London Borough of Hackney, Housing with 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

People were kept safe with staff and their relatives were reassured their family member was safe. There were enough staff to support people, however relatives felt there could be more staff at the weekends. Staff received safeguarding training and knew their responsibilities for reporting suspected abuse. Safe recruitment of staff took place and staff received training and ongoing support to ensure they were effective in their role. Medicines were managed safely, and infection control procedures were followed by staff.

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 living at the service told us they thought staff had a good understanding of their needs and had the knowledge to provide good quality care. One person said, “Yes, I think they know how to do the job.” Another person said, "“I think they [staff] have the skills. Nothing lacking. I’ve met good staff who greet you. They’re very good.” Family members were positive about the knowledge and understanding staff demonstrated about their family members needs.

Staff were appreciative of the training and learning support available to them. Records showed openness and transparency was encouraged when things had gone wrong. Staff told us reflective practice meetings took place where they discussed what had happened. A member of staff told us they were all provided with stroke awareness training as part of learning in response to a fall and possible stroke.

Staff engagement with learning at the service was positive. Information was shared promptly with external stakeholders as part of learning after incidents. Relatives could see lessons were learnt after accidents or incidents which reassured them. A relative said, “They [staff] were very prompt with [person] when he fell in the summer and he slipped recently. Now they check him more and tell him not to force himself to go to the bath.”

Accidents and incidents were recorded promptly and lessons learnt meetings took place to help staff learn from these. Records confirmed there were monthly meetings with the registered managers and scheme manager where they discussed accidents, incidents and best practice in providing care. It was evident the managers were always looking for ways to learn after things had gone wrong, records confirmed this.

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 told us they felt safe living at the service and relatives were assured their family member was being kept safe. One person said, “Yes, they do keep me safe. They make sure I get my medication, food and everything.” Another person said, " The best thing is that I am safe here. The staff are always available to help me when needed, and the security of the building keeps me safe.” Relatives gave positive feedback on safety and knew they could raise concerns with the service. A relative said, “[Person] is a million percent safe there.” Another relative said of safety, “Very much so (safe). They [carers] are very attentive to [person] and remind [person] of the pendant around their neck. [Person] is checked regularly.”

Safeguarding was fully understood by staff working at the service. They knew the importance of keeping people safe from potential abuse and reporting it if witnessed or suspected. A member of staff said, “If I observe something that doesn’t seem right, I have to document it, reassure the person and report it.” The same person said, “I know that once this has been reported, they [manager] need to raise a safeguarding. I’m very confident this would be done here. They are very strict on safeguarding here and making sure people are kept safe. I’m confident and have seen them act speedily, they are on top of this.”

Staff were seen to speak to people kindly and respectfully and we observed staff ensure people had what they needed before they left their homes, this included checking their personal pendant alarm was with them and in working order . We observed people were comfortable in staff presence, they were seen coming to the scheme managers office and others were laughing and chatting with staff.

Safeguarding and whistleblowing policies and procedures were in place for staff to access. Staff had completed safeguarding training and staff awareness was checked during team meetings and during one to one meetings, records confirmed this. The registered managers were open and transparent when it came to reporting and investigating safeguarding concerns to ensure people were kept safe. They reported allegations of abuse to the CQC promptly and kept accurate records of this.

People were involved in managing their known risks and systems were in place to reduce risk. One person said of being involved with risk, “I’ve had no falls and I get creams put on my sore ankle. The carers treat you well and are kind and considerate. I’m happy with the carers.” Relatives told us they found the service proactive in responding to accidents and incidents and were prompt in putting measures in place to reduce the risk of the same incident occurring again. A relative told us after their family member had a fall, “[Person] now has a three footed stability aid and grab rails in the bath and on [person’s] bed. The occupational therapist got them. They moisturise the dry skin on [person’s] legs mobility is difficult.”

Staff were aware to inform their relevant scheme manager within the service or tell one of the registered managers if they noted changes in people’s needs. Staff received training and support to ensure they knew how to monitor and manage risk. A member of staff said, “I follow the risk assessment which helps me do day to day observations, for example, I always remind people to use an ashtray when they smoke indoors.” Another member of staff said, “I need to make sure [person] always has their zimmer frame, use their walking stick and check their wheelchair is in good condition.”

We saw people were supported in line with the care plan and where people used equipment to support their safe movement around the service or out in the community this was with them, for example, walking aids were in close proximity for people to use.

There were systems in place to monitor and update risk where there were any changes to people’s needs. Records confirmed risk assessments were updated regularly and after an incident, this ensured information was up to date and staff had clear guidance on the steps to follow. Handovers at each shift meant that staff were informed of important information and changes in people’s needs and appropriate follow up with health professionals could take place, records confirmed this took place.

