Care at Home Gloucester

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.

This is the first assessment for this registered service. This key question has been rated 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.

The provider ensured all accidents and incidents were reported, investigated and any areas of learning or improvement were identified and shared with the staff team. Staff confirmed they were able to discuss any incidents and learn to improve future practice.

The provider had a new digital platform to log and monitor any accidents or incidents, which all managers had access to, for oversight. Following previous incidents, the provider had developed a digital risk register for people at high risk of choking or in need of support from the Speech and Language Therapy Team (SALT).

Incidents relating to people’s behaviours of distress were documented for staff to identify themes and triggers. These were discussed at staff meetings and shared with the staff team. Analysis of the use of Positive Behaviour Support (PBS) when managing increased behaviours enabled staff to learn from these incidents and confirmed the efficacy of their methods.

There was a clear process for raising complaints and concerns and staff were aware of when and how to raise concerns.

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.

Continuity of care was maintained by ensuring staff had access to current and clear records. When people moved into the service, the transition was well managed, and relatives told us they had a positive experience. Comments from relatives included, “[My relative’s] settled in and seems happy since 2021. [They] moved suddenly as the previous home closed” ; “Before [they were] in a place that was dreadful and yet these do so much with [my relative], it’s an amazing place.”

Each individual had a detailed person-centred personal emergency evacuation plan (PEEP) which gave instruction to staff on how to safely evacuate people based on their individual needs. PEEP’s identified areas of risk and the evacuation process during the day and at nighttime.

We reviewed people’s ‘passport to hospital’ care documents. These were detailed and gave clear and concise information to hospital staff, who may not know the person, in a red, amber, green (RAG priority rated) format for ease of use. These included, ‘Things you must know about me’, ‘Things that are really important to me’ and ‘Things I would like to happen’. People’s passports also included a reminder for hospital staff to consider the person’s capacity to consent to any care and treatment. Grab bags were left near the front door with vital information for emergency services.

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.

The provider had clear processes to manage safeguarding events and worked collaboratively with the local authority to support people safely. Referrals and notifications to the relevant partner organisations had been appropriately submitted.

Safeguarding was discussed and reflected upon in team meetings. Staff we spoke with were knowledgeable about safeguarding, and how to recognise, manage and report abuse. Staff told us they had received safeguarding training which was regularly refreshed and discussed.The open-door policy meant staff were fully able to voice any concerns.

Staff comments included, “I've never had to raise [a safeguarding concern]. I have supervisions and 1:1's with my manager. If I had any concerns about self-neglect or abuse I would go to my senior or the registered manager.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority.This can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that some people were living under legal authorisations to restrict their liberty. Where DoLS were issued, these were clearly documented in support plans. Staff were aware of these restrictions and why the DoLS was in place.

Relatives told us their family member was safe. Comments included,“Yes, I think [they are]”, “Safe,I should think so. I haven’t heard anything contrary to that” and “Yes, [my relative’s] safe because [they are] very happy and well looked after, and clean and tidy.”

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.

People’s individual risks were managed well. Risk assessments were person centred, personalised and clearly detailed actions to mitigate the risk identified. Staff demonstrated they knew people well. Staff could identify social and environmental factors which triggered people’s behaviours of distress. As a result,they were able to adapt people’s social and environmental surroundings to proactively respond to the behaviour and minimise escalation. When behaviours of distress could not be prevented, staff spoke to people respectfully and with understanding, to support them to return to their baseline behaviour as soon as practically possible.

There was a culture of positive risk taking which meant people had the opportunity to increase their independence and experience and lead full and active lives.

However, 2 people were identified as not having a risk assessment relating to the purchasing of large amounts of items and having restrictors on their kitchen cupboards.Whilst we saw there had been no impact, we shared this with the registered manager who took immediate action to resolve.

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 were completed,including hot water and scalding, maintaining a safe environment and fire safety. Fridge temperatures in people’s homes were monitored to ensure food was chilled correctly. We observed people’s homes were well-maintained and safe. Small electrical portable appliance testing (PAT ) were up to date. Some areas required re-painting but were clean and tidy.

Outside spaces were relaxing and garden landscaping and furniture was suitable and fit for purpose. People were supported to go in and out of garden areas as they pleased. A Head of Estates was in post who managed the maintenance team. They used an electronic system for referrals and monitoring progress, and staff told us maintenance concerns were addressed quickly.

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.

The provider had safe recruitment practices. The registered manager had a team to screen and check staff employment histories and criminal backgrounds as part of the provider’s recruitment process. The provider completed risk assessments when they were unable to obtain a complete employment history of staff. This assisted the registered manager to demonstrate how they had evaluated the character of new employees.

Regular agency staff were used when permanent staff where not available to support people. New systems had been implemented to verify the employment backgrounds and qualifications of agency staff to ensure staff could meet people’s support needs. A comprehensive induction programme including shadowing experience and training was available for new staff.  

Most relatives and people we spoke with told us there were enough staff on duty. One relative said, “Whenever we go, there are always plenty of staff there sat with [my relative]. It’s a really good place and I feel we’re lucky.” Another relative told us, “There are enough staff because they are usually one to one even at night.” A person told us, "I really like it here and staff are really nice."

Some relatives told us they would like to see more female staff and staff who could drive people’s vehicles. We shared these comments with the provider so they could review their practice in this area.

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.

The home environment including kitchen areas were visibly clean and hygienic. A poster was displayed in one kitchen,reminding staff to use different chopping boards to prevent cross contamination. Bathrooms had hand washing guidance and personal protective equipment (PPE), and hand sanitisers were readily available.

Where able, people were involved with looking after their homes and engaged in some food preparation with support from staff. All staff had received infection prevention and control training and food safety and hygiene training.

The provider 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.

Medicines were stored, managed and administered safely and accurately.

The provider and staff were aware of the STOMP principles (Stopping Over Medication of People with a learning disability, autistic people, or both) and worked with people and staff to ensure people were not over prescribed with medicines which negatively affected their well-being. STOMP is a national NHS England program focused on reducing the inappropriate prescribing of psychotropic medicines to individuals with learning disabilities and/or autistic people.

Staff received medicines training and their competency was regularly assessed. Spot checks on medicines administration were conducted weekly. People’s individual medicines care plans were reviewed monthly and audited by senior managers. Where needed, staff were up skilled in competency for specific care needs, such as diabetes and insulin training.

We reviewed people’s medicines care plans and found medicines had been administered in line with GP instructions. As required medicines,such as paracetamol,had individual protocols which were reviewed annually to check for usage and possible GP review. Protocols included instructions to staff and what to consider, such as‘[person] will show you signs of excessive coughing, wheezing…will pull clothes around [their] chest as a sign.’

We saw people had a medicines pen picture for them to more easily understand the medicines prescribed.

We reviewed monthly audits of medicines which identified actions or improvements where required. These had been completed by the following monthly audit,with a marked reduction in medicine errors.