followed people’s risk assessments and plans which helped to keep people as safe as possible whilst taking reasonable and acceptable risks.

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

The provider completed environmental risk assessments prior supporting people and at regular intervals thereafter. This helped to ensure that people were cared for in an environment that was both safe for them and for care workers.

Risk assessments included risk in relation to both the environment and any mobility equipment in people’s homes, such as hoists.

The service 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.

At the previous inspection, we received mixed feedback about staff timings and attendance to calls. People and their relatives complained about staff punctuality on calls which left them unhappy. The electronic system used to monitor staff attendance on their calls did not always work as intended and office staff had to manually log visits.

At this inspection, we found that the electronic call monitoring system was fully operational and working well and the scheduling was well managed. There was travel time provided in the scheduling and punctuality was excellent, showing that 99% of calls were delivered within 15 minutes of the planned time.

There were still some issues with some occurrences showing as staff logging out of one call and into the next call instantaneously, staff logged in at two locations simultaneously and also some unlogged calls, however these were known to the provider and they were working with the application vendor to work through these issues.

A healthcare professional told us, “When I have reviewed specific Electronic Call Monitoring (ECM) records, punctuality and continuity have both improved and I’ve been able to close several service concerns as not upheld because they can produce reliable ECM evidence.”

People, and their relatives, told us they received care from a consistent care team. They said care workers arrived on time, and they were informed if they were running late. Comments included, “They arrive on time, they let me know if they are going to be late” and “We have a consistent team, days off are covered by people she knows.”

Staff recruitment practices were robust and only fit and suitable staff were employed to work at the service. Staff files contained evidence of robust recruitment checks including application forms, references, interview questions and right to work and identity checks. The provider completed Disclosure and Barring Service (DBS) checks. This helps employers make safer recruitment decisions by processing requests for criminal record checks.

Newly employed staff were subject to a 3 month probationary period and received mandatory training when they first started which included shadowing an experienced care worker and a medication competency which was assessed by the clinical lead.

Staff had the opportunity to reflect on their working practices, including identifying any training needs, through regular supervision. They were also observed on their working practices through spot checks.

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.

The provider completed risk assessments in relation to infection control and cleanliness.

People told us care workers wore Personal Protective Equipment (PPE) when supporting them and staff confirmed they had access to adequate supplies of PPE. Training records showed that infection prevention and control training was delivered as mandatory training.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Medicines systems were well-organised and safely managed.

People told us staff supported them to take their prescribed medicines as and when they should.

Care plans included guidance for staff about how people’s medicine support needs including any prescribed medicines they took and their preferences.

Staff received relevant training and their competency to continue managing medicines safely was routinely assessed. Care workers completed medication administration records which showed that people received their medicines on time.

The provider carried out regular audits of medicines, including any missed medication or gaps in medication administration which were then explored further to identify any root causes.