Flamelily Independent Living

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 good. At this assessment the rating has remained good. People’s risks records were not always robust enough to inform staff how to keep people safe. People received their routine planned medicines as prescribed. Staff received training but not all competencies were in place to ensure they were safe to conduct their role. Incidents were reported appropriately. Staff felt supported and there were enough staff to support people safely. Staff were aware of infection control guidelines and conducted safe care in people’s homes.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people felt the service learned from incidents. One relative told us, “I would definitely feel able to talk to staff or management about anything relating to my relatives care.”

Staff we spoke with were aware of the need to report accidents and incidents or concerns. Senior management would investigate any concerns and pass down any learning to staff usually in team or supervision meetings or as appropriate. Staff confirmed this. One staff member told us, following an incident they usually got feedback from the office and the person. They said, “I recently got sent a message saying well done as I stayed till the service user got help and got positive feedback about my involvement.”

The provider had processes in place for staff to report incidents and near misses. This included reviewing and learning from incidents and adjusting people’s care accordingly to keep them safe.

People and relatives told us their experience of starting to use the service was positive as communication with management had been good. One relative told us, “I have felt completely involved during the whole process of my relative’s admission (joining the service). Flamelily spent a lot of time with my relative and I during his initial care plan and have had several meetings since to discuss any changes to his needs or preferences, which is very reassuring.” Another relative said, “They did a full care plan and introduced themselves properly and we have a folder with all the information in.”

The provider supported people to transition into the service including from hospital and to also move to another care setting if required. One member of the management team told us how they liaised with the discharge team at the hospital. They kept regular contact with them about people’s discharge dates to ensure people would receive a timely service on discharge. When people came back home from hospital a senior member of the team would visit them at home to check if any changes were needed and to update all the team and health professionals involved.

A professional felt the service worked well with other professionals ensuring people were moved into the service safely following risk assessments and joint working to ensure continuity.

Systems were in place to ensure people transitioned to the service in a safe manner and there was continuity of care. Management liaised with healthcare professionals to make sure people’s needs were met. The provider had systems to ensure information was shared with relevant professionals.

Not everyone at the service always felt safe. We received mixed feedback from people and their relatives about whether people felt safe receiving care and support from the service. One relative felt staff could be heavy handed in their care which had put their loved one at risk. Following the inspection the provider was reviewing staff practice and training. Others told us they did feel safe when being supported by the service. One person told us, “I feel safe and never at risk.” A relative said, “He feels very safe in their care.”

Staff we spoke with had received safeguarding training and knew how to protect people from harm and abuse. Staff reported any concerns to management and were confident appropriate action would be taken to keep people safe. Management told us staff had an application on their mobile phone where they could raise an alert should they have any concerns. They said it would come straight through to the office or out of hours for senior staff to action straight away.

Records showed the provider had reported safeguarding concerns to the relevant authorities and cooperated with investigations. A safeguarding policy was in place and staff knew how to access this.

People and their relatives did not always feel the service managed risks well due to the skills of some of the staff. One relative told us, “The carers just don’t have enough experience and a lot of them don’t even know what [person’s name] has and haven’t looked at the care plan.” Another relative said, “Generally the training is OK but sometimes the carers don’t understand the importance of little things when caring for someone with complex needs.” However, 1 relative told us, “My relative is completely supported to manage his health care needs. I'm confident that if there was any concern about his safety, staff would discuss it with him and myself to resolve any issues.”

Staff had a good understanding of people’s risks. One staff member told us, “As soon as I enter I do a risk assessment. If I see a trip hazard of furniture which could cause injury or harm I report to the office. I am confident they are dealt with. I remember that recently I reported the heating wasn’t working in a service users’ home and it was resolved the next day.”

