Serene Healthcare Group Office Also known as Main Office

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 requires improvement. At this assessment the rating has changed to good.

We reviewed 8 quality statements for this key question. There was a learning culture which included learning from any accidents, incidents or any shortfalls found during audits of service provision. Focus had been given to staff training to enhance knowledge, but also to ensure staff had a clear understanding of their responsibilities. Improvements had been made to risk management and information now provided staff with improved guidance to ensure safety. However, work was required to help staff support people with distressed behaviour; the provider was aware of this. There were enough staff to cover existing care packages and people received a reliable service. Staff knew people well and positive relationships had been established. There were systems to prevent and control infection. Improved systems had been introduced to ensure people received their medicines as prescribed, but formats such as body maps were not available on the electronic system. Leaders were aware of this and were considering how to address the shortfall. People received a detailed initial assessment, which enabled a smooth transition to the service. Staff gained advice and worked alongside health care professionals as required.

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.

Relatives told us staff worked with them and learnt from their experience to help shape the person’s care. They said staff also learnt from health care professionals and would then add this learning to the person’s care plan. This included discussions with a physiotherapist about a person’s mobility. People and their relatives told us they were confident leaders would listen and satisfactorily resolve any concerns they had.

Leaders told us a learning culture was promoted. They said they had experienced a steep learning curve since they started the service in 2021. Leaders told us they had shared this learning with staff. This was to ensure staff’s understanding, but also to highlight their part and responsibility in service delivery. Staff told us they had opportunities to develop their skills and agreed a learning culture was promoted.

There were systems to promote learning. Any accidents and incidents were investigated, and measures were identified to minimise a re-occurrence. These were discussed with staff and additional training was sourced if necessary. Learning had occurred following an incident whereby staff had not followed the person’s care plan. This had included the development of processes to ensure staff were aware of any care plan updates, and how staff evidenced the care they provided. Leaders demonstrated a clear desire to learn and develop their own leaning and that of others. They were working with staff to further develop their report writing skills and had held sessions about approach and communication.

People and their relatives told us there was a smooth transition to the agency from other services. They said this was enabled by leaders giving them time and asking lots of questions. This ensured a detailed assessment was completed and the service could meet their needs. People and their relatives told us staff worked closely with other professionals including those with specialist expertise in their health condition.

Leaders told us they always ensured a comprehensive initial assessment was undertaken to ensure the agency could meet the person’s needs. This included gaining information from others as appropriate. Leaders said they shared information about a new person to the service by discussion with staff and adding information to the electronic recording system. Staff confirmed this and said they were always informed about a person before supporting them. Leaders and staff told us they gained advice and worked alongside other professionals as needed.

Partners did not raise any concerns about safe systems, pathways and transitions.

Care records showed people had received support from a range of professionals to meet their health and care needs. People’s wishes in the event of an emergency were detailed in their care records. This included details of whether they wished to be resuscitated if needed.

People and relatives told us they felt safe with staff and trusted them in their home. They said this was because of the positive attitudes of staff and good relationships that had been established. People and relatives told us they were able to contact the office easily if they had any concerns. They were confident they would be listened to, and their concern would be quickly resolved.

Leaders told us focus was given to safeguarding to ensure those people supported were safe. This included regular discussions, training and checking staff’s knowledge. Leaders told us they gave people and their relatives their contact details. This enabled any safeguarding concerns to be raised directly and immediately if needed. Staff told us they had received safeguarding training and would inform leaders or the local safeguarding team if they suspected or witnessed abuse.

There were a range of safeguarding systems. This included covering safeguarding in induction and regularly checking staff’s knowledge. Safeguarding formed part of the mandatory staff training plan and there was a safeguarding policy, which was available to staff as needed. However, care planning did not ensure staff had clear guidance about supporting people who experienced anxiety or distress. One care plan stated staff needed to provide reassurance so the person felt comfortable and secure, but there was no explanation as to how staff should do this. There were no documented triggers to the person’s anxiety for staff to be aware of or an evaluation to show the techniques staff used were effective. Staff had used subjective language to describe one incident, which showed a lack of understanding of distressed behaviour and the person’s needs. Leaders told us they were aware of this and had discussed the incident with the staff member. They said they were planning workshops to enhance learning with the whole staff team.

People and their relatives told us staff worked with them to identify any risks. They said they then devised a plan together with staff to enhance safety. This included the risk of falling and sore skin. People and their relatives told us they had the equipment they needed such as a walking frame and a riser recliner chair. One person told us staff were very good at reminding them to use their walking frame, as they often forgot. People told us staff arrived to support them on time, which ensured a reliable service. This minimised the risk of delayed care interventions or a missed visit.

