DBAGZ SOLUTIONS LTD - BRIGHTON

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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

People were safe due to effective recruitment which ensured that appropriate and suitably skilled staff supported them. Staff received relevant training that allowed them to support people safely and effectively. Medicines were safely managed and administered. Risks had been assessed and mitigated through guidance for staff. People were supported by enough staff to keep them safe and provide effective care. People who required help with their medicines were supported safely. People were protected from harm by staff who understood safeguarding principles. Staff were trained in safeguarding and understood how to protect people from the risk of abuse. Environmental assessments of people’s homes had been undertaken to protect them and to allow staff to undertake their role safely.

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.

Incidents and accidents were consistently recorded. Staff understood their responsibilities to report any concerns. The registered manager had oversight of recorded incidents to determine whether changes to people support needed to be made. Incidents were monitored, and actions were recorded. Incidents were reviewed and there was clear description that included any actions taken, these included any staff methods used to alleviate anxieties of people they supported. Risks were not overlooked, and care plans and risk assessments addressed any concerns over people’s mobility and health etc. Relevant referrals had been made to address any additional support people needed to stay safe. A complaints process was in place, although the registered manager confirmed that there had been no formal complaints submitted. Carers receive duty of candour training as part of their initial training.

There were systems in place to facilitate safe pathways and transfers for people. assessments of need and risk assessments were completed during the initial assessment of care to ensure safe, effective support. Care plans detailed people's health conditions and provided the guidance staff needed to seek additional professional health support and when to make appropriate referrals to partners. Referrals had been made to specialist services such as physiotherapists. The provider had worked with Speech and Language therapists to support one person with safe eating and drinking. There was a collaborative, joined-up approach to safety that involved staff and partners in their care. The registered manager said, “Information sharing is fairly good.” One professional said, “They (the provider) have on many occasions supported our patients at such short notice which has inevitably helped take pressure off of the NHS community services and possibly helped avoid hospital readmissions.”

People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. People told us that they felt that staff understood their needs well. There was a clear understanding amongst management and staff of safeguarding issues, reporting responsibilities and understood what signs to look for that may indicate any safeguarding concerns with the people they supported. Feedback from people was positive and indicated they felt safe with carers in their home and providing them with care. The registered manager was aware of what safeguarding information to submit to local authorities and how to notify the CQC of any potential or suspected abuse. Staff received appropriate safeguarding training and knowledge to ensure they could recognise when people may be unsafe and to identify potential signs of abuse. Information about people’s care was safeguarded by adherence to data protection policies and consent processes.

Risks to people’s health needs had been assessed, were person centred and managed safely. There was sufficient guidance in place for staff to safely support people with their assessed needs. Environmental risk assessments were completed to ensure that staff could undertake care and support safely in people’s homes, while the providers electronic care system allowed management to monitor completed care calls. Risks were recorded effectively and related to the specific needs of that person. For example, one person was assessed as being at risk of developing pressure sores and there was guidance for staff to monitor and identify any potential changes in skin integrity while completing personal care. Repositioning charts were in situ in people's homes to guide staff while repositioning charts were viewed by the inspector. One person (who did not require direct support with the condition) had a diabetic care plan and risk assessment and place which detailed carers who supported the person manage this. One relative said about staff’s approach to moving and handling, " They are careful when they support her.” Risks to people’s health were considered and mitigated through effective care planning and monitoring. For example, one person had fluid intake charts in place that monitored how much fluid they had, while output recordings monitored their fluid output when carers supported with catheter management. Body map charts in place guided carers in where the person was most at risk of pressure sores and where to apply the relevant creams.

Environmental risk assessments were completed to ensure that staff could undertake care and support safely in people’s homes. Assessments of the interior and exterior of people’s homes highlighted any risks or factors that could impact carers access and their ability to undertake safe and effective care. For example, one person’s risk assessment detailed how staff should temporarily move floor coverings so that equipment could be put in place effectively to use. Care planning showed that SU's had equipment in place to support with people's mobility. Guidance was in place for staff to use this equipment and moving and handling training supported this practice.

There were enough staff in place to ensure people remained safe and meet their needs. People told us that staffing was generally consistent, they had good continuity in their care and carers stayed for their allotted time. A review of the scheduling system showed that continuity was good and that carers were provided with travel time between calls. Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through 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. New staff completed an induction and probationary period. Staff completed shadowing shifts with established staff members prior to lone working. Training had been identified and provided to staff according to the needs of the people the service supported. These included training in areas such as safeguarding, Mental Capacity Act (MCA), medication, and moving and handling. When needed, additional specialist training was sourced to meet the needs of people they supported, for example, catheter care or epilepsy awareness. Partners in care spoke positively about the skills of staff. One professional said, “The carers have demonstrated that they are competent and well trained in being able to meet complex social care needs and have successfully managed the support provisioned.” Another professional told us, “They have worked collaboratively with myself and my client’s occupational therapist to maximise the support in place, and to learn to use new pieces of equipment to support the safety of themselves and my client.”

Systems and processes were in place to protect people and to prevent and control the risks of infection. Staff were trained in infection control and food safety awareness and there was an IPC policy and procedure in place which staff could access. Staff demonstrated a good understanding of how to prevent the spread of infection. People stated that staff were careful in disposing and cleaning when support was provided with continence needs. One person said, “They are very careful, they disinfect everything.” When supporting people in their homes and providing personal care, staff used the appropriate personal protective equipment, such as face masks, disposable aprons and glove. People confirmed that staff were consistent in this practice. The registered manager stated that, depending on the environment, shoe covers will also be used. Staff had access to a good supply of personal protective equipment. Review of peoples care plan and risk assessments showed that any relevant IPC practices were integrated in the daily routine guidance for staff. For example, daily preferences of people formed part of the guidance on IPC measures. One person expressed a preference for sanitary baby wipes to be used when carers carry out personal care as it was felt that they reduced the risk of infection more than the use of flannels. Guidance for another person made clear to staff that different flannels were to be used during washing for different parts of the body.

Systems and processes were in place to ensure that people’s medicines were administered safely. Staff had received training in administration of medicines. We reviewed Medicine Administration Records (MAR) sheets, which had been completed appropriately. The registered manager monitored medicine administration daily and received electronic alerts if medicines had not been recorded as administered. The registered manager confirmed that should there be any identified gaps in administration, and they would address this with the carer. RM completed weekly audits of MAR charts and monitor stocks and storage. Monitoring of real time medicine administration was completed through the electronic monitoring system. The registered manager stated that when they started a package of care which involved the administration of medicines, they would contact the GP and pharmacy to inform them. Staff confirmed they'd received medicines training. They confirmed that information about people's medicines was in their home. People told us that they were supported safely and effectively with their medicines. One person said, “They make sure they give me the right ones (medicines). They know what I take. If in doubt they ask me.” Care plan documents for five service users were reviewed. Each person had a medication care plan in place that assessed the level of support needed and what carers supported them with. Detailed when relatives provided support with administration or ordering of medicines.