Access Dignity Care Limited Also known as Access Dignity

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question inadequate. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

The service was in breach of legal regulations in relation to safe care and treatment, safeguarding and risk. Improvements had been made and the provider was no longer in breach.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Following the previous assessment the provider had now created a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The registered manager told us they had an improved approach to monitoring and reviewing safety concerns. A daily meeting was now held with all relevant staff where every accident, incident and safeguarding concern was discussed and any information cascaded to staff if needed. The registered manager said, “The biggest thing I have learnt since the last assessment was about auditing processes and oversight. It has come part of everyday process that as a team we sit every morning and discuss all concerns. We give everyone a task from updating risk assessments to cascading information to front line staff.”

Staff told us they were able to raise concerns with managers and were confident these were taken seriously. A staff member told us, “Any concerns they listen to me. We do a meeting and they talk to us about lots of things.”

People told us they were confident to raise concerns about their safety. A relative told us, “I only spoke to them about safety concerns when carers were arriving late, but that has improved now.”

Since the previous assessment new risk assessments had been developed to ensure information recorded about people was up to date and current. This meant there was a stronger awareness of risks to people across the organisation and this information was easily accessible to staff working with people and any care journeys people may take.

The registered manager told us they worked with partner agencies to develop safe systems, pathways and transitions.

Additional learning had been undertaken to ensure staff had awareness of people’s health conditions and how to respond to emergencies and administer first aid if this was necessary.

The Provider has maintained a consistent staff team; however, the registered manager did tell us whilst they are mindful of continuity of care staff, there were still occasions where they had to send different care staff to people but they had more detailed information to provide safe care and treatment.

People and relatives told us staff liaised with other professionals when this was needed. A relative told us, “The company has worked with other health care professionals throughout the time [family member] has had care.”

A professional told us, “They used a small team to ensure continuity for a patient and there were never any issues.”

The provider had worked with partner agencies to improve their systems and processes to ensure people were safe from abuse and avoidable harm. They had developed a system where any safeguards were reported appropriately to the relevant agencies. We discussed 2 accidents where information may have indicated a safeguard or CQC notification was required. The registered manager explained the injury sustained by the person was very minor, however this had not been made clear within the investigation information. The registered manager told us they would be adding this to their investigation.

People and relatives told us they felt safe, a person told us, “I feel safe with the carers as they give me confidence, they help me to move around safely. They have made sure that my bed is downstairs with a commode and I have a special armchair.” Another person said, “They treat me very well. They chat about all sorts of things. They know I have problems with one of my hands and can’t use it very well, so they take that into account when they are supporting me. I have had problems with understanding some of the staff in the past, but now they know to speak slowly to me. I have no concerns about the staff at all.”

Staff had a good understanding of their responsibilities to safeguard people. A staff member told us, “First I will inform my manager and if I will be unable to inform them, I will inform the police, CQC or Essex County Council.” Another staff member said, “We raise the concerns with managers or [local authority]. I know the signs to look out for.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Following the previous assessment all risk assessments had been revisited and updated to ensure the guidance for staff was comprehensive.

Risks to people’s care and any guidance were now part of the tasks information so staff had at a glance guidance. A staff member told us, “They have everything in the care plan we need, for catheters I need to be aware of infection or blockage, we contact the office and the district nurses if we have any concerns.”

People and relatives told us they were involved in managing any risks associated with their care. A person told us, “I am at risk of falling, so when I started with the company, they talked to me about the risk of falling. People came to my house to assess my home and the risks. My risks are often reviewed to make sure I am still safe.” A relative said, “Risk assessments were carried out prior to the service starting support. I feel [family member] is safe as they are aware of their needs and how to support them. [Family member] is bedbound and so the only risks are bed sores and catheter management. As such they turn [family member] frequently and they are trained in catheter management.”

Since the previous assessment the provider has delivered additional training for staff when identifying a need to support someone with specific health conditions. A staff member told us, “We complete training for specific conditions, we have recently received training for Huntingdon’s disease, the training manager constantly updates and improves the training. This was external training.”

The provider detected and controlled potential risks in the care environment. They had improved their assessment process and included a comprehensive environmental risk assessment to ensure they were aware of any potential risks to people’s environment and equipment within their homes. This included information on flammable emollient creams, COSHH, fire and equipment risks.

Staff told us they received practical training in relation to equipment used in people’s homes such as mobility equipment. This training was followed by a competency assessment to ensure staff understood the training and could put it into practice.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff told us their visits were manageable and they received travel time. A staff member told us, “We do get enough time, if we get an issue with a service user who needs more time, they come out and assess. They do give us travel time there are gaps between service users.”

People and relatives told us about improvements to their visit times and reliability. A person told us, “I feel there are enough staff, I haven’t experienced any difficulties.” However, there was one comment about continuity of staff. A person told us, “I have a variety of carers, there isn’t much continuity. I am allowed to refuse carers if I don’t take to them.” The registered manager told us they continued to work to improve continuity and would follow up the concern raised about continuity.

Following the previous assessment the training manager told us they had added to their induction processes and now completed training for international staff in relation to cooking and domestic tasks they are expected to do. Cooking facilities were now in place to ensure staff were able to provide the choices people requested with confidence. The training manager told us, “There is so much for international staff to learn. We are much more aware of cultural differences and trying to support staff with this through training, supervision and competency checks.” Records showed that staff had received training in areas relevant to their roles.

Staff told us they were supported by management through training, supervision and team meetings. The provider had not recruited any new staff since the previous assessment but were aware of safe recruitment processes to follow. Previous staff files were audited and risk assessments added where gaps in recruitment processes were noted.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Processes were in place and a monthly audit was undertaken by the service. The audit findings were discussed in full by the management team to ensure all staff were following policies and procedures. The registered manager told us, “Reporting from carers has really changed so staff are reporting things early, which means we can follow up any shortfalls quickly.”

Staff told us they had access to personal protective equipment (PPE) and told us this was checked by senior staff during spot checks and competency assessments.

People and relatives told us care staff followed infection control processes. A person told us, “They have clean gloves and aprons for visits. If they forget they go and get more from their car.” A relative said, “They keep everything clean and wear clean gloves and aprons when they support [person].”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Following the previous assessment, improvements had been made to medicines processes. Audits were carried out daily, weekly and monthly. The daily check was completed to look for any concerns with administration that could be picked up straight away and all errors were investigated thoroughly. Improvements had been made to processes for the application of topical creams and transdermal patches.

The provider had recently begun a project with the purpose of empowering people to manage their medicines independently. The main objective to enhance people’s confidence and capability to self-administer medicines where appropriate.

People and relatives were positive about management of their medicines. A person told us, “My medication is reviewed every month and they take photos of my prescription for reference. I take my medication myself but they do check if I have taken them.” A relative said, “The carers do [family members] medication, most of the time. Some of their medicine has to be given before some other medicines, so they give the first one straight away on entering the house. I get it ordered from the doctor and it is delivered to our address.”