Real Social Care Solutions Ltd

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

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

This is the first assessment for this registered service. This key question has been rated requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. The management team listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Complaints, incidents and accidents were all recorded and investigated and records showed appropriate action was taken to learn from these to improve people’s care. Staff told us there was not a blame culture which enabled a learning culture. One staff member told us, “If mistakes occur, management discuss them professionally either individually or during team meetings to improve practice and reduce risks.”

The provider did not always work with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

There was no effective system or process in place to ensure care records were consistently updated with clear and relevant information when other healthcare professionals were involved. We found information provided by healthcare professionals had not always been reflected within people’s care plans. This meant there was a risk staff may not always have access to the most up to date information needed to support people safely and in line with their assessed needs. Therefore, we were not assured that if information was required to be shared with other professionals, such as emergency services for continuity of care, that the correct information would always be available and shared.

The provider worked with people to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and relatives told us they felt safe, one person told us, “I have come to feel safe with them (carers) and I trust them completely anywhere in the house.”

Staff had received safeguarding training and were confident in recognising and responding to safeguarding concerns. One staff member told us, “I know how to recognise different forms of abuse including physical, emotional, financial, neglect, discriminatory, and sexual abuse. If I suspect abuse, I would ensure the person is safe, report immediately to management, complete documentation, and follow safeguarding procedures. If needed, safeguarding referrals would be made to the local authority.”

The provider did not always work effectively with people to understand and manage risks. People and relatives told us they had not always been involved in managing risks. One relative said, “There has been no risk assessment meeting or fact-finding call to gain details about my [family member] so I can only assume this information was given to the carers.” Records were not person-centred, and lacked sufficient detail, on how to provide safe care in relation to people’s health conditions and equipment in place such as a Ventilator. One person told us, “If it’s someone [staff member] different then I do have to explain to them what they have to do as I don’t think they have anyone else on their books like me.” This meant people were at risk of potential harm due to a lack of clear guidance for staff to follow. The registered manager tool immediate action and told us they would review all care plans and ensure they were detailed.

The provider did not always identify and control potential risks within the care environment. Environmental checks and risk assessments had not always been completed to identify hazards. Staff were not always given clear information about key health and safety controls, such as the location of gas or water shut-off points for use in an emergency. This meant people and staff were at risk of harm from potential risks in the environment.

The provider did not always ensure there were enough suitably qualified, skilled, and experienced staff. They did not consistently provide staff with effective support, supervision, and development.

We received mixed feedback from people about staffing levels for people who required 2 staff to support them. One relative told us, “There have been about 3 times when I have had to step in for one of the carers at weekends until the other one arrived.” Another relative said, “I would say they arrive together 9 times out of 10. Otherwise, one will sit and chat to me until the other one arrives.”

Staff told us they did not always receive regular supervision. One staff member said, “I only had one supervision; the other was cancelled.” Training records showed that not all required training had been completed; for example, some staff had not completed end-of-life training.

This meant there was a risk that staff were not adequately supported, trained, or deployed to consistently provide safe and effective care.

The provider assessed and managed the risk of infection. They identified and controlled the risk of infection spreading and shared concerns with appropriate agencies in a timely way.

People and relatives told us staff followed good infection prevention and control practices. One person said, “They are very particular about wearing their PPE (personal protective equipment) and make sure it goes in the bin before they leave.” Staff had completed relevant training, and there was a clear, detailed policy in place outlining how to manage infection risks, including responding to outbreaks. This meant people were protected from the risk of infection and staff had clear guidance to follow to keep people safe.

The provider did not ensure that medicines and treatments were safe or met people’s needs, capacities, and preferences. People were not consistently involved in planning their care.

Feedback from people, and care plan records, showed people were not involved in decisions about their medicines. The provider did not have appropriate systems in place in line with the National Institute for Health and Care Excellence (NICE) guidance, or the providers medicine policy. For example, there were no medication administration records (MAR) in place to record when medicines had been administered. Staff had recorded when medicines were given or declined in daily notes, which did not provide a clear or reliable audit trail. In addition, where ‘as required’ (PRN) medicines had been prescribed, there was not always clear guidance on when and why these should be given. This meant there was a risk that medicines were not managed safely increasing the potential for errors and not ensuring people’s needs and preferences were met. The provider told us they had implemented paper MAR charts after recognising the electronic system in use did not meet national guidance.