Mayfair Homecare - Wycombe

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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

Safeguarding processes and systems were in place to protect people from the risk of abuse and neglect. We found the service prioritised and effectively responded to safety concerns, and safe medicines practices were promoted. Staff understood their responsibilities to report any potential concerns for people’s health, safety and welfare. People felt safe and were supported to manage risks in their lives, assisted by staff who had access to personalised care plans and risk assessments. Staff told us they received training and support that equipped them effectively for their roles, however the feedback from people and relatives showed staff timekeeping and visit scheduling was not always consistent.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Records indicated accidents/incidents were infrequent events. We reviewed records for the most recent incident which had occurred. The provider’s processes encouraged the effective sharing of information and learning following incidents. This included an accident/incident form which identified learning and outlined actions taken to prevent reoccurrence, which had included updating the person’s care plan and risk assessments. Staff were asked to sign the accident record to acknowledge the identified learning and there was evidence of registered manager oversight.

People described a culture of safety where staff monitored and promoted their wellbeing. People’s comments included, “They [staff] watch me go up the stairs…and they watch me come down. They are really nice people.” Most people and families were fully satisfied the service was responsive when safety incidents occurred. A person advised, “If I’ve got a problem I know I can ring the office after 9am and they will sort it out” and a relative added, “[Person] had a fall…and they [staff] called the paramedics and called me and stayed until the paramedics arrived.”

Staff told us there was effective and proactive communication when safety incidents occurred, or when new risks arose, such as changes to people’s mobility or increased support needs. Staff consistently advised they were promptly kept updated via telephone calls and electronic messaging. Staff understood their responsibility to report safety concerns to the office and were satisfied their concerns were addressed. A staff member stated, “If we raise [concerns] with office, they sort it out straight away.” Leaders described having oversight of accidents/incidents or other events such as safeguarding concerns to ensure they were satisfied sufficient action was taken to reduce the risk of recurrence.

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 were kept safe from avoidable harm because staff understood how to protect them from abuse. All staff we spoke with were fully satisfied people were safe and protected from harm, and had confidence the office team were accessible and acted on any concerns raised. Staff understood their responsibilities to keep people safe and demonstrated their knowledge of safeguarding and whistleblowing procedures. Staff also consistently told us people were not subject to any restrictions or restraints, and noted they would immediately report any incidents of restrictive practices as concerns. Leaders understood their responsibilities to work cooperatively with the local safeguarding team to investigate and respond to any potential safeguarding concerns.

There were effective systems and practices to ensure people were safe from the risk of harm and abuse. Staff undertook safeguarding training, including refresher training where required, and had access to the provider’s safeguarding and whistleblowing policies. We reviewed records for a sample of potential safeguarding concerns reported over the previous 12 months. Records showed the service had followed a process of investigation, and where required had identified learning and necessary actions to prevent or minimise risk. Records also demonstrated feedback was given to relevant parties such as the local authority, CQC and the person’s family.

People and families were generally satisfied the service provided was safe. Where people received support from regular staff, this was highlighted as a positive contributing factor to their views about safety. Comments from people included, “I feel safe with my regular carers, they know what I need and they keep me safe”, “They always make sure I’m alright” and “They are just so caring. I’ve never felt unsafe.” Comments from relatives included, “We are very happy with our Monday to Friday carer…I wouldn’t be confident about [person’s] safety with some of the others [staff].”

Staff were updated when people’s support needs changed, and all staff consistently told us they referred to care plans, risk assessments and recent communication notes before delivering support. Staff knew people well and demonstrated their knowledge of risk management arrangements. For example, staff understood how to support people at risk of falls, with staff comments including, “If [person] have frame make sure frame near them, same with [walking] stick, make sure in reach, [ensure] no tripping hazards, wires, boxes and nothing they could fall on.” Staff described how they would safely manage tasks including use of moving and handling equipment, maintaining skin health, assisting with eating and the use of drink thickeners, and assisting people experiencing pain or distress.

