Clarendon Home Care

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

The provider operated a positive culture of safety in which safety concerns were reported, investigated and lessons were learned. Staff told us they were encouraged to raise concerns and systems were in place to ensure this happened. The provider ensured safe continuity of care between services and policies and procedures supported this. The provider acted appropriately to minimise the risk of abuse. There were clear systems in place for reporting and investigating concerns and staff were trained to recognise the signs of abuse. The provider involved people in the management of risks to their health and safety. They took action to support people to reach their goals, while working with them to limit the risks involved. Risks within people’s physical environments as well as their equipment was assessed and mitigated. At our previous inspection we found there was a breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this assessment, we found improvements had been made in this area and they were no longer in breach. The provider ensured there were enough suitably qualified staff to support people in a timely manner. Staff received adequate training, induction and ongoing supervision of their performance. The provider had policies and procedures in place to minimise the risk of infection. People’s medicines were appropriately managed to ensure they received these on time and accurate records were kept of administration.

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 told us they were encouraged to raise concerns and they felt confident these would be listened to and appropriate actions taken when needed. One person told us they had raised concerns to their care workers who ensured these were acted on. A relative told us they had complained about the consistency of their care workers and as a result, the provider “has listened and tried to do something about it… for the last 6 months we’ve had the same carers”. Another relative said they had raised concerns before and these had been acted on. They said “I don’t have one individual I speak to, but there’s one lady who’s taken calls from me who’s been very helpful”.

Staff confirmed they were encouraged to raise concerns. They told us that when they raised concerns, they were listened to. One care worker told us “we are always encouraged to raise concerns when things go wrong and the office alert and advise us at all times” and another said “we are encouraged to raise concerns, which on the whole are listened to, acted on, and talked about, lessons learned, and directives sent out.” The provider confirmed they took appropriate action to ensure lessons were learned from incidents and complaints to improve the service.

The provider ensured incidents and complaints were properly investigated and reported. There was an accident and incident policy and procedure in place that stipulated the process as well as responsibilities. We reviewed a sample of accident and incident records and saw clear records demonstrating what happened, what actions had been taken to keep people safe and what ongoing actions were needed to mitigate future risks. The provider had a clear complaints procedure in place and appropriate investigations and ongoing actions were undertaken where complaints were raised.

People and their relatives gave mixed feedback about whether their views were listened to and taken into account. Some people told us their views on issues such as what care they wanted delivered had been taken into account. However, we received feedback from one person using the service and one relative who told us changes had been implemented to the care delivered without consultation and without requested changes being made. The relative added that they believed this was a communication issue and they now requested changes directly with the carer who ensured these were implemented.

The provider had clear systems in place for maintaining continuity of care. The deputy manager told us they received an appropriate handover from either the hospital in which the person was staying or any other professionals involved in the person’s care. Where information was not forthcoming the deputy manager told us they would make repeated attempts to obtain the information. They also told us they tried to limit the numbers of care workers seeing people to prevent confusion and ensure ease of communication.

We contacted the health and social care professionals working with the service about safe systems. We received feedback from one professional who spoke positively about their experience of working with the management of the service.

The provider ensured there was safe continuity of care where people moved between services. We reviewed care plans of a sample of people who had transferred from a hospital setting to receiving home care and we saw their records included evidence of liaison with the hospital team as well as other professionals such as Occupational Therapists where needed. We saw multi- disciplinary advice was incorporated into people’s care plans as needed to ensure risks were well- managed. The provider had clear policies and procedures to ensure people safely moved between services. This included a specific discharging from hospital policy that clearly stipulated what information the provider was expected to obtain and share before people moved back into their homes.

People told us they felt safe using the service. One person told us “The staff we see are very nice, they make you feel safe…they’re trained, they know what they’re doing, one carer has been there for 6 years”. A relative told us their family member was “So far very safe; the carers are very nice”.

Staff demonstrated a good understanding of and commitment to keeping people safe from abuse. They confirmed people were safe and they had received training in safeguarding adults from abuse. Staff demonstrated a good understanding of the different signs of abuse and knew the policy to follow if they had any concerns about a person’s safety. One care worker told us “If we had any concerns we would inform the office and make sure they were investigated”. The registered manager demonstrated a good understanding of their responsibilities to keep people safe from abuse as well as the procedure they would follow if concerns were raised. The registered manager confirmed that although they had not experienced any safeguarding concerns since the last inspection they had reported information of concern to the local authority as required.

The provider had a clear safeguarding policy and procedure in place which set out what the provider was supposed to do in the event of an allegation of abuse. Although the provider kept clear records of incidents that had occurred during care delivery, since our last inspection, there had been no safeguarding incidents at the service.

People told us they were informed of risks about their care and how to keep safe. One person told us their care worker removed clutter or other obstructions for their safety and another person said their care worker always ensured they wore their alarm before they left them. Two relatives told us care staff were mindful about their family member’s care and the risks to their health and safety. They gave us specific examples of how care staff had reported concerns about their family member’s health and had insisted on calling emergency services. One relative told us “I thought [the relative was] fine but the carer insisted, and [they] did end up in hospital”.

Staff demonstrated a good understanding of how to support people to do things that mattered to them, whilst also managing risks to their health and safety. Care workers gave us examples of risks they managed and how they supported people to be as active as possible. One care worker gave us examples of people they supported and the different physical and mental health conditions they had. They told us they encouraged people to do as much for themselves as they could in order to support and maintain their independence. The deputy manager confirmed they assessed individual risks to people’s health and safety to ensure there was a clear plan to support people to be as active as possible. They gave us a specific example of an activity one person wanted to undertake, which did present potential risks to their physical safety. They confirmed the risk assessments and measures they had put in place to ensure this could happen. They told us “We risk assess on a case by case basis. We want people to reach their goals, but we need these things to be done safely. Sometimes you have to be creative with these things. We do what we can to support people and do risk assess everything.”

