Lifeline Agency Limited

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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 assessed a total of 8 quality statements from this key question. During our assessment of this key question, we found staff understood people’s risks and people felt safe when receiving care. People received their routine planned medicines as prescribed. Incidents were reported appropriately. Staff felt supported and there were enough staff to support people safely. Staff received training and competencies to ensure they were safe to conduct their role. Staff were aware of infection control guidelines and conducted safe care in people’s homes. Some improvement was needed to ensure all records were completed appropriately and incidents were reviewed to ensure all agencies were informed as required.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were not able to give us any detailed feedback about how the service learned from incidents.

Staff we spoke with were aware of the need to report accidents and incidents or concerns. We spoke with the registered manager who told us they would investigate any concerns and pass down any learning to staff. They would also inform people, relatives and the local authority of the outcome of any investigation. When things went wrong, staff would apologise and give people honest information and suitable support. However, the registered manager had not informed CQC when people came to harm. They have since started to inform us of any incidents as needed.

The provider had processes in place for staff to report incidents and near misses. This included reviewing and learning from incidents and adjusting people’s care accordingly to keep them safe. However, incident reviews could be more robust. For example one person was admitted to hospital and there was no follow up as to what happened and what injuries had occurred to determine if lessons needed to be learned. We were also not assured that serious injuries to people were notified to CQC as required by the provider’s registration.

People and relatives told us they were happy with the care and that communication with senior staff was positive. One relative told us, “There always used to be two of them for her care. We decided with health and services that one was enough. She was on an end of life programme when she came out of hospital but is so much better now. They always talk when they are with her and she does respond sometimes.”

The provider supported people to transition into the service including from hospital and to also move to another care setting if required. A senior staff member told us following a referral they conducted a full needs assessment for the person to ensure they could meet their needs. They stressed the importance of open communication with the person, their relatives and health professionals during the transition period to ensure people’s risks were fully understood.

Partners we spoke with raised no concerns and said the service worked in collaboration with them to ensure a smooth transition when the service started working with people.

Systems were in place to ensure people transitioned to the service in a safe manner and there was continuity of care. The service consulted with healthcare professionals to make sure people’s needs were understood from the start. Health information was also available to healthcare professionals and staff to inform care and treatment decisions. There were robust handover meetings with health professions when people moved between services. This included, for example in relation to people’s moving and handling needs and the equipment required to deliver safe care.

People told us they felt safe. One person told us, “I feel extremely safe with the carers.” Another person said. “They never let me down.” Relative’s comments included, “My mom is kept very safe,” “I know that she is in safe hands,” and “Keep him very safe indeed, make sure he is comfortable.”

Staff we spoke with had received safeguarding training and knew how to protect people from harm and abuse. Staff reported any concerns to management and were confident appropriate action would be taken to keep people safe. We reviewed records which showed a staff member was given a small cash gift from a person. The provider had not identified this was not in accordance with their policy. Following our feedback the registered manager informed us they would set up gifts register to record any gifts provided to staff. They would ensure all staff were aware of the correct procedure for accepting gifts to protect people from abuse.

Records showed the provider had reported safeguarding concerns to the relevant authorities and cooperated with investigations. A safeguarding policy was in place and staff knew how to access this. Policies and procedures were clear staff were not to accept gifts from people. Management systems were not sufficiently robust to ensure management identified staff had not always worked in accordance with this policy.

People felt supported and safe with staff. Relatives were confident people were supported to move around their homes safely. One relative told us, “She has a walking frame she uses. The carers carefully watch her when she uses it, they are very good.”

Staff had a good understanding of people’s risks such as, people’s health conditions and mobility. They knew where to access guidance on how to keep people safe. The registered manager and senior staff worked closely with relevant health professionals if they had any concerns about people’s safety. Including working with occupational therapists if people needed equipment in their home due to failing mobility to help keep people safe.

