Respectful Care

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 as good. At this assessment the rating has changed to outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 94 (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 strong, proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

The provider clearly understood their responsibilities in relation to Duty of Candour. A relative told us, “I always get a call from a carer to alert me if things are not ok.” Staff were prompted of this duty, whenever there was an incident such as a medicines error or missed call.

A root cause analysis was carried out whenever there was an incident to identify any lessons learnt or any training needs, as well as ensure the appropriate professionals were liaised with, such as a pharmacist.

The provider had cultivated a learning culture, staff told us, “If it's a mistake by an individual, you are informed personally, but also information is fed back to the whole team by email so the mistake can hopefully be avoided again, this also helps people learn.”

An action plan was developed to ensure people’s safety from identified trends, outcomes and referrals. For example, a team meeting was organised to help staff on how to identify signs of cuckooing (cuckooing is a form of action in which the home of a vulnerable person is taken over by a criminal in order to use it). Learning from incidents was also shared across other branches the provider was responsible for.

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. Comprehensive initial assessments were undertaken with people prior to them being supported, to make sure their needs and requirements were known and could be met as soon as they transitioned into the provider’s care. They liaised with healthcare professionals to ensure people received a continuity of care.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus 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 always shared concerns quickly and appropriately.

The provider always worked with people to understand what feeling safe meant to them and the best way to achieve that. People told us they felt safe with staff, comments included, “I feel very safe with all of it,” and “If I thought for one minute my mother was at risk the carers would not return.”

Staff clearly understood their responsibility to report concerns within the service and to external agencies if needed. Staff had exceptional knowledge on how to recognise all forms of abuse. A staff member said, “I have received safeguarding training to recognise all forms of abuse, including physical, emotional, financial, neglect, and institutional abuse. If I suspect abuse: I would immediately report concerns to my line manager or the safeguarding lead. If necessary, I would escalate the issue to external agencies such as MASH (Multi Agency Safeguarding Hub) or the CQC. I understand that safeguarding is everyone’s responsibility, and any concerns are taken seriously and addressed swiftly by the management team at Respectful Care.”

The provider took their role in safeguarding very seriously and kept a log of all referrals and outcomes, identifying actions to be taken. Staff explained to us safeguarding concerns were also discussed at staff meetings and supervision sessions.

Staff ensured people were actively encouraged to report any potential safeguarding concerns and were given information on types of abuse and contact numbers.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care that fully met people’s needs and was safe, supportive and enabled people to do the things that mattered to them.

The provider continually and robustly identified and assessed risks alongside the person at the initial assessment, prior to care commencing. Risk assessments prompted staff to involve people in decisions about their safety. For example, if they preferred their door to be locked or unlocked; if they choose to leave the door unlocked, staff advised them about the risks associated with that decision. Risks associated with specific medicines were identified, assessed and guidance given to staff on what action to take if they identified side effects. It was clear people and those close to them had input into care plans, particularly around specific risks. These were highlighted in bold for staff. For example, not to be left alone in a bath.

Where people were at risk of falls, they were provided with an easy read guide to falls prevention to empower them with tips on how to reduce the risk of falls. A professional that worked with staff to manage risks around mobility told us, “I have provided lots of advice which has been taken on board, but we/they have been limited by [the person’s] deteriorating mobility so there has been much difficulty in predicting what [person] will need on any given day/time. They have dealt with this challenging and complex situation safely and correctly and have come to a safe resolution.”

The provider had implemented a comprehensive and collaborative risk rating process which was discussed and agreed with people and their representatives. This enabled the provider to identify which people they supported were at the highest risk. A system such as this is particularly useful in emergencies.

People and their families felt safe when it came to staff managing risks, a person told us, “I am totally convinced she is in safe hands.”

