Princess Homecare

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 reviewed 8 quality statements for this key question and identified three breaches of the legal regulations. Risks people faced had not been properly identified or assessed and appropriate action had not been taken to ensure safety. The service undertook people’s shopping as needed, but there were inadequate systems to minimise the risk of financial abuse. Medicines were not safely managed, and best practice was not being followed. Staff had not received regular training in medicine administration. Staff received informal support from the provider but had not received formal supervision sessions in line with their policy. There were enough staff to support people and staff knew people well. Personal protective equipment was available to help minimise the risk of infection. However, staff had not received up to date infection control training.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives told us they were confident the staff and provider would address any concerns raised with them.

Leaders told us learning was important to them. However, whilst they regularly researched different subjects of benefit to the service, best practice was not always followed. This included not following effective decision-making processes or ensuring safe practice when assisting a person to eat. Leaders said they were aware staff training had lapsed, so their trainer was asked to address this. Staff gave variable feedback about their training and its quality. Leaders told us there had not been any accidents, incidents, or complaints. This meant the provider could not demonstrate learning from such events and make improvements.

Processes were not effective. For example, although there was online training for staff and a trainer was used to facilitate some face-to- face sessions, records demonstrated staff completed much of their training in March this year, with a lapse in completion before this. Some topics, such as those related to people’s needs, had not been covered. Reviews to agree training targets for the year, as per the provider’s policy had not been undertaken. This meant the provider could not ensure a learning culture and incorporate best practice and on-going development.

People and their relatives told us staff worked well with other health and social care providers to enhance the support provided. They said care plans were used to transfer information to those who needed to know.

Leaders told us they worked well with other health and social care professionals to ensure people received the support they required. This included liaising with the local surgery to negotiate how the new system of ordering prescriptions would work for people. They said there was a transfer sheet that was used if a person needed to go to hospital.

There was limited feedback from professionals about smooth transitioning to other services. One health and care professional told us there had been difficulties in the past. This had been because of inadequate information being sent with a person when transferring to another service.

Processes were not effective. For example, there was a transfer sheet which contained details about people and contact details of their family. Information about the person’s medicines were added at the time. The information was used to make any transitions to hospital easier for the person. However, the information did not show the complexity of the person’s needs. This did not give a full picture of the person, to aid their transition.

People and their relatives told us the service made them feel safe. They said this was because of the reliability and consistency of staff and their awareness of people’s needs.

There was a lack of focus on safeguarding. Leaders told us they had a speaking up policy which everyone was encouraged to use, but there had not been any safeguarding concerns since June 2023. However, leaders had not completed safeguarding training for managers. This meant they could not assure themselves, or others, of the concerns to be raised. After the assessment, leaders told us they had arranged this training. Staff told us people had a right to feel secure and they did their upmost to keep people safe. However, there was variable feedback about reporting concerns. This included staff not being feeling comfortable in raising concerns with leaders.

There were poor financial recording processes for people. Agreed arrangements for a person’s shopping were not recorded in their care plan. There were receipts for the shopping undertaken, but these were not ordered or numbered and did not cross reference to a record of transactions. This meant they could not be assured people’s finances were being properly managed. Furthermore, there was not a clear audit trail to ensure adequate safeguards were in place. The speaking up policy was clearly displayed in the office, but staff had not received regular safeguarding training. We found an example of an occurrence of unexplained bruising which had not been investigated, monitored, or reported to safeguarding.

People and their relatives told us the provider was good at identifying risk and taking action to enhance safety. This included identifying a person’s risk of falling and requesting a healthcare professional to assess their mobility. This was completed and new equipment was supplied, which improved safety.

Feedback from staff and leaders about risk management was conflicting. Leaders told us they assessed any risks people faced, discussed them with the person and got them to understand the reason for any required action. However, staff said some areas of risk management could be improved upon. This included greater transparency and better recording and reporting of any incidents.

Systems did not demonstrate risks had been identified or assessed and there was a lack of action to ensure safety. For example, people’s health conditions and associated risks were not documented or assessed. This did not ensure safe interventions or timely action if the person became unwell. Records showed 1 person needed a soft diet due to a perceived choking risk, but this had not been further assessed. There was no guidance for staff to assist the person to eat safely and high-risk foods had been recorded as given. This meant people were at risk of choking.