Assessments were undertaken to assess any risks to people and to the care staff who supported them. Areas covered by these assessments included risks associated with the environment, personal care, communication and moving and handling. Most risk assessments set out how risks were minimised or prevented. However, some risk assessments needed more information to ensure they were fully comprehensive, this included risks such as those relating to people’s mental health and self-harm.

People told us they felt safe in their home with staff and that staff used equipment within their home safely. One relative told us, “She spends a lot of time in bed now but does occasionally sit in her chair. She has a walking frame she uses. The carers carefully watch her when she uses it they are very good.” Another relative told us, “They keep him very safe indeed and make sure he is comfortable.”

Staff we spoke with felt confident about using equipment in people’s homes. The registered manager told us, they have a risk manager who goes out to people’s homes to carry out environmental risk assessments. If people needed any equipment to assist them for example a shower chair or hoist they would make a referral to the relevant health professional. If any equipment was issued staff were assessed to ensure they were safe to use this.

The service conducted audits of moving and handling equipment used in people’s homes. For example walking aids, slide sheets and hoists to determine if these remained safe to use. Records showed that a staff member had received a manual handling competency that required the staff to have more training and records showed this was completed.

People and their relatives were all happy with staffing levels at the service. One person told us, “They never let me down, always turn up, never missed a call, they are all so generous with their time. I have 2 carers three times a day, one female and one male I’m happy with that.” A relative told us, “They stay the full time, never leave until they have made my husband comfortable, they are brilliant.” Other comments included, “There is enough staff to support her needs” and “They make sure I am comfortable, they give me more than a fair amount of time. There is definitely enough staff.” People felt staff were knowledgeable. One person told us, “The carers have the knowledge what to do and they are well trained in what they do.”

The majority of the current staff team had been recruited via a Home Office Sponsorship Scheme. The provider held a license allowing them to sponsor overseas workers to work in the UK. Staffing levels were determined by the number of people receiving care and support and their needs. One staff member told us, “I enjoy working for the service rotas are given in a timely manner, we have enough breaks and enough time given to move between clients safely.” New staff completed an induction programme before working on their own. Staff felt they had been given appropriate training to acquire the skills they needed to undertake their role. They were provided with annual face to face and on line training to support them in their role.

Safe recruitment processes were followed that meant staff were checked for suitability before being employed by the service. Staff records included an application form, 2 written references and a check with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, we found some minor gaps in employment records. The provider had picked this up in their staff audit and were taking action to ensure employment records were complete. Staff were provided with supervisions (one to one meetings) with their line manager. These provided an opportunity to provide staff with feedback on their performance, identify any concerns, offer support, assurances and learning opportunities to help them develop.

People were happy staff supported them safely with infection control. One person told us, “The carers always wear the apron, gloves, and mask. I feel I’m kept safe with them all.” A relative told us, “They all wear full PPE. Lifeline is really good here, if one of their staff on rota is ill, even a cough they swap the rota around.”

Staff demonstrated a good understanding of infection control procedures. Staff had received infection control training and had access to personal protective equipment (PPE) to safely manage and control the prevention of infections.

An infection control policy was in place to support staff. Care plans needed to be more robust to ensure staff had comprehensive information to know for example, how to keep clinical equipment clean such as assisted breathing machines.

Most people managed their own medicines independently. People were happy with their medicines support. One relative told us, “The carers give mum her tablets, she is always given her medication at the same time, and everything is noted on their phones.”

Staff told us they were trained in the safe administration of medicines and underwent an assessment of their competency to administer medicines in line with best practice guidance.

There were up to date policies and procedures in place to support staff and to ensure that medicines were managed in accordance with current regulations and guidance. However, there were no protocols in place to support staff to ensure ‘as required’ or PRN medicines were always administered safely when needed. The electronic medicines administration records (eMARS) viewed, provided assurances routine medicines had been administered as prescribed. The eMAR system provided alerts should a person’s planned medicines not be administered allowing senior staff to take remedial action.