Alina Homecare Specialist Care - Southampton and Hampshire

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

There was evidence of a culture of safety and learning. When concerns had been raised, these had been used as an opportunity to put things right, learn and improve. There were systems, processes, and practices in place to ensure people were safe from the risk of harm and abuse. Staff undertook safeguarding training and safeguarding policies and procedures were available. Easy read versions of the policy were available for people. People told us they felt safe and knew who to speak to if they had any concerns. There were safe recruitment processes in place. Overall there was enough suitably skilled staff available to meet people's needs. Risks were assessed and planned for.

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 were only able to give us limited feedback about the learning culture within the service. However, 1 person told us they were involved in a group which had recently reviewed staff recruitment questions and provided feedback to the leadership team. They told us how the group held regular meetings over Teams which they chaired.

There was evidence of a culture of safety and learning. When concerns had been raised, these had been used as an opportunity to put things right, learn and improve. Accidents and incidents were monitored by the leadership team to ensure these were appropriately investigated and reported. There were systems in place to review medicines related incidents to identify any themes or trends. Actions taken in response included staff being retrained in medicines administration. A registered manager completed an annual audit of medicines related incidents. In response to 1 medicine related concern, we saw that a reflective practice session had been completed with staff led by the clinical lead nurse. The provider had processes in place to ensure that the Duty of Candour was followed. On 1 occasion correct procedures had not been followed after a person fell. In response, additional training was provided, and an apology was issued to the person in a format they were able to understand. The provider ensured that national safety alerts were reviewed to identify whether there was any actions the organisation needed to take to reduce risks to people and prevent similar incidents from happening. The content of training was revised and updated in light of feedback from staff or changes in national guidance and best practice. Staff supervision was used as a tool to reflect on learning from safety related incidents that had occurred within the service and to reinforce best practice.

The leaders told us how they monitored incidents and accidents to look for themes or trends so that improvements could be made. A registered manager told us, “We found there were more incidents for [Person] during transition, so we changed the way we supported him when he went from 1 activity to another. Staff have told us they have seen a drop in incidents”. The nominated individual told us there was a scoring system in place which highlighted the level of risk or severity of incidents and accidents. They said, “We can see who made the report, and who this has been assigned to, we can see when it’s followed up, so we have really good oversight”. They added, “We take themes from monthly incident reports and that goes to our quarterly meeting with the board of directors and heads of quality and safety”. A registered manager told us. “We have a thing called ‘Hot topics’ for clinical governance and we have done some work on the back of some medication errors”. Staff overall told us there was a culture of safety and a no blame approach used by the leadership team. Staff were confident they could report concerns with anyone of their managers and this would be acted upon. Staff were able to describe to us how they reported incidents to help ensure people were kept safe. A representative comment was, “When incidents occur, I appreciate the structured approach the company takes to address such issues. During safeguarding or other training sessions, past incidents are discussed as case studies, providing everyone with the opportunity to talk through them and learn from the shared knowledge… Importantly, I have never experienced being blamed for any incident, which fosters a culture of learning and improvement”. Some staff felt that there needed to be more effective processes for senior staff feeding back the outcome of safeguarding concerns. We discussed this with the provider, who took this feedback on board and agreed to review how this might be improved.

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.

There were systems, processes, and practices in place to ensure people were safe from the risk of harm and abuse. Staff undertook safeguarding training and safeguarding policies and procedures were available. Easy read versions of the policy were available for people. The safeguarding incidents we reviewed had been appropriately escalated and investigated in line with the provider’s policies and procedures. The leadership team reviewed all safeguarding concerns at weekly meetings to ensure these were being responded to and to ensure safeguards were in place. We saw for one person, following feedback from a health care professional, additional support and monitoring had been put in place to proactively address potential safeguarding concerns to help ensure the person lived safely. The team followed the principles of the Mental Capacity Act 2005 to help ensure that people’s rights and choices were safeguarded. For example, mental capacity assessments were undertaken to establish whether people understood why they were taking medicines. The records viewed were decision specific and considered whether planned actions were the least restrictive. For 1 person, we saw that staff had undertaken several attempts to assess the person’s capacity to ensure they were given every opportunity to understand the information and communicate their responses.

