Care Outlook (East Sussex)

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 good. At this assessment the rating has remained good.

This is the first assessment for this service following a change in provider.

This meant people were safe and protected from avoidable harm.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Relatives of people being supported by the service told us they were kept informed if anything happened to their loved one, one telling us, “Yeah, they have contacted me on several occasions after a fall.” Staff knew the procedures to follow in the event of an accident or incident, and made sure people were safe and supported. Staff told us they would seek advice from a supervisor and would immediately call paramedics to attend if needed. Staff were confident in reporting incidents and entered details on a mobile phone application which was immediately sent to managers. A staff member said, “It’s a straightforward process using the app on our phones. We then have feedback when next in the office.” The forms were clear to read and showed the detail of what had happened and the actions taken by staff. The deputy manager told us it was then easy to pick up on trends if for example, a person had had more than one fall. There were processes in place for capturing lessons learned when things had gone wrong and also to highlight positive practice where things had worked well. Staff supervision meetings and team meetings were used to discuss accidents and incidents and to record actions and learning for the future. One to one meetings with staff were arranged quickly after an event if immediate actions were needed. Care plans and risk assessments were updated with learning and any changes resulting to people’s care and support needs.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The registered manager told us they had developed a positive working relationship with other health and social care professionals which helped to support people when they moved to the service or if they needed to move on into a residential care setting. The registered manager said, “If people need to move on this works well and we work with social workers and adult social care from the local authority. Important to involve the person and their relatives. It can be a difficult move for people so the support we provide is important.” When people needed support from other professionals for example, their GP, a dentist or community nurse, most appointments were made by family members. However staff were able to support when needed. A relative said, “Usually, it’s me but sometimes the staff will get in touch with the GP as they get a better response.” A staff member told us, “We work with district nurses. Some clients have catheters and some have insulin. We have a good relationship with them.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and their relatives told us they felt safe when being supported by staff. Comments from relatives included, “Yeah, mum is safe, I have no concerns about the care at all” and “She feels safe, never a complaint and I am normally here.” Managers and staff had a good understanding of safeguarding and the steps they needed to take if they saw something was wrong. A staff member said, “Inform line manager so they can investigate. Would call the police if really bad.” Staff were quick to identify concerns for example, if a person began to neglect their own care by not eating or taking their medication or by declining support, staff would immediately raise concerns. Staff had been trained in safeguarding and were aware of the whistleblowing policy. Whistleblowing allows staff to raise concerns anonymously. A staff member told us, “Could be a fall or something else. If staff involved I’d talk to them first but would whistle blow if I needed to.” The registered manager was aware of the support and advice they could get from the local authority and the CQC relating to safeguarding.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were in place relevant to individual needs and risks. Risks were assessed at the initial pre-assessment and then became embedded within care plans and were regularly reviewed by the registered manager. The registered manager told us that all risks were reviewed after the first six weeks and then yearly. However a review would be prompted following any incident or if a person returned home following a hospital visit or if there were any other changes in their circumstances. Relatives were confident that any known risks to their loved ones, had been identified and plans put in place to minimise risk. A relative told us, “They are at high risk of falls, risk assessment has been completed they have hospital bed and handrails. Full skin care is managed well also, staff apply creams.” Assessments contained clear instructions for staff. For example, a person requiring support with mobility had a clear moving and handling assessment in place with instructions for staff to check all equipment before using, how best to support the person when moving as well as detail of what the person could safely achieve for themselves. Similarly, people living with diabetes had assessments advising staff of the important steps to take in the event of a diabetic emergency. Staff told us all the information they needed to safely support people was on their mobile phone applications and that they had time to read updates before starting a call.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Environmental and ‘access’ risk assessments were in place, for people’s homes. These considered physical elements for example, electricity and water supplies as well as any trip or other obvious hazards. Guidance for staff included key safe numbers, reminders about infections risks and the presence of any medicines on the property. Fire risk assessments described points of access, presence of smoke alarms and the level of support people would need in the event of needing to be evacuated from their homes.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People and their relatives told us there were enough staff with the right skills and training working for the service to support them safely. Comments included, “They are all there when they should be,” “Yeah, they are very good and well trained” and “Yes exceptionally (well trained), more so thant I expected.” Staff rotas confirmed there were enough carers available for every call and contingencies were in place in the event of staff running late. Staff had been safely recruited. We looked at four staff files and all contained the required safety documents for example, references, photographic identification and Disclosure and Barring Service (DBS) records. DBS records help providers make safe recruitment decisions. New staff went through an induction which included initial training, getting to know people they would support and then an opportunity to shadow more experienced staff. Ongoing support to staff was provided through regular supervision meetings, appraisals and refresher training. A staff member said, “I have regular supervisions, every four months. Can raise issues if I need to but they always ask.” Supervisors carried out regular, unannounced supervision of staff practice and these were recorded for staff development and learning.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Everyone we spoke with told us that staff wore personal protective equipment (PPE) appropriately during visits to their homes. Comments included, “They supply PPE, they use and dispose of it, they always wear foot protector,” “Yes they always wear gloves and aprons” and “I’ve seen gloves and aprons, at times masks. Recently dad had a chest infection, so they were worried about infection, so they wore a mask all the time.” Staff had received infection prevention and control training and refreshers and told us they had ample supplies of PPE. A staff member said, “I’ve done infection prevention and control (IPC) training and there is plenty of PPE.” The importance of staff washing hands between tasks and using PPE appropriately was highlighted in care plans.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Some people were supported by relatives but several people were supported by staff with their medicines. A relative said, “Dad was in hospital for a month over January, since he’s been home the carers have taken on the management of medicine, that has been a god send for me.” Reviews of medicines were carried out by GP’s when needed or if requested by staff. Medicines were stored safely in people’s homes and Medicine administration records (MAR) were kept on site but were collected monthly for auditing. Electronic records were also kept to allow supervisors to see when and where medicines had been given and to follow up on any gaps. Staff had received medicines training and were able to tell us the actions they would take in the event of medicines being refused or if there were an error. A member of staff told us, “Can’t force people so would make a note and tell a supervisor.” Another added with regard to errors, “Inform the manager and document.” Separate protocols were in place for ‘as and when required’ (PRN) medicines for example, occasional pain relief. Staff were aware of these processes and administrations were recorded separately on the MAR charts. Managers carried out regular competency checks on staff to ensure medicines continued to be administered safely.