Assessments were undertaken to identify risks to people and to the care staff who supported them. Areas covered by these assessments included risks associated with the environment, personal care and moving and handling. Most risk assessments set out how risks were minimised or prevented. However, some risk assessments needed more information to ensure they were fully comprehensive, this included how risks such as those relating to people’s modified diets and bathing were to be managed. Where people had bed rails in place, there was no risk assessment in place to ensure the risks such as entrapment had been considered. The registered manager reviewed these following our feedback, but the risk assessments continued to lack robustness. We saw one person had to wear special clothing equipment and there was no risk assessment in place to support staff on how to use this. Following the site visit the provider put this in place.

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

We received a mixed response regarding staffing turnover from a number of relatives. One relative told us, “There are different carers every day and we have no idea who is coming” and another said, “[Person] might have two carers one day and then all change, it makes her feel unsafe. Sometimes two new carers are put together which is frightening for someone so vulnerable.” Relatives gave mixed feedback about whether their carers were adequately trained and understood their needs. One relative told us, “I would find it difficult to recommend the company as I don’t think the staff are very good or well trained. I am awaiting a response from the company concerning issues I have raised.” Another relative said, “Mostly well trained but it’s changed a bit now. They used to come round with new carers but not now, they just turn up”. Other comments included, “I think they are well trained”, “I think there are gaps in their training and little experience of care.”

Staff felt they had been given appropriate training needed to undertake their role. The registered manager told us, staffing levels were determined by the number of people receiving care and support and their needs. A member of the management team told us, this year they have focused on staff supervisions. We have set up a robust process with a self-appraisal form for staff to complete prior to their supervision. This enables us to get to know our staff and sit down with staff to monitor how they are preforming.

Overall, safe recruitment processes were followed that meant staff were checked for suitability before being employed by the service. Staff records included a check with 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. Nearly all the staff team had been recruited via a Home Office Sponsorship Scheme. The provider held a licence allowing them to sponsor overseas workers to work in the UK, relevant right to work checks had been completed. New staff completed an induction programme before working on their own and staff were provided with supervisions (one to one meetings) with their line manager. These provided an opportunity to provide staff with feedback on their performance, identify any concerns, offer support, assurances and learning opportunities to help them develop. Records showed staff had mostly received the training relevant to their role. However, some staff had not received training, or competency checks, to safely perform more complex tasks such as providing nutrition through a tube and using equipment to help people breathe.

People and their relatives were happy staff supported them safely with infection control. Everyone told us staff wore personal protective equipment (PPE). One relative told us, “They always wear PPE and wash their hands when not wearing gloves.”

Staff demonstrated a good understanding of infection control procedures. Staff had received infection control training and had access to personal protective equipment (PPE) to safely manage and control the prevention of infections. Staff were also observed to ensure they were providing safe care following infection control guidance. One staff member told us, “We are working with the most vulnerable people, so we are aware of infection control, we have the training and do a refresher.”

An infection control policy was in place to support staff. Senior staff carried out spot checks on staff to make sure they were putting their training into practice.

People and their relatives were happy with their medicine management. One relative told us, “The carers give him his medication morning and night. It is delivered automatically from the chemist and Flamelilly come and check regularly too so all is good.” Another relative said, “They do it, they took over when I was in hospital, and it is all in separate boxes, but everything is in place.”

There were up to date policies and procedures in place to support staff and to ensure medicines were managed in accordance with current regulations and guidance. However, staff did not fully understand best practice when making decisions for administering medicines covertly (when a person receives medicines without their knowledge or consent, usually by disguising it in food or drink). Staff told us they were trained in the safe administration of medicines and underwent an assessment of their competency to administer medicines in line with best practice guidance. A senior member of staff told us, if any medicines were or refused that it would go into an alert box. Which they monitored closely so they can put measures in place to ensure safe medicine management. For example, one person run out of medicines and they were able to raise an emergency prescription, so they had their medicines that evening.

The electronic medicines administration records (eMARS) viewed, provided assurances people had received their routine medicines as prescribed. The eMAR system provided alerts should a person’s planned medicines not be administered allowing senior staff to take remedial action. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Some records of medicines administered ‘as required’ or PRN medicines records could be confusing and could increase the risk of medicine errors occurring. The provider had not identified these records concerns through their audits but took action during the assessment to review records to made this clearer to staff.