Pathways of Hope

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 Good. At this assessment the rating has remained 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 provider had a proactive and positive culture of safety. Staff understood their responsibility to report incidents and concerns. Staff documented accidents and incidents involving people and escalated concerns to the management team. Incidents and concerns were reviewed appropriately to identify any learning. For example, falls and accidents were analysed to identify any trends and make necessary changes to areas such as staffing, equipment or the environment.

The registered manager had oversight of recorded incidents to determine whether changes to people’s support needed to be made. Incidents were monitored, and actions were recorded. Risks were not overlooked, and care plans and risk assessments addressed any concerns over people’s mobility and health. Relevant referrals had been made to address any additional support people needed to stay safe.

A complaints process was in place, although the registered manager confirmed that there had been no formal complaints submitted. Carers receive duty of candour training as part of their initial training. Staff had recognised when incidents had put people at potential risk of abuse and made the appropriate referrals and notifications.

There were systems in place to facilitate safe pathways and transfers for people. Assessments of need and risk assessments were completed during the initial assessment of care to ensure safe, effective support.

Care plans detailed people's health conditions and provided the guidance staff needed to seek additional professional health support and when to make appropriate referrals to partners. Referrals had been made to specialist services such as occupational therapists.

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, within people’s care and support and when people moved between different services.

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. People told us that they felt that staff understood their needs well. Management and staff understood safeguarding issues, their reporting responsibilities and understood what signs to look for that may indicate any safeguarding concerns with the people they supported. One care worker said, “I look at the mood of the person and any changes, not willing to talk, facial expressions will tell you if something is wrong.”

Feedback from people was positive and indicated they felt safe with carers in their home and providing them with care. The registered manager was aware of what safeguarding information to submit to local authorities and how to notify the CQC of any potential or suspected abuse.

Staff received appropriate safeguarding training and knowledge to ensure they could recognise when people may be unsafe and to identify potential signs of abuse. Information about people’s care was safeguarded by adherence to data protection policies and consent processes. The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

Risks to people had been identified and assessed. Risk assessments were person centred and ensured that care plans had the information staff needed to manage them safely. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Environmental risk assessments were completed to ensure that staff could undertake care and support safely in people’s homes.

Risks were recorded effectively and related to the specific needs of that person. For example, risks to people’s skin integrity, their nutrition and hydration needs and mobility had been assessed and reviewed. One relative said, “They seem to know what they are looking for, signs to look out for.” Staff told us that information about risks to people was clear in their care planning and gave them the guidance to mitigate them. One staff member said, “Keeping a person I support safe at home involves practical measures, risk assessment and personalised support towards their specific need.”

Environmental risk assessments were completed to ensure that staff could undertake care and support safely in people’s homes. Assessments of the environments of people’s homes highlighted any risks or factors that could impact carers access and their ability to undertake safe and effective care. For example, one person’s care plan and risk assessment showed a proactive strategy and working with staff to maintain their environment, which they had struggled to maintain independently. One staff member said, “I ensure items are not kept in a way that will make service user have a fall. I keep items needed within reach and make sure the house is locked and key kept in the key safe and key safe scrambled to hide the password.”

Care planning showed that people had equipment in place to support with their mobility. Guidance was in place for staff to use this equipment and moving and handling training supported this practice.

There were enough trained staff in place to ensure people remained safe and to meet their needs. People told us that staffing was generally consistent; they had continuity in their care and carers stayed for their allotted time. One person said, “There are 4 roughly I see all the time. They are paired off every day but change with annual leave. They are all absolutely brilliant. I get great continuity of care. There’s always one I know.” Another person said, “Yes very much so, new carers happen but it’s good to meet new people but have regulars.”

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. Staff completed shadowing shifts with established staff members prior to lone working. Training had been identified and provided to staff according to the needs of the people the service supported. These included training in areas such as health and safety, safeguarding, Mental Capacity Act (MCA), medication, and moving and handling. When needed, additional specialist training was sourced to meet the needs of people they supported, for example, dementia, diabetes and mental health awareness.

Systems and processes were in place to protect people and to prevent and control the risks of infection. Staff were trained in infection control and food safety awareness and there was an IPC policy and procedure in place. Staff demonstrated a good understanding of how to prevent the spread of infection.

People stated that staff were careful in disposing and cleaning when support was provided with continence needs. One person said, “They are very careful, they disinfect everything.”

When supporting people in their homes and providing personal care, staff used the appropriate personal protective equipment, such as face masks, disposable aprons and gloves. People spoke positively about staff practice and use of personal protective equipment (PPE) when in their homes. One person said, “Yes, they all wear PPE and they change them two or three times while they are with me. They also use masks and dispose the gloves properly.” Another person stated, “They always wear them; every time they are here.”

The provider assessed and managed the risk of infection. The registered manager said, “We have discussed infection prevention control and have a policy which everyone’s read. Carers change gloves in houses between each task. Especially after personal care and during medication and food making. We review this on spot checks on the frequency of changes.”

Systems and processes were in place to ensure that people’s medicines were administered safely. Staff had received training in administration of medicines. People’s care plans contained guidance for staff on medicine administration or prompting. Each person had a medication care plan in place that assessed the level of support needed and what carers supported them with. For example, when one person required time specific medicines to be administered, care plans and risk assessments detailed this clearly and why this was required.

Staff confirmed they'd received medicines training. They confirmed that information about people's medicines was in their home. People told us that they were supported safely and effectively with their medicines. One relative said, “Yes, they do. All her medicines are administered; they do it efficiently. I have no worries whatsoever.” One person said, “They prompt to remind and check I have taken my medication, but I do this for myself.”

Leaders had oversight of medicine administration and completed audits and analyses of any incidents. These determined why discrepancies occurred, what actions staff had made and what changes had been made to adjust practices and delivery.