The provider appropriately managed risks to people’s health and safety in order to keep them safe from avoidable harm. The provider had clear risk assessments in place that described the area of risk, level of risk as well as what actions staff were required to take in order to keep people safe. This included areas such as people’s risk of falls, their skin integrity as well as environmental risks within their home environments. We saw risk assessments were reviewed every six months or sooner if people’s needs changed.

People and their relatives told us their home environments were kept safe and clutter free by their care workers. One person told us “They are very good, especially when I’m not well… They tidy up after themselves, put their gloves in a bin… They’re respectful, they put things away to keep me safe”. A relative also told us “They tidy up after themselves. They prepare meals and wash up afterwards…They keep everything tidy”.

Care workers demonstrated an understanding of ensuring people’s environments were safe. Care workers told us they ensured people’s home environments were safe and looked out for hazards. One care worker told us “We make sure there is no clutter, we tidy up after ourselves as well. We make sure there are no trip hazards.” The deputy manager confirmed people’s home environments were assessed for safety concerns as part of the initial assessment. They explained that care workers were expected to report any concerns in relation to people’s home environments or the safety of their equipment as and when they occurred so these could be dealt with appropriately.

The provider ensured people were cared for in safe environments designed to meet their needs. We saw environmental risk assessments were completed as part of the initial assessments of people’s care. As part of this assessment the provider ensured people’s internal and external living environments were safe for the purposes of providing care and for people’s ongoing safety at home. Where issues were identified, these were reported and actioned by office staff. As part of initial and ongoing assessments, the provider ensured people had the equipment they needed to stay safe. We saw various communications between the provider and occupational health services among other professionals about the appropriateness and timely delivery of moving and handling equipment as well as other equipment.

People told us staff were knowledgeable and appeared well trained. One person told us “they’re trained, they know what they’re doing” and a relative said “They’re all very nice, they seem to know what they’re doing.”

The provider took measures to ensure staff had the support they needed to perform their roles. The deputy manager confirmed they provided an induction to new staff as well as refresher training to existing staff. They told us supervisions were used for ongoing, supportive discussions and obtaining feedback about any further support that may be needed. The deputy manager told us “I try to make things as relaxed as possible and remind staff they can share things freely. There’s also a lot of ongoing day to day contact. We try to create an open environment where we try to talk comfortably about mistakes and support them. We try to avoid a blame culture and work on improving.” Staff told us they had received enough training and had regular spot checks, supervisions and appraisals to support them in their roles. One care worker told us “training is provided, we go for supervisions and discuss what needs to be improved in the future. We have our supervisor who does spot checks, every time.”

The provider had clear processes in place to ensure suitable staff were recruited to the service. Staff files showed appropriate pre- employment checks were conducted including a check of staff’s right to work in the UK, two references as well as criminal record checks. The provider took action to ensure there were enough staff in place to support people. The provider used an electronic call monitoring system to log and monitor care calls. Where the data identified discrepancies, these were followed up to ensure people received the care they needed. We reviewed a month’s call log data and although these did identify some issues, the provider was aware of the reasons for these as well as how they had properly managed these. Records showed staff received regular training, supervisions, appraisals and spot checks of their performance. The regularity of the checks was monitored by the provider and staff were contacted if any of these were overdue. The provider had a clear disciplinary policy and procedure in place to support their management of poor performance.

People and their relatives confirmed that staff adhered to good infection control and wore Personal Protective Equipment (PPE). One relative told us ‘They’re very clean… the carers use PPE and throw it away afterwards”.

Staff demonstrated a good understanding of how to maintain good infection control when supporting people. They confirmed they had received training in infection control and that this was repeated on an annual basis. One care worker told us they had received the appropriate training and resources to do their roles. They told us “We’ve been given written resources and get training- a workbook is sent out. We are given enough PPE or we can go over the office to collect it ourselves.” Staff told us there was enough PPE available to enable them to safely support people. The registered manager confirmed there were no issues with provision of PPE and they monitored staff had completed their training.

The provider took appropriate action to effectively manage the risk of infection for people using the service. There was a comprehensive and up to date infection control policy in place which referenced current guidance and stipulated the provider’s responsibilities. Staff received annual training in infection prevention and control and their levels of compliance was monitored at biannual spot checks within people’s homes. Spot check records we saw did not identify any issues with staff compliance in this area.

People and their relatives confirmed they received their medicines as required. One relative told us accurate records were kept of their relative’s medication administration and they could see this.

Staff had a good understanding about their roles with regard to medicines administration. They confirmed they had received annual training and their competence to administer medicines safely was assessed. The deputy manager confirmed they worked with pharmacies and health care professionals in ensuring people had their medicines administered safely. They told us they reviewed medicines records to ensure appropriate records were being kept of the care delivered. They told us “We monitor people’s records live too. We check that tasks are completed, including that people are being given their medication. If anyone’s refusing their meds we would make sure professionals are informed about this. We try to ensure we get people’s meds before they run out.”

The provider had clear medicines care plans in place which stipulated which medicines people were taking, the dose as well as the times they needed to be administered. Care plans were clear about the level of support people needed with their medicines and if they were able to self- administer their medication, this was clear. Care workers filled in Medication Administration Record charts (MARs) upon administration of people’s medicines and we saw these were reviewed on a monthly basis. Staff received annual training in medicines administration and their competency to administer medication was checked. The provider had a clear medicines administration policy and procedure in place which referenced current guidance.