People’s care plans contained clear risk management information. These included areas such as mobility, skin viability, medicines including risks associated with emollient creams, nutrition and hydration including swallowing difficulties, psychological wellbeing, and environmental factors such as fire safety. Risk management information stated what the risk to the person was and what action was necessary to mitigate it. We identified some information relating to people’s medical conditions was not fully person-centred. The service was responsive to our feedback and updated people’s records and communicated updates with staff during our assessment.

Most people and relatives indicated staff worked safely to manage risks, for example, assisting with moving and handling tasks, identifying signs of illness, and responding appropriately to incidents such as falls. One person advised, “She [staff] assists me when I am trying to stand up. She is giving me instructions all the time. She’s very patient.” A relative added, “[Staff] will always alert me if they think a UTI is present or starting.” People told us they were involved in decision making about how risks were managed, with comments including, “I was involved with the assessment and subsequent care plan, we all spent an hour or so sorting out what was needed and that is all followed correctly.” Feedback from some relatives indicated some inconsistencies in staff approach or risk awareness, for example, a relative explained staff did not always ensure their family member wore their safety alarm.

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

Staff had the induction, training and support they needed to do their jobs effectively. Safe recruitment practices were in place, and the service operated continuous recruitment to ensure sufficient numbers of staff were maintained. Where staff had been recruited internationally, we noted a delay in receipt of a UK DBS check. We were satisfied the service had checked the staffs’ international Police certificates and induction processes included checks of competency. The provider advised they were not currently recruiting from overseas and they will review their approach in relation to DBS checks should they recommence overseas recruitment.

People and families expressed varying views on subjects such as staff competency, timekeeping and whether scheduled visit times were delivered as agreed to meet people’s identified needs. Comments pertaining to staff skills included, “My regular carer is fantastic and knows what she is doing. The new ones aren’t trained and don’t know what they are doing”, “When they wash [person] they just wash [person’s] face and use wet wipes, not a proper wash and they don’t change the bed”, “I would say [staff] are all well trained and caring people” and “[Person] is used to having the same carers and the [staff] are all well trained in dealing with dementia.” People’s views relating to visit times included, “99% of the time they arrive on time”, “The care has been very sporadic. I really worry about the gaps between visits”, “They are punctual and they do what I want them to do” and “One call recently they stayed less than 10 minutes of a half hour call…one evening…the time they wrote in the book was much longer than the time they stayed.” The service planned to use electronic visit monitoring in the near future and outlined interim measures they were taking to monitor staff performance, which had included additional spot checks and care reviews, and the introduction of paper timesheets.

All staff we spoke with were satisfied required induction training was completed before they delivered care. Staff stated they worked closely as a team and told us management and other office staff were responsive and supportive. Staff we spoke with were satisfied their rota of scheduled care visits provided sufficient time to support people and enough time to travel between visits. Staff told us cover was arranged if this was needed urgently, for example, if they were supporting someone who was unwell and cover was required for their rota until either paramedics or a family member arrived to support them.

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.

Staff confidently described the checks and record keeping they were required to complete to ensure safe medicines administration. This included supporting people to receive ‘as and when required’ medicines. For example, a staff member explained before administering pain relief they would speak with the person about their pain levels and check there was a safe time period elapsed between doses. Staff confirmed they received medicines training, and had their competency assessed, before administering medicines. Staff told us people’s care records contained the information they required to deliver safe medicines support, such as information about where to apply prescribed topical medicines such as creams. Staff were aware of their duty to report potential concerns, such as any suspected medicines errors.

Assessments identified the level of support people needed to safely manage their medicines, including where medicines were time sensitive. Systems and processes were in place to ensure staff were trained and their competency assessed to administer medicines. Records showed where an error occurred an investigation process was followed and actions taken to reduce the risk of reoccurrence, including staff refresher training followed up by a competency assessment. There was a process to audit medicines records, we found the medicine records for 1 person did not accurately identify the type of pain relief or dosage of their prescribed medicine and the registered manager supplied an audit which indicated the issue was later identified and rectified.

People and their relatives were generally satisfied medicines were safely administered and that any issues were promptly addressed. Comments from people and their families included, “They give [person] her medicines and it’s all recorded correctly in the folder as far as I know”, “We have a dossette box and it’s fine – we double check and it’s always been good” and “They always ring me direct if there are ever any problems such as missing tablets.”