People told us they felt safe and knew who to speak to if they had any concerns. One person said, “I feel safe because I am safe”. They told us who they could talk to if they were concerned about anything. They felt they would be listened to, and action taken. Relatives were confident their family members were safe and protected from harm. One relative said, “He presents as relaxed with his care staff. His body language gives me reassurance” and another told us, “I think the staff are kind and gentle with [Person]…. I think she feels safe…I am not worried about any of her care at all”. People were supported by the provider to have access to information in an easy read format about how to protect themselves from scams. One person told us they had found this useful in relation to their online activity.

Staff understood their responsibilities in relation to safeguarding people from abuse. They were confident that any concerns they reported would be acted upon by the management team. One staff member told us, “Any bruising or marks are immediately reported and logged on a body map and put in the communication book and on [provider’s real time electronic recording system]". We are a professional team where the safety of our clients and our duty of care to them are our top priority” and another said, “All of us care very much about the well-being and safeguarding of the clients, I'm confident that any concern I might have would be taken seriously by management and the necessary action would be taken”. Another staff member told us, “We have detailed risk assessments and care plans for each client to ensure they are safe from harm and exploitation. For example, every client has a financial risk assessment, they are encouraged to budget for things and have a daily allowance and their own money tin. They are supervised to purchase things in a safe way”. Staff told us whistleblowing procedures were in place and they were aware of the actions they could take if they felt their concerns were not being acted upon. The registered managers had a good understanding of their role and responsibilities in relation to safeguarding people from harm or abuse. A registered manager told us, “We have 2 levels of training, an annual refresher for staff which covers recognising signs and symptoms of abuse and how to whistle blow. The second type is a more advanced training for managers and covers how to do reports, investigations, and attendance at safeguarding meetings”. Leaders also displayed a good understanding of the deprivation of liberty safeguards (DoLS). A registered manager told us, “We have a DoLS register, we liaise with the local authority if we feel a DoLS might be required, we always look at the least restrictive option”.

Staff told us risks were assessed and plans were in place to manage these. One staff member said, “Each client undergoes a risk assessment, and risk mitigation strategies are put in place to ensure their safety. Upon joining the company, I thoroughly reviewed the care and support plans of the clients I worked with to gain insight into how to provide effective support”. A staff member told us how they had been involved in assessing potential risks involved in a new activity a person was undertaking and another staff member told us, “[Person] can have falls because of their mobility, so we check the environment, we check everything is clear. He is a choking risk, so we need to cut up everything for him”. Staff were confident they were trained to manage people’s emotions or distress in a positive way. For example, 1 staff member said, “I undergo training to equip myself with the knowledge and skills to support people in distress” and another said, “We have [Positive behaviour support] training, we do not use restraint, more about releasing / removing yourself”. A registered manager told us debriefs were used following the use of positive behaviour support to ensure there was an opportunity to reflect on the incident, what could have been done differently, to consider least restrictive options and to consider improvements in care. Risk management was balanced with peoples’ choices. For example, a registered manager told us, “We support [person] with their gastrostomy, they can only have a limited amount of oral food, she is involved in managing the risks, e.g. training staff and has lots of wrap around support, we are working in a measured way with multidisciplinary team to increase the amount of oral food allowed”.

People were only able to provide limited feedback about whether they felt involved in managing risks, however, 1 person was able to tell us how they were being involved in teaching staff how to support them with their feeding tube. Being able to facilitate this was clearly very important to the person. This person told us they were hoping to have their feeding tube removed later in the year and so were gradually building up their oral intake in a planned way to support this. Relatives were overall confident that risks were assessed, and that staff understood these. One relative said, “Staff are very familiar with him… he has his own room and there are rules in the kitchen, this keeps him safe”.

Overall, there were clear processes in place to mitigate risks to people. People’s care plans contained detailed and personalised risk management plans for needs such as, epilepsy, falls, choking and the care of feeding devices. The provider continued to review the effectiveness of their risk management systems. They were enhancing their monitoring of people’s food and fluid recording and supporting staff to maintain effective communication and joined up support with for example, education providers. The provider’s real time electronic recording system allowed information about changes to people’s needs and risks to be communicated to staff quickly. The service operated a 24/7 on call system which staff could contact to raise concerns or seek advice. Staff received training in how to respond when people displayed distressed behaviours. The use of positive behaviour support was monitored by their training academy to ensure this was being used appropriately. The leadership team monitored those subject to a community Deprivation of Liberty Safeguards Authorisation (DoLS) to ensure any restrictive practices were proportionate and appropriate.

