Bexley Home Care

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• 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 identified two breaches of the legal regulations. Risks to people's safety were not always assessed and identified. Risk assessments did not have clear guidance for staff on how to keep people safe, prevent or mitigate risks where identified. Staff were not always aware of people’s needs and associated risks to help maintain people’s safety. Staff had not received appropriate training in relation to some people’s specific needs. Staff were not effectively deployed as the provider did not have an effective system to monitor care calls and staff timekeeping for lateness and missed calls. The service did carry out appropriate recruitment checks, however, application forms had gaps in education and employment histories that had not been accounted for. People told us they felt safe using the service and that there were enough staff. Processes were in place to protect people from abuse. Staff told us they felt supported by the service.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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 and their relatives told us they felt safe using the service. One person told us, “I feel safe and secure when [staff] are here.” Another person said, “I feel safe and secure when [staff] are here.” A family member said, “…I feel very safe with everyone”.

Staff understood their responsibilities in relation to safeguarding. They had completed safeguarding training and were able to demonstrate knowledge of different types of abuse and reporting procedures if they had any concerns of abuse. One staff said, “I have had safeguarding training and would refer any concerns to my manager. I know they would act on it immediately.”

There were safeguarding, whistleblowing and duty of candour policies in place to help protect people from potential abuse. A duty of candour means taking professional responsibility for when things go wrong. The provider understood their responsibility under the duty of candour and took responsibility when things went wrong.

Risks to people were not always identified and managed to ensure people were kept safe. Risk assessments and management plans did not always include information about how to minimise associated risks and maintain people’s safety in accordance with people’s specific needs.

Staff we spoke with were not always aware of people’s individual health conditions, such a multiple sclerosis or mental health conditions and the risks involved to ensure support was provided safely. For example, one staff member said, “I don’t know about all of [person’s] conditions.” Another staff member said, “I am not aware of all the health conditions [person] has, I don’t really know. I don’t look, but they are all in the care plans.” Staff told us that relatives administered medicines due to staff not being effectively deployed to attend people’s calls. One staff member said, “[Person’s] partner administers medicines due our timetable. This is because the [person’s] last call can be too close to the previous one, so there isn’t always a large enough gap between the doses. The gap isn’t enough between calls because once we have seen to other people, it’s time to go back to [person’s]. Another staff member said, “[Person’s] partner…also administers medicines. The [Partner] doesn’t always let carers do it.” When speaking to staff about this issue, they did not understand the risks associated with this and people being at risk of potentially not receiving their medicines as prescribed.

Potential risks to people’s health and safety were not always assessed and mitigated. There were no risk assessments in place for people in relation to their specific needs such as living with Multiple Sclerosis, Parkinson’s disease, and strokes. For another person who had poor mobility and were unsteady on their feet and could not weight bear, the falls risk assessment did not record the support the person needed, how to safely mitigate the risk of falls or what to do should the person have a fall. For two people, risks were not appropriately assessed when relatives were having to administer people’s medicines due to staff not attending their calls in a timely manner. 4 care files were incomplete. Information about people’s needs were missing and there were no risk assessments. We raised this with the provider who told us due to recruiting and retaining field supervisors, some people’s records were not up to date. Following the onsite assessment, the provider sent us 1 care plan that had been updated, however information was insufficient. For example, the person’s medicine risk assessment stated the family member ‘‘Will on occasions assist [person] with medication if the gap is not big enough and carers are to document this on the MAR and daily notes’, However, there was no further information detailing the potential risks for this and how these would be managed safely. Staff not knowing about people's health conditions and risk assessments lacking this information put people at potential risk of harm. Records did not always document when risk assessments and management plans were reviewed, to ensure they were still relevant to people’s needs and people were receiving safe care and support. We raised this with the provider who assured us that going forward all reviews would be documented and suitable risk assessments and management plans would be put in place as soon as possible to maintain people’s safety.

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 relatives told us that there were enough staff, however, care calls were not in accordance with people’s needs and preferences. People told us that they did not always know when staff were coming. One person told us, “We are not given set times. It could be anything from 6-9 in the morning, but it starts about 7.30 now. It can be 7, 6.45 which is a bit early.” A relative said, “Bedtime – every day is different. Sometimes [Person] gets very tired in the evening, it does vary. They (timings) work sometimes but we just work around it.” Another relative said, “We let [office] know that the carers do come a bit early. It’s supposed to be between 9.30 and 10 am and sometimes they're coming as early as 6 – 6.10am. So, [Person] gets so confused, as they are getting [Person] up. There are other times of where [staff] come too late and [Person] is already up. There have been times of where they have turned up at 5pm for bed and that is much too early, 6.30 – 7pm is probably still too early.”

Staff told us there were sufficient staffing numbers to safely meet people’s needs, except for weekends when there could be a shortage of staff. One staff member said, “There are enough staff but weekends can be hard.” Another staff member said, “There can be staff shortages at the weekend, because nobody wants to work weekends” Staff told us the provider did not give them specific times for people’s calls. One staff member said, “No we don’t have specific times for calls.” Another staff member said, “We don’t commit to time slots.” A third staff members said, “I start work at 6am – it’s impossible to give particular time slots.” The provider told us that they could not commit to offering specific time slots to people as this was not possible. Staff received online training, however, practical training in relation to stoma and catheter bag training had not been provided. Staff told us, they shadowed experienced colleagues or people themselves showed them what they needed to do. One staff member said, “Have had Catheter and Stoma online training, [Person] showed us what to do as [Person] can’t manage.” Another staff member said, “We’ve had no face-to-face training we had stoma training online and then shadowed another member of staff, this was the same for catheter training.” The provider confirmed that staff competency in relation to Catheter and Stoma care had not been assessed. Records showed that staff undertook learning disability training, however staff were unable to tell us how they supported people with learning disabilities effectively and safely. A staff member told us, “I have had learning disability training, but this is general and no specifics that I can remember.” Another staff member told us “I can’t remember what learning disability training entailed.” Staff told us they were supported with regular supervisions and appraisals.

The provider had no electronic call monitoring (ECM) system for approximately a year, which could accurately reflect the times staff attended care calls and ensure staff were effectively deployed to attend people’s calls in a timely manner. There were no other measures put in place that monitored and demonstrated that people received their care calls on time and that staff stayed the allocated time. The provider relied on staff ringing the office or people directly to tell them they were going to be late. The provider also relied on people/relatives ringing the office to inform them that staff had not arrived. The provider did however document out of hour calls. The provider could not ensure that staff had the appropriate skills and knowledge to support people safely and in accordance with their specific needs. For example, staff did not receive practical and assessed stoma and catheter training. Records showed that staff had undertaken some learning disability training; however, staff were unable to tell us how they would support people with learning disabilities effectively and safely. Records also showed not all staff had received Equality and Diversity training at the time of the assessment. Recruitment and selection processes were in place. We looked at 6 staff files and found that pre-employment checks were completed before staff were employed by the service. However, we saw application forms for all 6 staff had gaps in education and employment histories that had not been accounted for. We discussed this with the provider, who acknowledged this and told us they would ensure that going forward all application forms were completed in full. Records showed that staff had received training in other areas such as safeguarding, mental capacity, moving and handling, dementia, falls, epilepsy, fire safety, first aid, food safety, medicines and health and safety.

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