A1 Quality Homecare Limited Eastbourne

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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

People were safe and well supported by the service. There were enough staff to keep people safe and they were sufficiently trained to effectively support people. This included training in safeguarding. Staff demonstrated a good knowledge of this, including how to spot the signs of abuse and when to report matters. The registered manager had good oversight of safeguarding and had reported these to the appropriate agencies. People were supported to take their medicines safely where needed. They also told us that staff wear appropriate personal protective equipment (PPE) whilst providing care. Risks were assessed and managed, with guidance given to staff in how to minimise them. Environmental risk assessments were also in place.

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.

People felt confident in approaching staff and that their concerns would be heard and acted upon. Relatives also told us that there was an openness regarding raising any issues and they were encouraged to do this. A relative said, “Staff are all very approachable and we have no complaints. Any little issues have always been addressed within 2 days.”

Staff knew what action to take in the event of an accident or incident occurring. Staff had forms that they carried with them which they completed if anything unexpected happened during their care calls. Details were called through to the office to make managers aware and follow up actions were then completed. A staff member told us, “We have incident forms in their folders and we carry them. Also report to family and office. Call 111 if needed, forms sent to office.” Another staff member said, “It’s not a blame culture, we are learning. Never made to feel bad. We have meetings to discuss the issues and any lessons learned for us.” The registered manager told us that completed forms were looked at by supervisors and that they had oversight. Correct follow up actions were taken in all cases however it was unclear whether any trends or patterns were fully explored or whether any lessons were learned from accidents or incidents.

Care plans contained risk assessments bespoke to people and their individual risks were documented. Within risk assessments there was a section called, ‘comments and required actions’ and another called ‘reduction steps.’ The latter provided guidance to staff as to how to minimise the likelihood of a recurrence of an accident or incident in the future. The registered manager told us that they escalated a lot of incidents to the local authority as safeguarding concerns. This however had resulted in there being no separate file for storing and analysing accidents and incidents themselves. Although individual incidents were investigated there were no processes in place to identify trends or patterns and therefore to learn lessons from any repeat incidents.

People were supported to access other services should they be required. For example, staff had helped people make appointments to see their GPs. A person said, “At the moment I have a medical need, and nothing seems to help. The carers helped me to the doctors and now apply the lotion that they prescribed.” People who had been discharged from hospital told us the process had been smooth and worked well, their relatives agreed.

Staff worked well with other professionals involved in people’s care and support. This helped with making sure people received the most appropriate care when needed and were able to move between support services if there was a need. A staff member described to us how they were working with the district nursing team to make sure a person’s blood glucose levels were consistently monitored. Another told us about working closely with a social worker and an occupational therapist to make sure a person’s home environment was safe and that they had the right equipment. If a person was starting a support package after discharge from hospital, a mana ger would attend the hospital as well as the person’s home to complete the pre-assessment process.

The service worked closely with other agencies and professionals to ensure people’s needs were safely met and transitions between health and care service were smooth. Professional feedback confirmed that staff worked alongside them to promote good outcomes for people. One professional said, “I have always found the staff in the office to be very helpful and quick to respond to any queries I may have. When we have been arranging assessments with them, they have kept to timescales and informed me of the process along the way.”

We looked at 25 care plans as part of this assessment, there were clear contact lists for professionals involved in people’s support, including social workers, district nurses, OT, physiotherapists, and GP’s. The registered manager told us of positive working relationships with other professionals and good communication which led to straightforward transitions between services.

People and their relatives told us they felt safe with staff. One person told us, “Absolutely safe, because we have got to know the same carer and have confidence in them.” People spoke of confidence in staff’s support to keep them safe. For example, someone who was supported with their mobility told us, “They are very good. When they dress me, they make sure I’m standing properly not falling. They stand in front and behind me, keeping me safe”.

Staff had received training in safeguarding and were able to correctly tell us about the kind of situations that would amount to a concern and the actions they would take. For example, one staff member described how they had raised concerns regarding the self -neglect one client was experience and discussed how this was impacting on their safety. Comments from staff included, “Pressure sore – report to office. Falls, call manager straight away. Get office support as well. Stay with the person until ambulance arrives. Update daily log and complete incident form” and “Could be abuse, health concerns, money, maybe family issues. Can look to see if things are happening that are not written in care plan, know then maybe something is wrong.” Staff were aware of the whistleblowing policy and told us they were confident to use the process if needed. A staff member said, “I usually report to office but I’m confident to whistleblow.”

Safeguarding and whistleblowing policies were in place and were regularly reviewed and updated. The registered manager maintained oversight of all safeguarding referrals and investigations. We looked at some of those investigations. For example, some concerns were raised by a family member about care call times which had impacted on the person’s usual daily routines, times of medicine and times of meals. A full review meeting was carried out with the person and their family and a new timetable drawn up that could be met by staff. Care plans contained body maps which, when needed, recorded skin damage and pressure sores. These were then monitored by staff with support from district nurses.

People told us that staff got to know them well and helped them to manage and minimise risks in their homes. People and relatives told us that they were involved in formulating their care plans and staff were responsive to any changes that were needed to keep people safe. A relative told us, “[Person’s] memory was starting to deteriorate. They have been really responsive about this, and they came out straight away and did a re-assessment”. This enabled an updated risk assessment to be implemented for staff to follow.

Risk assessments were in place for people and staff told us they had time to read any updates or changes before beginning to support people. The registered manager told us that as part of the pre-assessment process all known risks to people were reviewed. Initial paperwork, usually from the local authority, would contain details of these risks and assessments were then written. The kinds of risk staff told us about included, moving and handling, risk of falls and any nutrition or hydration concerns.