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 and their relatives provided mixed feedback on staffing levels. We were told staff were overall on time for visits and stayed for the duration, but people and their relatives understood this could be affected if they had to tend to others. People and their relatives felt more staff were needed, particularly at the weekend. One person said, “Not really enough staff.” A relative told us their family member was put to bed earlier than they wanted and when they called for help someone did come within 10 minutes. They said, “There’s always staff around but I know there are less at the evening and weekends.” Another relative said, “There’s probably not enough staff, could do with more. During the week is fine but weekends can be quiet.” Where people felt there were enough staff, one person said, “Yes, there are enough and they’re very friendly.” Another person said, “Yeah, yeah, they [staff] come twice a day, every day there’s enough staff.” People appreciated the flexibility of staff when it came to arranging timings for care. One person said, “They are quite flexible with me and happy to work around my timings. I let them know when I’d like support and we schedule a time. They do encourage me with personal care and always offer me options of having a shower.” A relative told us they felt their family member would benefit from a male member of staff for support but knew that recruitment of male staff was difficult.

Staff felt each shift was covered during the day and night and they had no concerns with staffing levels. Staff confirmed they were inducted into the service and shadowed an experienced member of staff. Online and in person training was available for staff to complete and covered a variety of training courses to enable them to be effective in their role. Staff said of the training, “It has helped me work to the best of my ability” and “Moving and handling training has been so helpful as we have many who need to use the hoist and other equipment and we all need to work safely as a team.”

We saw staff were present in the different schemes we visited and supported people with their needs. Staff did not appear rushed and had time to talk to people.

Records confirmed staff were recruited to the service safely and in line with the appropriate policy and procedure. The service had recently completed a phase of new recruitment which meant existing agency staff, who had worked with the service for a period of time were permanently recruited to the different schemes. The benefit of this meant staff knew people already and had the experience. Records showed recruitment checks had been completed which included a criminal records check with the disclosure and barring service. Staff received regular supervision meetings with the scheme manager, called “check in’s”, records confirmed this. These meetings provided an opportunity for staff to discuss their work and how they supported people. Systems were in place to support staff with their learning within the service. Records confirmed staff had access to mandatory training and specialist training courses to support them in their role.

People told us staff maintained good hygiene when they received personal care and around their living space. People told us staff wore personal protective equipment (PPE) to reduce the risk of infection. A person using the service said, “Yes, they do that, can’t fault them. Their hygiene is good.” Feedback from relatives was positive around infection control and staff use of PPE. A relative said, “Yes, I’ve seen staff there and they wear them. The standard of hygiene is very good. They will ring me to say that cleaning products are running low. They use two mops. One for the bathroom and one for the flat.”

Staff followed good infection control practices, staff told us they had enough PPE to use at the service. A member of staff said, “I follow the guidelines and wear PPE at all times. I wear apron, gloves, arm sleeves and mask, they’re all single use .” Another member of staff said, “We have an Infection Prevention Control (IPC) champion in the scheme that carries out checks and reports what needs to be done.” We spoke to an IPC champion who confirmed they did this within their scheme.

We saw staff follow IPC guidelines and use PPE within the different schemes. There were appropriate disposal areas for PPE to reduce the risk and spread of infection.

IPC training was provided and records confirmed staff had completed this. Each scheme had an infection prevention and control lead who was responsible for ensuring good IPC practices were being followed. Staff knowledge around IPC was checked at each “check in” meeting to encourage good hygiene practices and keep people safe.

People’s medicines were managed safely within the service. People told us they were supported to receive their medicines on time and supported to attend health appointments where they needed to receive their medicines. Where people were independent in taking their medicines, they appreciated that staff checked them and documented the medicines had been taken. Relatives were pleased with how medicines were managed at the service, they knew what was being given and they were informed of changes in medicines promptly, for example, after a hospital discharge.

Staff told us how they administered medicines in a safe way. A member of staff said, “Medication is so complex, I have to be focused. I check the name and date of birth and the name of the medicine matches what has been prescribed.” Staff followed the principles of the mental capacity act and asked for people’s consent before administering medicine. Where people refused to take their medicines, staff recorded this on medicines administration record (MAR) and informed their scheme manager and inform staff during handover.

We saw MARs were completed correctly with no unexplained gaps within the sample viewed.

Information about people’s medicines was documented in their care plan for staff to follow the safe administration. Medicine administration records were audited to check for any errors. Staff received medicines training and had their competency checked regularly. Medicine to be given on an as required basis (PRN) needed to be clearer and this was raised directly with the registered manager who put in place PRN protocols.