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

There were safe recruitment processes in place. This included the completion of a check with the Disclosure and Barring service and the gathering of references. Staff completed an induction which helped to ensure staff were knowledgeable and ready to perform their role. The induction included opportunities to shadow existing staff. The organisation had developed a training academy. All training was delivered in person. The completion of training was monitored by the registered managers through weekly and monthly meetings with the training academy manager. Staff completed mandatory training in 5 subjects and specialist training relating to the needs of people they would be supporting. This included support with tasks such as enteral feeding, positive behaviour support and insulin administration. We reviewed the training records for the 4 households we visited and were assured that appropriate training had been completed. Refresher training in the 15 Care Certificate standards was completed as part of the mandatory and specialised training. The Care Certificate is an identified set of standards that health and social care workers should demonstrate. A range of competency assessments were undertaken to ensure staff were able to understand and apply their training in practice. Some people used a limited number of Makaton symbols or signs when communicating. Some staff told us they would value training in this communication tool. We discussed this with the provider. They stated that the induction of staff and shadow shifts were used to support staff to become familiar with people’s use of these signs, but provided assurances monthly courses were scheduled for the rest of the year which staff would be encouraged to attend. There were systems and processes in place to ensure that each person’s commissioned hours were being delivered. Staff received support in the form of continual supervision. The systems in place helped to ensure this was delivered effectively.

Overall, staff told us there were sufficient staff to meet people’s needs. Comments included, “Yes staffing levels are always met, and the company ensures that every client gets their support hours” and “Staffing has improved a lot through better recruitment over the past year…I feel we are better resourced now with staff”. Some staff said that on occasion, people’s 1:1 hours had to be rearranged due to staff not being available, but they confirmed these would always be provided at a different time. Where there were shortfalls in staffing levels due to sickness or other absence, staff told us these shifts were covered by colleagues picking up extra hours or by the office team. Some staff felt this did not always work effectively, particularly when the people being supported had complex needs. They felt this was an area which could be developed further. We have discussed this further in the people’s experiences section of this quality statement. The leadership team, whilst confident there were sufficient numbers of staff available to meet people’s needs, told us they were continuing to work hard to recruit new staff including staff who were able to drive. Staff told us their induction covered what they needed it to. A representative comment was, “I participated in comprehensive training sessions where my knowledge and skills were also assessed. Additionally, I had the opportunity to shadow experienced support workers for another 4 weeks, allowing me to gain valuable insights and learn from their expertise”. A registered manger told us, “We have a meeting every week with the training academy manager. Anything that needs to be booked in is booked in… We record the key skills that staff need to work in that particular property. We wouldn’t put staff in to support [Person] who hadn’t had epilepsy training”. Staff were positive about the training provided. A representative comment was, “Yes the training is good with specialised topics if you want them".

Overall, people confirmed there were enough staff to meet their needs. One person said, “Yes there is always staff around to help me. I always have my one to 1:1 when I am at college the staff do shared support with others and when I come home, they go back to being 1:1 with me”. People said, there were sufficient staff to support them to undertake activities or to attend healthcare appointments when they wanted, or needed to. For example, we met 1 person who was being supported to go for lunch following their visit to meet our inspector. They had sufficient staff with them to facilitate this safely. The staff accompanying people were competent in using people’s preferred communication techniques. We visited 8 people in their homes. In each case there were sufficient staff, who knew people well, available to meet their needs. One person told us they had been involved in reviewing the interview questions for prospective staff to ensure these were reflective and appropriate to the role. Relatives were overall confident there were sufficient staff and that their relative was supported by staff who knew their family member well and were suitably trained and knowledgeable. One relative told us, “His carer [name] has worked with him for over 16 years…. There are no words to describe how I feel about [Staff member], I can’t praise him enough…. He knows my son inside out”. Another relative said that unfamiliar staff being introduced could sometimes unsettle their family member, but added, “I do feel confident with the overall quality of care she receives”. We discussed this with the registered managers. They told us they were continuing to recruit new staff and felt this was an improving picture. They provided assurances they would continue to work with people and their relatives to ensure the introduction of new staff was managed in a collaborative way in order to reduce the impact of this on the person.

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.

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