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider consistently carried out environmental risk assessments prior to care commencing which included clear guidance for staff and was included in people’s care plans for staff to support people to maintain a safe home environment. Staff had access to crucial information in a clear way, such as where the fuse box and water stopcocks were in people’s homes in the case of emergency. Various environmental risks were also assessed with mitigation measures identified, such as what to do in the event of a fire or a power cut. Staff understood their duty and responsibility to maintain safety in people’s homes. A staff member explained to us, “I would ensure that the environment is safe and comfortable for everyone involved in the care at that moment in time.”

The provider proactively supported people where they identified risks, such as referring to the fire service for safe and well checks.

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked well together to provide safe care that met people’s individual needs.

The provider always ensured staff completed a thorough induction and training process prior to delivering care. Staff told us, “I felt fully supported before starting independently, and my Client Relationship Manager checked in with me regularly throughout my initial days to make sure that I am receiving enough support.” Another said, “At support sessions we are always asked if there are any gaps in our knowledge that we would like further training for. During my time at Respectful Care, I have also been part of a small team of carers that have cared for clients with more complex needs and Respectful Care sourced the additional training we all required.” We saw evidence of this in the provider’s training records, including specific training to support people who required a feeding tube (PEG training). The registered manager also explained the digital safeguard on their rostering system; which would not allow a staff member without specific training to be assigned to the people who had specific specialist needs.

The provider always ensured they had the appropriate number of skilled staff and people confirmed this saying, “They always turn up on time, we have had no missed calls.” Staff told us, “Management and the recruitment team ensure that we have adequate staffing levels to provide safe and high-quality care. Our teamwork and shift planning allow us to manage workloads efficiently, ensuring the best outcomes for our clients and work life balance for staff,” and “Our rotas are well-planned, giving us enough travel time between calls. Realistic call durations allow us to provide person-centred care without rushing. If delays occur due to unforeseen circumstances, we have strong communication with management, who offer support and adjustments.” Management stated, and we saw evidence of, that they “regularly monitor staff allocation and ensure we have the right balance of skills and availability to meet client needs safely and effectively.” We saw audits of visit times which demonstrated this.

Professionals who worked alongside the service told us “I have always found the care team to be enthusiastic about the training sessions and are always involved by asking appropriate questions around patients’ safety and care,” and “Although I am unable to undertake competence training the feedback that I receive from patients is always positive.”

People told us they felt staff were very well trained and appreciated having regular and consistent carers. People said, “Having the same carers all the time has meant they know my parent and what is best for her,” “Complex needs but all handled so well,” and “Carers went on courses at a special place to learn how to best look after them.”

Respectful Care's commitment to excellent training meant people received consistently positive outcomes in their care.

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. Each person had a risk assessment for infection control risks, which identified if there were any particular concerns unique to them as well as more general infection prevention risks. Regular spot checks were carried out by managers to ensure staff wore the correct personal protective equipment (PPE) and followed appropriate infection, prevention and control guidelines. Staff had a good understanding of infection control, for example they told us, “I always wear a clean pair of gloves when doing medication and remove once finished administering medication.” We saw evidence of this is in the spots check documents.

The provider always made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Information on which medicines people were to be supported with was established at initial assessment prior to care starting. This included completing any PRN (PRN are ‘as and when required’ medicines such as pain relief) protocols. Care plans had specific guidance on how to administer medicines in people’s preferred ways for example, “I like to only have 3 tablets per medication pot so I can easily see what medication I am taking.” Where people were on time critical medicines it was made very clear in care plans and the use of alerts on electronic devices.

Staff had an excellent understanding on how to safely support people with medicines. They told us, “Every time we are administering medication we check the medication, the dose, the route, the time of day to be administered and check for any special instructions e.g. to take with food. If there is a discrepancy between what is on our system and what is in the client’s property, we contact the pharmacy/GP to determine if the medication has changed or if its potentially a pharmacy error, we then document the outcome and inform the office.”

Regular audits were carried out to ensure medicine documentation was correct and that medicines had been noted to be administered as prescribed. Staff told us, and we saw evidence of, “We have regular observations where a member of the management team comes out to observe us administering medication and we have discussions around potential side effects of medications, where we can find information relating to medications and how we should respond in different situations.”