Independent People Homecare

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• 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

We reviewed 5 quality statements under this key question: learning culture, safeguarding, involving people to manage risks, safe and effective staffing, and medicines optimisation. At our last inspection, the provider had failed to robustly assess the risks relating to the health safety and welfare of people. Medicines were not managed safely and there was a lack of evidence of embedding change or learning lessons when things went wrong. Systems and processes in place were not robust enough to demonstrate people were protected from the risk of harm, potential abuse or neglect. At this assessment we found the provider had made enough improvement and was no longer in breach of regulation. During this assessment we found risks to people’s safety were assessed and acted on. There was an open and transparent culture in relation to accidents and incidents and they were used as opportunities to learn and lessen risks. Any changes in practice or policy were shared with staff and used to drive improvement in the service. Staff had been recruited safely and there were enough suitably trained staff to meet people’s care and support needs. Medicines were managed safely. People’s medicines were managed and administered by trained staff whose competencies were regularly reviewed.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff were well supported by the provider and had the skills and knowledge to meet people’s needs. There was an honest and open culture embedded within the service which was driven from the top down. This empowered people and staff to voice their opinions and focused on continuous improvement. Concerns about safety were listened to and acted upon. People and relatives were complimentary of the service and the care they received. Comments included, “I am very happy with the company. I have had cause to raise an issue, and it was handled to my complete satisfaction.” And “We have had some issues with a relief carer. I contacted the office by phone and e-mail, and it was handled immediately to our satisfaction.”

When accidents or incidents occurred, we saw lessons had been learnt and action taken to mitigate future risk. To ensure actions taken were imbedded into staff’s day-to-day practice they were reflected on and discussed during team meetings. The registered manager described the actions they had taken to support continued learning and to help identify themes and trends to improve the service. A member of staff told us, “Information is shared amongst the care service to enhance the wellbeing and improve care for the person.”

Systems and processes were in place to support continued learning. There was a positive approach to the training of staff. This ensured they had the necessary skills to support people. The provider supported staff to continue to develop in their role through a variety of measures including, supervision, spot checks, staff meetings, feedback surveys and reflective practice. Systems were in place to record and analyse data relating to investigations of concerns, completion of logs for incidents, accidents, potential safeguarding events and complaints. This information was used to look for themes or trends within the service.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People had confidence in the staff and felt safe in their care. Relatives told us they had no concerns about their loved one’s safety. Comments included, “It is a very settled arrangement. There are two regular carers. One main one and one back up. Everything feels very safe and there have been no accidents. There has been far less hospitalisations with this arrangement,” “I always feel safe” and “Yes, person is very safe. I have been away for 5 days; I was confident that they could manage.”

Staff and managers had completed appropriate levels of safeguarding training for their roles and understood their responsibility to report any concerns. Staff were confident the management and office staff would take appropriate action if concerns were raised. A member of staff told us, “As a care manager, I would report any concerns to the registered manager. I have had to raise safeguarding’s in the past. I have a duty of care to the people we support.”

Systems and policies were in place to reduce the risk of people being abused or harmed. Records showed the service had made appropriate safeguarding alerts to the local authority when necessary.

People and relatives had confidence in the staff and were positive about the support they provided. Relatives praised staff for the support provided to meet people’s changing needs. A relative told us, “[Member of staff] wears PPE and is very careful to address all risks appropriately,” “Management do spot checks on their staff to assess them; check [persons] petty cash, medication records, finances etc. They take photocopies of all records and email them to the office for their records.” And “They [staff] always keep an eye on risks. The agency knows [person] and will come to me if they are concerned.”

Staff knew people well and understood how to manage potential risks. Staff told us they read people’s care plans and were updated about changes to people’s care requirements. Staff were proactive in responding to people’s changing needs and care was adapted to ensure people continued to be supported safely and effectively. A member of staff told us, “We talk about risks identified for people. If someone is on a special diet this is discussed with them and the staff supporting them. For example, some people have meals delivered which are specific to their dietary requirements, like soft or pureed meals for ease of swallowing.”

Systems were in place to assess and continually review people’s individual needs and preferences. This information was used to develop each person’s care plan and ensure it reflected their current care and support needs. Care plans included clear guidance for staff about how to minimise potential risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

No concerns were raised about staffing levels. People were supported by a stable and familiar staff group who understood people’s needs. Staff had a set rota, providing a 1:1 live in care service for1 to 3 weeks. Comments included, “I was not convinced at first that the 2 carers who came to care for [person] would be up to it. However, they were absolutely great. I cannot fault their care,” “The live in carer is very good and sleeps in our house. They are consistent.” “The staff are consistent. The new ones have to shadow for a minimum of 3-4 days,” and “They are usually quite experienced and any new ones that come, we get to see their profile and have a meet and greet over zoom.”

Staff were complimentary about working at the service and gave positive feedback about staffing levels. Comments included, “We are in regular contact and discuss staff suitability as a team. We know the needs of the customers and their experience,” and “There are no issues with staffing, as it is one to one support (Live in Care) people always have someone with them.”

Systems were in place to ensure there were enough suitably qualified, skilled and experienced staff. Safe staff recruitment processes were in place which included the completion of appropriate pre-employment checks such as references from previous employers and disclosure and barring service checks (DBS). This helps employers make safe recruitment choices. We checked the recruitment records for 4 members of staff and all the required pre-employment checks had been completed. The provider had introduced new staff profiles which allowed people the option to interview and choose their own care staff, giving them greater control. The care coordinator reviewed these profiles and matched staff according to the customer’s preferences.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

Medicines were managed safely. Care plans provided clear guidance for staff about the medicines people took and medicine administration records (MARs) recorded when staff had supported people to take their medicines. Comments included, “The live in carer gives us our medication and prepares our food,” and “The carer gives the medicine. They usually contact the pharmacist, and the tablets are on a strip. Everything is always given on time. They have a birdy computer monitor, and the medicine is always updated on there.”

Staff had been trained and assessed as being competent in the safe management of people's medicines. A member of staff told us, “I have completed the medication administration training. The Field Care Supervisor has observed me administer medication to the person and has deemed me to be competent.”

Systems were in place for the safe management of medicines. This included a medicines alert tracker to monitor any person’s refusal, missed medicines or other reasons why medication may have been omitted and actions taken should this occur. Medicine administration records (MARs) recorded when staff had supported people to take their medicines. Where people were prescribed PRN ‘when required’ medication, protocols were in place to ensure the medication was administered as intended. However, they did not always specify what they were used for and why it should be given. The registered manager advised they would be reviewing people’s PRN protocols and ensuring they were all completed.