DKM Healthcare Limited

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

We assessed 5 quality statements in the safe key question and found areas of good practice and concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. Though the assessment of these areas indicated areas of concern since the last inspection, our rating for the key question remains good. People and those important to them knew how to raise concerns when they didn’t feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Safety risks to people were managed but care plans did not always reflect how to do this clearly. People’s involvement in care planning was not always documented clearly but people told us managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough staff to support people with their needs. Some people required support from more than 1 staff member and this was always provided. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers carried out spot checks and competency assessments on staff to ensure they were able to safely provide people’s care.

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 did not tell us they had any concerns regarding the service about safety concerns being listened to or the openness and honesty of the team. One relative told us, “I cannot fault the effectiveness of this service."

The management team had adopted a learning culture. This meant when things went wrong, or there were safety concerns, they reviewed the incident to see what could be done differently in the future. The registered manager gave us examples of recent events that had prompted them to change to a safer way of working with people. They told us they were sharing information with staff and encouraging staff to discuss any concerns they had. The registered manager said, "It’s a professional way of working, feel free to talk, talk to colleagues and report to management. If you [staff] don’t say something things could go wrong, and we have vulnerable people we are looking after."

Historical feedback from one local authority had highlighted several concerns about the provider’s way of working. However, the recent feedback we obtained did not highlight any concerns from local authorities.

The management team were responsive to feedback from the inspection team and appeared keen to learn and improve ways of working. The provider had introduced a new process for staff to provide feedback and this was implemented further in response to CQC feedback on concerns received. This demonstrated the provider learnt from concerns and changed ways of working to address issues.

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 consistently told us they felt they, or their relative, was safeguarded from harm and they felt safe with the care staff. One relative told us, "My [relative] feels very safe in their supported living."

Staff told us they had access to policy guidance around safeguarding, they respected people’s wishes and rights, including the right to refuse care and treatment, and had received training on Mental Capacity. One staff member told us about what they had learnt, “It is assumed everyone has capacity until they are assessed, also capacity is specific as someone might have capacity to make a decision about one thing but not on other things. We support people to make choices and be in control of their care.”

We observed staff supporting people in their home and the local community and saw they were focused on improving people’s lives while protecting their right to live in safety, free from discrimination, avoidable harm, and neglect. Staff were seen to be aware of people's whereabouts both in and out of their home and were vigilant for risks which included road safety. People were supported to engage with other citizens when out in the local area and promote them being included as part of their local community. We noted that staff had identified a health concern for one person, and they had shared these concerns appropriately with the person's GP.

The provider had implemented training for staff in safeguarding, both children and adults, equality and diversity and the Mental Capacity Act. The provider had appropriate policies in place and information for staff on the procedure for reporting any safeguarding concerns both internally and externally.

People told us staff were skilled at understanding people's needs and emotions in the way they communicated both verbally and non-verbally. People described how staff that knew their relatives well and supported them to manage risks. One relative told us, "The carers and management know [relative] needs well including managing risk by using calming strategies. If a new member of staff is introduced, they always double up and give good shadowing to ensure my [relative] is happy at all times."

We spoke with staff who demonstrated an understanding of how to manage risks by thinking holistically about how best to meet people’s needs and how people communicated their needs. One staff member described a scenario where they had identified a potential trigger for someone becoming distressed and that they had contacted the GP regarding this as well as introducing strategies to support this person in a way that reduced the risk of them harming themselves.

During visits to people’s homes, we saw that each of their home environments were specific to the person’s wishes but also their needs which included supporting them to manage risk. This meant people could live in a safe environment that still enabled them to do things that mattered to them. For example, one person expressed an emotional reaction when attending hospital and it caused them to become distressed, so a plan had been put in place on how to manage hospital visits in a way that would be less upsetting for the person. Another example was the presence of window restrictors. This meant the person could freely access the room but the risk of them falling from a window had been removed.

The provider’s assessment and care planning process involved people in managing risk. People’s communication and how they expressed their feelings was documented meaning staff understood how best to support them and decrease or de-escalate potential risks to people. Staff had received training on how to support people’s individual needs. Some people at the service could become distressed due to their mental health diagnosis. Staff had received training on how to support people when they became agitated.

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

People felt that there were enough staff to meet people's care and support needs. People who required more than 1 staff member to safely support them always received the appropriate level of care. People told us staff were well trained and could meet people's specific needs. One relative said, "The carers are very well trained in all aspects of [relative] care."

Staff told us they felt they had the training they needed to carry out their role safely and effectively and that there were enough staff available to do this. One staff member told us, “If a person who receives 1:1 support suddenly becomes unsettled and cannot be managed by one staff member, the company provides another well trained support worker to provide extra support.”

We observed that people's individual needs had been considered when allocating staff to support them. People who required support from 2 staff had this in place and staff confirmed they had received training that was specific to meeting the needs of that person. Staff knew people well and understood what people needed to keep them safe and to make them feel staff which we observed when they were supporting people.

The service provided care to people with diverse needs, some people had more complex needs and the provider had implemented person-specific training to ensure that staff were appropriately experienced and trained to safely meet people's individual needs. We reviewed training certificates and the service’s training matrix which included specialist training staff had received. There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rotas suggested these staffing levels had then been arranged according to this calculation.

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.

We spoke with people's relatives about the support their loved one received with medicines. People had no concerns about the support staff provided with medicines. One relative told us about their loved one being supported to take an as-required medicine when they were distressed but they knew this was done appropriately and only when necessary.

DKM Healthcare provide supported living services to people with a learning disability and Autistic people. The registered manager described following the STOMP pledge. STOMP is a national project introduced by the NHS working to stop the overuse of psychotropic medicines for people with a learning disability, autism or both. They told us, "We are trying to reduce medication, for example: are we using too much PRN (as required) medication? What can be done better. Do we need input from the consultant, or for the GP to do a referral."

Overall, medicines were managed safely. Medicines were stored appropriately, they were given in a way that met the person’s needs and preferences, and medicines were recorded when given or for any reason they weren’t taken. However, we did see one example of a medicine that had been opened and was not labelled to show when it was opened. This was pointed out to the staff and highlighted to the manager who advised this medicine had been disposed of.

The provider had an appropriate policy in place to guide staff on the safe use of medicines. Medicines recording records were completed and records were audited by the management team to identify and respond to any issues. We saw medicines were given as prescribed. People's medicines were reviewed by the management team as well as healthcare professionals to ensure their treatment was safe and met their needs. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, to ensure they were following best practice.