Brighter Days Care at Home

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, 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. Incidents and accidents were recorded on an electronic care planning system and staff also reported any incidents to management. Once initial actions to keep people safe were completed, management carried out reviews to identify any actions to prevent recurrence.

We found records relating to incident management had not always been completed in full and did not consistently evidence all actions taken by management, for all incidents. The registered manager took immediate action during the inspection to review and implement changes to recording.

Learning alerts were shared with staff giving them information on what had happened and how to prevent recurrence. We saw the alerts were designed in both text and pictorial formats with the aim of helping staff to understand what improvements or safe ways of working were required.

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care when people moved between different services.

Management teams worked with people and relatives to navigate health systems when moving between services. Feedback from people and relatives was very positive about the support they had received from management to move between services as smoothly as possible. Comments from people and relatives about this quality statement included, “I am involved, they [staff] prioritised a home from hospital visit, they are receptive to change” and “[Person] went into a care home for a week. They [staff] were there the minute [person] got back home, and the care continued as normal, I am very impressed with the company.”

One relative spoke with us about the difficulties they faced when trying to help their relative discharge from hospital. They told us, “Management have been tremendously helpful, I don’t think I could have done it without them. When [person] came out of hospital, [person] was so confused, it was distressing. Brighter Days rode to the rescue, went above and beyond trying to help us. Care staff were often going over their hours to help us out.” Another relative told us how staff had supported them with understanding of medical terminology when their family member was discharged from hospital. Staff made sure everyone understood the risks involved and worked with relatives in a collaborative way. This gave people and relatives confidence in the care provided.

Management monitored hospital admissions and kept in touch with ward staff to identify any possible discharges in a timely way. This enabled them to make sure people had any equipment they needed, and staff were ready to recommence any care visits without delay.

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.

Any safeguarding concerns had been shared with the local authority in a timely way. Management identified potential safeguarding concerns at an early stage and worked together with local authority staff to find resolutions. For example, where people were at risk of self-neglect, management shared information with the local authority and always attended any safeguarding meetings.

Staff received safeguarding training as part of their induction when starting at the service and an annual refresher update. We observed safeguarding was on the agendas at staff meetings and within staff supervisions.

People and relatives said people were safe using this service. One relative told us, “It is very reassuring to know that my [family member] feels safe and supported by her carer. Her views are listened to and the level of care is to a very high standard.”

The provider 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’s safety were identified and assessed to provide staff with guidance on how to support people safely. Risk management plans gave staff guidance on a range of risks including moving people safely, supporting skin care and responding to distress. However, we found guidance for supporting people with a Percutaneous Endoscopic Gastrostomy (PEG tube) was not clear for staff to know what to record in the daily care notes. A PEG tube is a way of enabling people with swallowing difficulty to receive food and fluid directly into the stomach. This meant recording was not consistent and did not capture all of the support provided. Management took immediate action to change guidance for staff and shared a learning alert with them regarding changes made.

People and relatives told us staff worked safely when supporting people with moving and handling equipment. One person said, “Staff seem to know how to use it [equipment] and they help when I need them to.” One relative told us they had observed staff supporting a person to move and thought staff worked to keep the person 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. Environmental risk assessments for people’s homes were completed prior to packages of care starting. Assessments included risks such as trip hazards, fire safety and parking arrangements for staff when visiting. Any potential hazards were identified and guidance on safe ways of working was recorded and shared with staff.

If people had equipment such as specialist hospital style beds or mobility aids, staff were provided with training on using this equipment safely. The service kept information on when equipment needed servicing and if required, staff contacted the relevant external companies to carry this out.

Where people had air mattresses there was little information on what settings the mattresses should be. Air mattresses sound an alarm if there are any faults, however, they may also lose pressure without there being a fault. If staff did not have guidance on what settings should be any loss of pressure was more likely to go unnoticed. The registered manager told us they would take immediate action to identify what pressure the mattress should be and ensure this information was recorded.

The provider 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.

Overall, people told us they had enough staff to meet their needs safely. Some people told us they had experienced a lack of continuity with their care workers. The service had also received this feedback through their quality surveys and were in the process of making some changes to improve continuity for people. This included arranging core groups of staff for people. Management told us due to staff absence, there were times people had visits from other staff. However, they had implemented more robust staff absence policies and procedures which were improving incidents of short notice absence.

Staff received a 5-day face to face induction when they started work and refresher training when needed. Staff we spoke with said the training was good and gave them the knowledge and skills needed for their work. Staff had regular 1-1 meetings and support from management, and were able to visit the office when they needed.

Staff were provided with support to complete work-based qualifications in care, leadership and management. The registered manager told us they were working with sector organisations to identify pathways for staff to progress in their development and careers.

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.

Staff received training on infection prevention and control (IPC) during their induction. Staff were shown how to use personal protective equipment (PPE) safely and given information on good practice relating to IPC. Staff were provided with the PPE they needed and had regular checks of their competence for IPC good practice.

People and relatives told us they did not have any concerns about this quality statement and staff worked safely following IPC guidelines. Comments included, “They [staff] have good hygiene, and they change their gloves” and “My home is cleaner than before they [staff] arrived. They wear gloves and I have no complaints with personal care.”

The provider did not always make sure that medicines management systems were consistently working to make sure people had their medicines as prescribed. We found gaps in recording relating to topical patches. Staff had not consistently recorded where on the body patches had been placed. Management took immediate action to add a body map to daily notes for staff to use to record this information.

Not all shortfalls regarding medicines management had been recorded as an incident. This meant the service could not easily evidence actions taken in response. For example, the service evidenced staff had phoned the on-call staff to report incidents, but ongoing action was not always recorded. Information relating to people’s medicines was not always clearly recorded in their care plan. This meant it was not consistently evident what support staff needed to provide.

Staff received training on medicines administration which included a practical demonstration and check of competence. Senior staff carried out ongoing observations of competence to support staff when working with people. Any areas for development were identified and further training or support provided.