Right at Home Chippenham

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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 reviewed 8 quality statements in this key question.

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 and relatives did not share any concerns about this quality statement.

The registered manager told us staff had information and guidance on actions to take to prevent accidents and incidents. When things did go wrong staff were able to reflect on what had happened and what could be done differently to prevent incidents happening. One member of staff told us, “They [management] do talk about learning and what to do differently, how to remedy things. They [management] are quite good.”

Accidents and /or incidents were recorded on the electronic care plans system and reviewed by office staff. Any immediate action required was carried out before a review to check for any learning. For example, if any contact was needed with GPs or community nurses, this had been completed. The registered manager told us they regularly analysed incidents looking for trends and whether any changes needed to be made to training or staffing. They said, “I look at what incidents and accidents have happened, and review do they involve the same carers, same people, looking for trends. I analyse the information and think do we need extra learning, extra spot checks, do we need to refer to falls clinic. We review the risk assessments and talk about learning in team meeting. The provider also shares learning across the organisation as a whole. For example, in May it was the hottest weather since records began, we noted more falls. So, we shared that with the provider to share with other branches in the organisation, which they did.”

People and relatives spoke positively about their experiences of starting with the service. One relative told us about care starting when their relative had been in hospital. They told us staff spent time talking with their relative and explained to them what would happen when they went home from hospital.

If people needed to move between services, for example, be admitted to hospital, the registered manager told us there were procedures for staff to follow. The registered manager told us, “If a person was needing to go to hospital, the carer would wait for ambulance to arrive and hand over to the paramedics. People have hospital passports in place, this shares key details of the person to the emergency services. They have details of what is normal for the person and hospital staff can see what their needs are.”

Professionals we contacted did not share any concerns about this quality statement.

Hospital passports were available to go with people if they were admitted to hospital. This recorded key information to share with healthcare professionals. For example, people’s communication needs and care needs. If a person was being discharged from hospital back to their home, staff would review the persons care and check if anything had changed. This assessment would be completed before the care package re-started to check staff could still meet people’s needs.

People told us they felt safe using the service. One person told us, “I don’t know what I would do without them [staff]. They [staff] are a lifeline for me because I don’t get any other visitors.”

Staff were aware of the safeguarding process and understood the type of concerns they needed to raise. Staff told us they would not hesitate to report any safeguarding concern to office staff. One member of staff told us, “I would report straight to [registered manager]. I am confident they would do something about it.”

Safeguarding concerns had been recorded and shared with the local authority safeguarding team. The provider had a safeguarding policy which was available to staff and staff were provided with annual safeguarding training. The registered manager told us safeguarding was discussed in staff supervision regularly. Staff also carried out wellbeing checks with people every 3 months and encouraged people to share any concerns they had about their safety.

People and relatives were assured risks were being identified and managed safely. People told us they had been involved in assessments of their needs which included risks to their safety.

Information on people’s risks was available to staff via an application on their phones. Staff also told us there was a paper copy of risk assessments in people’s homes. Staff told us they had the guidance needed to work safety with people. One member of staff told us, “I have access to assessments online, we can see past visits, times of medicines and I can see the body maps. Falls is a common risk, so we make sure they [people] have their walking aids with them. I walk beside them giving assurance, they [people] know I am there. I would report any changes to the team leader, or the deputy manager.”

Risk management plans were completed once any risk to people’s safety was identified. Office staff reviewed risk plans regularly and made updates if needed. If any equipment was needed to help staff support people safely, this was obtained through occupational therapists or community nurses. For example, if people needed hoists to help them move or air mattresses to help prevent pressure damage.

People did not raise any concerns about this quality statement.

The registered manager told us they always assessed people’s environment before starting any package of care. If equipment was needed this was obtained from healthcare professionals and it was usual for an occupational therapist to provide staff with guidance. Staff regularly checked equipment such as hoists were serviced and safe to use. Staff were provided with moving and handling training and able to practice using equipment. There was a training room at the office which had a hospital bed, wheelchairs and a hoist for staff to be shown how to use them safely. Staff also had the opportunity to practice using this equipment to gain confidence and skills.

Environment risk assessments were completed to identify and manage any risks in people’s homes or in the immediate neighbourhood. Staff had access to guidance to help reduce any risks and work in people’s homes safely. One member of staff told us, “Everything has been assessed in the environment, it is safe for me and the client.” Office staff knew how to contact occupational therapists if needed for additional guidance on any equipment in use.

People and relatives had the visits they needed because there were enough staff available. Some people thought the staff needed more training, but others told us staff had been well trained. People were aware that new staff were shadowing more experienced staff as part of their induction. One relative said, “[Person] often has somebody new shadowing the carer and sometimes the management staff come out to check on the carer.”

The registered manager told us there had been periods of time where staffing had been a challenge. This was mostly due to staff sickness and absence. The registered manager said, office staff had stepped in to carry out visits to people and tried to cover all essential visits needed. However, at the time of the assessment staffing had improved and the registered manager told us staff sickness was being better managed. Staff told us they had a good induction and training updates when needed. Staff also told us they had regular supervision. One member of staff said, “We had a 3-day induction which was very informative, we did moving and handling, medication and safeguarding. I did some shadowing [of other staff] and met a lot of clients.” Staff also told us they had enough time to travel between visits and did not need to rush anyone. One member of staff told us, “There is enough travel time, the clients are not too far from each other. I try to stay on time and the time allocated with the clients is good, I don’t rush anyone.”

All new staff received a 3-day face to face induction at the office and were asked to complete online learning. New staff were expected to do the Care Certificate which included training, knowledge checks and assessments of competence. Staff also had regular supervision and the opportunity to attend regular team meetings. The required checks had been carried out on all staff before they started work. This included obtaining references from previous employers and a check with the Disclosure and Barring Service (DBS). All office staff had been trained to do care shifts if needed. This meant there was staff to cover short notice sickness or emergency leave.

People told us staff used the appropriate personal protective equipment (PPE) and washed their hands when supporting them with personal care. One person said, “They [staff] are always changing gloves 4 or 5 times.” Another person said, “They [staff] wash their hands and always put gloves on.”

Staff told us they had plenty of PPE and could get more from the office if needed. We observed there was ample stock of PPE at the office during our visit.

Management carried out checks with staff to make sure they were wearing the correct PPE when visiting people. The provider had policies and procedures on infection prevention and control guidelines. Staff were provided with access to all the providers policies.

People had the support they needed to manage medicines safely. Comments from people and relatives included, “They [staff] make sure [persons] medicines are in a box, they come from pharmacy with a sticker on it” and “The carer calls the tablets out as she’s giving me them and has to tick all my medicines off in their phone.”

Staff told us they were confident administering medicines as they had been provided with the training they needed. Staff told us if they had any concerns about medicines, they could call the office staff and get advice.

Staff had training on medicines as part of their induction. This included a check of their competence completed by management. The levels of support people needed to manage their medicines was recorded in their care plans. This ranged from a verbal prompt by staff to staff fully administering all of people’s medicines. Where people were prescribed ‘as required’ medicines, there was a protocol in place to give staff guidance. However, for people prescribed more than 1 medicines for the same condition, it was not clear which medicines to give in what order. For example, for a person experiencing anxiety and prescribed multiple medicines ‘as required’ there was no guidance on which medicines to give first. The registered manager addressed this during our assessment to provide staff clear guidance.