Staff told us they informed leaders if they identified any risks whilst supporting people. These were investigated and actions were discussed with people to promote safety. Leaders told us risk assessments including any action required, were completed and available for staff reference. They said they ensured people were supported by a consistent team, which enabled any changes in wellbeing to be more easily identified and treated.

Improvements had been made to risk management processes. Records showed risks people faced had been identified and assessed, and the action needed to enhance safety was identified. Regular discussions about risk were held with staff, and practice such as moving a person safely was regularly monitored. However, some information in care records about risk management lacked detail. For example, a sore area of skin was not clearly described and phrases such as ‘needs to be repositioned’ were used. This did not ensure the person received appropriate support to meet their needs or enable effective monitoring. Another record identified a person was prone to bruises due to the side effects of a prescribed medicine, but alternate causes of any bruising had not been considered. This increased the risk of harm not being identified. Leaders told us they would address these shortfalls by providing staff with additional training in record keeping.

People did not have any concerns about their environment and said they had everything they needed.

Leaders told us the safety of the person’s environment formed part of their initial assessment. This enabled any concerns to be identified and discussed with the person at an early stage. Leaders told us sometimes it was difficult as the person might not agree with the risks identified, but it was their home and this had to be respected. They said they would assess and document the risks and liaise with other health care professionals if needed.

There was a section within each person’s care plan about their environment. This included any key safes which enabled staff to have access to the property if needed and any fuse boxes or switch off points for utilities. Assessments identified any risks such as poor lighting or uneven flooring.

People told us there were enough staff and a small team of 3 or 4 staff usually supported them. This enabled staff to know them well, including their needs and preferences. People told us staff were well trained and had the right skills. They said they liked the staff. They described them as ‘gentle and caring’ and ‘sweet and polite’. One relative told us their family member was very attached to their main carer, as they worked together very well. Another relative said staff were particularly good with their understanding of dementia.

Leaders told us there were enough staff to cover existing care packages and staff absences such as sickness and annual leave. They said staff recruitment was ongoing to meet the demands of a growing service. Staff told us they were well trained and their allocation of visits each day was manageable. This included enough travel time to ensure they arrived to support people on time. Staff told us they always stayed the full allocation of the visit, unless the person told them to leave early.

People were allocated a small team of staff to undertake their support. The whole team, however, were aware of each person’s needs. This ensured any cover arrangements were effective and enabled each person’s support to remain safe and familiar to them. Staff undertook a range of online and face to face training. This included subjects such as moving people safely and understanding dementia. Additional training would be sought if a prospective new person to the service had specialist needs, which the team were not familiar with. Safe systems were followed when recruiting new staff, but leaders had not signed relevant documentation to confirm the identity of the staff members. This was a requirement of providers who used the government’s Staff Sponsorship Scheme, an initiative to promote skilled workers from overseas. Leaders immediately addressed this once brought to their attention.

People and their relatives told us they were happy with the infection control practices staff followed. They said staff were always well presented with clean uniforms. People told us staff regularly washed their hands and wore protective clothing as needed.

Leaders told us there were ample supplies of personal protective clothing which staff could help themselves to as needed. They told us staff completed infection prevention and control training, and their practice was assessed within spot checks of their performance.

There were systems to prevent and minimise infection. Staff had received on-line infection control training, which included the use of personal protective equipment. There were sections within the electronic care planning system, which enabled staff to assess and mitigate any risk of infection. An infection prevention and control policy was available to staff for their reference as needed.

People and their relatives did not raise any concerns about the management of medicines. They told us staff prompted them to take their medicines when required and applied topical creams as prescribed. Staff helped some people order their medicines. Other people told us they managed their own medicines and did not need any staff assistance.

Staff told us they received training before administering people’s medicines. They were able to demonstrate the measures they needed to take to ensure safety. Leaders told us they assessed the administration of medicines within spot checks of staff’s performance. They said any shortfalls identified were addressed through additional training and further monitoring.

Improvements had been made to the safe administration of medicines. Staff had appropriately signed the medicine administration records (MAR) and there were no gaps in recording, as identified at the last inspection. This showed people had received their medicines as prescribed. Details of the prescription were clearly stated on the MARs and additional auditing was being undertaken. However, there was limited information in people’s records about topical creams and the administration of ‘as required’ medicines. Leaders told us formats for these were not available within the electronic care planning system, but they were looking at ways to address this. They told us in the meantime they discussed these medicines with staff to ensure appropriate use. Staff received training before administering people’s medicines and there was a medicine administration policy.