ResCare

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.

This is the first assessment for this 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 medicine management and staff recruitment and training.

This service scored 44 (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 did not consistently promote a proactive and positive safety culture based on openness and transparency. While staff listened to concerns and were aware of how to report incidents, their understanding of what constituted safety risks was limited.

Staff understood their responsibility to report accidents and incidents. Although the provider informed us these events were documented, we were not assured that relevant external agencies, including the local authority, had been notified where required. Accidents and incidents were not consistently analysed to identify trends or patterns to reduce future risks.

There was limited evidence of consistent learning. While the provider stated that accidents and incidents were reviewed, there was no limited evidence of actions taken to minimise recurrence.

Engagement with external partners, including the local authority, and awareness of fire safety and health and safety requirements were limited. The provider acknowledged that oversight required improvement and demonstrated a willingness to learn and improve, including responding to concerns raised by the inspector.

Relatives reported that staff and the registered manager were responsive and acted promptly to address concerns relating to their family member’s safety and health.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. The provider had systems for safe transitions and pathways but was not always used to manage and monitor people’s safety or promote continuity of care.

The digital care system had the ability to produce hospital pack containing essential information about the person, including their health and care needs and how best to support them. However, the information was not kept up to date. The lack of accurate and current information when needed meant the risk and safety of people’s care in emergency situations. Although the provider addressed this for the individual when we raised it, this demonstrated the need to strengthen record-keeping ensuring people’s information was accurate and kept up to date.

The provider did not always ensure people were protected from the risk of abuse or neglect and not always safeguarded from restrictive practices. During the inspection, we observed that access to the kitchen was restricted by the use of a gate. This restriction had not been planned, risk assessed or reviewed for appropriateness. The person was not identified as being at risk, and there was no evidence that the provider had sought legal authorisation to deprive a person of liberty where they lacked capacity to consent. These concerns were discussed with the provider. The following day, we saw the gate had been removed, and the person was observed using the kitchen safely. The provider also confirmed an application for legal authorisation had been requested.

Safeguarding information and policies were accessible to all staff and people using the service. While not all staff had completed safeguarding training, they were able to recognise signs of abuse and understood how to report concerns.

Relatives had no concerns about their family member’s safety. A person felt safe with staff and the support provided. Appropriate arrangements were in place to support people with managing their finances and to reduce the risk of financial abuse.

The provider did not always work well with people to understand and manage risks. We found risks to people had not been assessed fully or consistently. Risks were assessed, such as choking, breathing, and specific health condition, however instructions for staff was limited and not always reliable. We were not assured if relevant health professionals had been involved. We also found people’s needs, care plans and risks were not consistently reviewed or updated regularly or prior to their next respite stay. This was raised with the provider.

At the next visit we found the provider had made some improvements. There was evidence people’s needs had been assessed prior to their respite stay and care plans included instructions provided speech and language therapist in relation to the managing choking risks. People’s daily care and support records were completed consistently and fully. However, further action was still needed as people’s medicines were not always verified when people returned for respite stay and dates of care reviews were not always clear. People were placed at risk of harm due to the provider's approach to risk management. The provider assured us this would be addressed.

Staff had been trained in fire safety, however regular safety checks and fire drills did not take place. Fire safety equipment was not in place. People’s personal emergency evacuation plans (PEEP) were not kept up to date. There was no emergency grab bag in place in the event staff and people would need to evacuate the premises. These concerns were raised with the provider. When we returned to complete the inspection, all the issues we raised had been addressed returned.

Staff had good insight and recognised how people expressed themselves using facial expressions and body language and what that mean. This was consistent with the information the care plan. A staff member said, “If [Person name] wants to do a particular activity or board game, then they will be smiling, relaxed and is keen.” Staff promoted positive risk taking and helped people to understand the associated risks and supported them with their interests and activities such as walking.

The environment was not always safe or suitable.Systems were not in place to assess, monitor and manage potential risks. We identified environmental risks including some did not have restricted opening to prevent people from falling out and unwanted intruders. Systems were not in place to ensure compliance fire and health and safety requirements. Records showed required electrical, gas and water safety had lapsed. There were limited evidence of fire safety equipment checks and fire drills. This increased the risk to people and staff.

The provider took immediate steps to improve safety, including windows fitted with restrictors and gas and electrical safety check and fire safety equipment and inspection. They also sent us evidence of further work they requested following our visits to the service.The provider assured us they would implement systems to monitor and manage the premises and equipment.

People lived in one adapted building, which promoted people’s independence and lifestyle. All areas were decorated and individual bedrooms were personalised. Relatives were happy with the premises and had no concerns. One person described the home as ‘small and cosy’.

The provider did not ensure staff were recruited safely. The provider did not always make sure staff received effective training, support, supervision and development. Staff recruitment records were incomplete. We found a curriculum vitae were not always dated. There were no application form completed, evidence of qualifications or certificates and no interview record, therefore we could not be assured how decisions were made to appoint staff. A disclosure and barring service (DBS) check was in place, but the required references were not sought. Staff did not always receive an induction and the training required for their role. A new staff member told us, “I did some shadow shifts with [Provider name] to support [Person name] and learnt what they need help with and support. It covered fire, infection control and health and safety and what to do in the event of an incident. I've got link to complete the on-line training, but I've not started it.” The provider told us they checked staff competency and practice, but there was no record of this. This included competency around infection control and prevent and medicines management. These concerns contribute to the breach of regulation in relation to staffing because staff were not recruited safely, fully trained and competent in their role. The provider has been told to make improvements in this area.

Relatives told us their family member was supported by the same staff, and they had no concerns about their knowledge or training. Comments included, “[Staff name] looks after me, beautiful and kind, and makes sure I don't rush my food when I'm eating” and “Staff know [Person name] and what to do in a medical emergency; but never needed it.”

Infection prevention and control (IPC) practices required improvement to ensure people were protected from the risk of infection.

Relatives had no concerns about the hygiene and cleanliness. They told us staff used personal protective equipment (PPE) to protect people from the risk of infections. Records showed most staff had completed IPC training. We observed staff used PPE appropriately.

People lived in a clean environment and were protected from the risk of infection. Action was taken to ensure porous surfaces were made good, when raised with the provider. However, there was no effective cleaning regime or monitoring the cleanliness standards. The provider told us they carried out visual checks, and ensure all areas were cleaned prior to anyone moving in for respite stay, however, these checks were not recorded. There were no checks carried out to monitor staff compliance with IPC procedure. These demonstrated there was limited oversight to. The provider assured us action would be taken to make the required improvements.

The provider did not make sure medicines were managed safely, placing people at risk of harm.

Significant concerns were identified in the provider’s systems and oversight of medicines management. Staff were trained to administer medicines, but their competency had not been checked. We found there was no secure stored to store medicines safely including medicines that needed to be refrigerated and the disposal of medicines.

Relatives told us their family member’s medicines would dispensed into a dossett box for the respite stay. However, there was no procedures to ensure medicines were booked in correctly and safely and booked out at the end of their respite stay.

There was no oversight or monitoring of medicines management. We found the medication administration records were not completed fully with the required information and instructions for staff to follow. For example, where the prescribed medicine was to be administered once a week on a specific day. The lack of instruction meant people were at potential risk of overdose and health risks. Decision specific assessments had not been completed for the administration of medicines disguised in food or drink known as covert medicines administration.

Although we found no evidence people had experience harm or health risks, the potential risk of ineffective systems, processes, training and oversight of medicines management contribute breach of regulation in relation to safe care and treatment. The provider has been told to make improvements in this area.