People and their relatives told us their environment was safe and they had the equipment they required to meet their needs. This included grab rails and a shower chair to minimise the risk of the person falling.

Not all risks had been assessed and leaders had not sought professional advice when purchasing equipment for a person. Leaders told us this equipment had been purchased from the internet, but had not been risk assessed, agreed by a professional or documented in the person’s care plan. This meant the provider could not be assured the device was safe to use or met the person’s needs. Leaders told us they always assessed people’s home environment for safety and any concerns were discussed with the individual or their family.

Processes were not always effective and safe. There was a procedure to assess the safety of the person’s home, but this had not always been completed effectively. For example, the fire risk assessment had not considered how people would be safely evacuated in the event of a fire. This meant the person was at risk of significant harm in the event of a fire. Fire risks associated with emollients were stated and there were numbers to call in the event of a service failure, such as a power cut.

People and their relatives told us there was a small staff team, and they were usually supported by the same staff member each time. This ensured consistency, and good relationships had been established. They said staff arrived on time and they were not concerned in any way that their visit would be missed.

Staff told us they felt very well supported by each other, but support from leaders was variable. This meant staff did not always feel supported. Staff did not have formal supervision, as leaders told us their philosophy was to make sure staff were competent and aware of their boundaries, then leave them alone. This was not best practice and meant there was a risk of poor practice and complacency. Leaders told us they had a team of 3 staff, who were all excellent, experienced and had worked at the service for many years.

Staff training had lapsed with no training in people’s health conditions. This did not ensure compliance with the provider’s supervision or training policies. Records demonstrated there had been staff meetings, and dates of formal supervision or appraisal were documented, but this conflicted with feedback we received. There were enough staff for the number of people supported and any sickness was covered within the team. Staff were on a rolling rota and supported the same people each week, which enabled consistency. We did not review the provider’s recruitment processes as there had not been any new staff.

People and their relatives told us they were happy with how staff minimised the risk of infection. This included staff being clean and tidy.

Leaders told us their infection prevention systems were successful as no one within the service had ever had Coronavirus. They said they provided a range of personal protective equipment for staff to use. This included gloves, aprons, visors and helmets. They said staff could help themselves to what they needed.

Leaders considered infection prevention and control when assessing a person’s environment for safety. There were also checks of staff’s infection prevention and control practice within spot checks of their performance. However, staff had not completed up to date infection prevention and control training. Records showed the last training for one staff member was in 2018, which was not in line with the provider’s infection control policy. This meant there was a risk staff would not be following safe practice.

People told us the provider helped them order their medicines, but otherwise they needed little help in this area. One relative said staff dispensed their family member’s pain relief for them to take later. They said this helped them manage their health condition more effectively.

Staff’s competency with administering medicines was assessed during the spot checks of their performance, but specific medicine competency assessments had not been completed. This did not ensure staff were fully competent in all aspects of medicine management. Staff confirmed they had undertaken medicine training and gave examples of changing, unsafe practice no longer followed. Leaders told us staff prompted people to take their medicines or administered them, depending on need. This included administering a medicine, then leaving it locked away, for a person to take later. Leaders told us staff completed training in medicine management, which included handouts and a small exam.

Medicines were not always safely managed. Records, of the medicine that was left for the person to take later, were missing and the risks associated with this had not been assessed. Two people were prescribed topical creams, but there were no records to show how or where it was to be applied. Guidance was also not available for the management of transdermal patches. However, after the assessment, leaders told us they had addressed this, and records now enabled staff to clearly apply the patches on a rotational basis, as prescribed. A hand-written instruction showed a change to the timing of a medicine, but it was not countersigned by another member of staff and there was no rationale, or authorisation from the prescriber. One person was given an ‘as required’ prescribed medicine repeatedly each day, but an analysis of this had not been completed or discussed with the GP. This did not ensure the medicine was given as prescribed or was the most effective way of managing the person’s symptoms. There was also a risk that another underlying health condition would be missed.