Care plans contained risk assessments that were completed as part of the pre-assessment process and then were regularly reviewed. A process of reviews to risks was in place and this was brought forward in the vent of an incident occurring. Family members were involved in helping to manage risks for example with communication, managing PEG feeds and making sure environmental risks such as trip hazards, were removed. These details were included in risk assessments. Examples of other risk assessments in place for people included, where oxygen cylinders were kept, their safe location, smoking, epilepsy, falls and risks associated with people’s mobility.

People were supported to keep their environment safe and tidy. Each individual had an environment risk assessment in place to promote safety in their homes. People and their relatives confirmed that they felt safe in staff presence. A person said, “They do my cleaning for me really well. They always let me help with little things like dusting or washing up, keeping everything clean and tidy, which is good for me and helps me to feel safe and that I am keeping some independence.”

Staff told us environmental risks were assessed as part of the assessment process. For example, risks associated with fire are reviewed any concerns are referred onto the fire brigade. Pets including dogs were risk assessed as some staff were scared of dogs. Staff called ahead to make sure dogs were shut in another room for the duration of the care call. Staff were aware of any environmental risks associated with the people they sup[ported. A staff member said, “We know what the risks are, we look at the care plan to see the risks for example, pets.”

Environmental risk assessments were carried out as part of the pre-assessment process. We saw assessments attached to people’s care plans clearly highlighting gas, electric and water supplies and indicating the quickest and safest route for people to exit their homes in an emergency. Other hazards for example, potential trip hazards due to rugs or uneven flooring, whether a person smoked and poorly lit areas of their homes, were all highlighted for staff in the care plans.

Feedback from people about staff was mostly positive. Some people told us that care staff can be late to their care calls. Generally, they were advised if staff were running late but sometimes, they were not informed. The registered manager advised that they are working to improve staff confidence in calling the person directly if they are running late rather than contacting the office. People felt there were enough staff and that they were well trained to care for them. One relative told us, “Staff use specialist equipment for [person]. They are well trained with this.”

Staff told us they were given an extensive induction period with lots of opportunities to shadow more experienced staff before working alone. The induction included covering essential training modules. Comments from staff included, “Basic training, paperwork to research. Shadowing with senior carers. Do a minimum of 3 days shadowing but can ask for more” and “Covered safeguarding, medicines, infection control and manual handling. Shadow for 4 days – I asked for 2 more days.” Ongoing support was provided to staff through refresher training and regular supervision meetings. Staff told us, “Manual handling is every year refresher. Trainer is lovely lady, nice, helpful and gives me the skills I need,” “Classroom and practical training” and “Supervision meetings are 90 minutes long. Can raise issues and concerns. Happy to raise things with managers.” The registered manager told us the service would not accept a new person to support unless staff had the correct training in place first to support them.

Staff had been safely recruited. We looked at 6 staff files and each contained the required documents for example, photographic identification, references and Disclosure and Barring Service forms (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. A training matrix recorded all staff training completed and dates of refresher training and this was all up to date. Regular spot checks, unannounced supervision of staff when supporting people, had taken place. Staff told us they had spots checks every week. The registered manager told us that spot checks were a way of making sure staff followed the training provided and if there were issues, further training would be provided.

People and their relatives felt safe from the risk of infection. They reported that staff used personal protective equipment and they didn’t have any concerns. A person said, “They wear gloves, they wash hands if a clean-up has been necessary. They come in with pockets full of gloves”. Another said, “I feel safe with my main carer. He wears a blue uniform and always gloves when required.”

Staff received training in infection control and had a good understanding of how and when to use personal protective equipment (PPE). Staff told us they never ran short of PPE. A member of staff said, “No issues, lots of boxes always available.” Another added, “Make up our own bags. Enough to change after every task.” Staff gave a good account and understanding of cross contamination.

Care plans each contained a brief but highlighted section about how and when to use PPE. This included changing between tasks, regular hand washing and instructions for the safe disposal of used PPE. During the office visit we saw large amounts of PPE stored and this was collected by staff when required.

People told us they received their medicines safely and in line with their needs and wishes. Relatives also spoke positively about feeling their loved one’s medicines were managed safely. A relative said, “They have got a chart to read. Somebody does a check of the medication on a Friday to make sure nothing is missing. It’s all given to [person], he takes it off them and takes it with water”. Another said, “They are on the ball with her meds, and they are given at the correct times.”

Some people needed support with their medicines and this was provided by staff who had been trained in medicine administration. Staff demonstrated knowledge about medicines, when and how to record their administration, what to do in the event of a medicines error and how to support people safely with the medicines in the event of a refusal to take them. Comments from staff included, “Pre-entered on MAR (medicine administration records). Will say, take with water or food. Allergies are listed. If meds refused enter that on MAR and tell office. Can use different methods to persuade to take” and “Errors, call line manager. Refusals – may need a re-assessment. Try your best but report to office and log. Also record on MAR chart.” Their were separate protocols and instructions for staff for PRN, ‘as and when required’ medicines. Staff told us, “PRN protocols re timings and reactions with other medicines and foods in place,” “PRN instructions re use for example, lazido – cannot give more than twice a day. This is clearly marked on the MAR chart” and “PRN meds like painkillers. Note allergies. Always complete MAR and daily notes too for PRN.”

MAR charts had been completed correctly showing date, time and details of the staff member administering. Also had a running count of medicines which protected against incorrect amount being given and alerting staff when medicines needed to be re-ordered. MAR charts were audited each month when charts were collected but in the event of an error or refusal to take medicines, MAR could be audited more frequently and GP’s contacted for regular reviews. Risk assessments were in place which covered all aspects of medicines. For example, highlighting risks if medicines taken with some other types of medicines, storage and dispensing points and any side effects or individual allergies.