B24 Healthcare Solution Limited

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 requires improvement. At this assessment the rating has remained 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.

This service scored 56 (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 always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

We found improvements had been made to care plans, with people’s needs being assessed and care records containing more personalised detail than previously found. This meant some lessons had been learnt.

However, the provider had missed some opportunities to learn lessons from mistakes. When an incident occurred, the provider had not ensured their policy related to staff handling people’s money was implemented across the service.

The provider told us the registered manager had turned off the service’s care call alert monitoring system but had not identified this as a concern. This meant there was not a pro-active culture of safety which increased the risk of staff not identifying missed and late care calls. This did not demonstrate best practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Most people and relatives told us most people had consistency of staff providing care calls to them. Risks associated with people’s care needs and home environment were assessed.

Staff understood the need to report any concerns to the management team and work with health and social care professionals involved in a person’s care.

‘Grab’ sheets were available to staff, and these contained key information in the case of an emergency admission to hospital.

Most people and relatives were positive about how staff liaised with them, praising the service they received.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from abuse.

Improvements were needed regarding the effectiveness of the provider’s systems and processes to keep people safe from abuse. Whilst the provider had made appropriate alerts to the Local Authority (LA) and Care Quality Commission (CQC), we found they missed opportunities to improve practices related to the potential risks of financial abuse. For example, a financial incident was only recorded in a person’s daily notes, and no full investigation had taken place. The provider missed the opportunity to learn lessons from not implementing their own policy related to staff handling people’s money. This is further reported on in the well led section of this report.

Following our inspection feedback, the provider took action to remind staff they were not permitted to do their own shopping when undertaking shopping tasks for people, with the intention of reducing the risks to people and staff.

Staff had completed training in safeguarding people from abuse and told us they would report concerns such as bruising to the management team.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks associated with people’s care needs were assessed and improvements had been made in the management of those risks since our last inspection. However, some further improvements were needed. For example, within a person’s diabetes care plan, there was good information directing staff on signs of ill health to observe for and the correct actions to take. However, later in the diabetes risk management plan there was contradictory information. The diabetes care plan stated 1 person’s insulin was administered by the district nurses, however, in their risk management plan staff were directed to tell this person to administer their own insulin. This meant the person was at increased risk of not receiving their medicine as prescribed.

Some people had been identified as at risk of developing sore skin on pressure areas. Care plans directed staff on what to observe for and some people had specialist pressure relieving mattresses. Risk management directed staff to ‘check equipment,’ however staff did not have the information they needed to ensure pressure relieving mattresses continued to be on the correct setting to ensure people received the full benefit. The provider told us this would be put into place.

One person’s care plan identified a known risk of self-harm, but there was no risk management plan related to this. However, risk mitigation was in place in the person’s home and daily notes showed staff knew where items should be stored safety.

Risk assessments were in place, for example, related to catheter care and epilepsy which included how to support people safely. One person’s care plan detailed a behaviour that may pose risks to staff, and their risk management plan told staff the triggers for this and how to manage the behaviour.

Care records included guidance for staff to follow related to moving and handling. This included detailed instructions on how to use moving and handling equipment and which coloured hoops to use and place onto the hoist.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

There were generic risk assessments in place to ensure staff remained safe when providing care. Where additional potential risks were identified, these were assessed further.

Guidance was in place to direct staff to check equipment, such as hoists, before using them to ensure they were in good working order.

However, there were no lone worker risk assessments. The deputy manager told us these would be completed.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

At the time of our inspection, medication and moving and handling competency assessments were completed by a staff member who had not completed a ‘train the trainer’ qualification and did not hold any topic specific training at a higher level than those staff members being assessed. We could not therefore be assured the staff member checking other staff’s competencies had the skills to do this. The provider told us they had completed some modules for their own ‘train the trainer’ qualification but had not yet been signed off. This meant no specific assessor training had been completed by any staff member. The provider told us changes would be made, and they would arrange for two staff to undergo specialist training, and they also intended to complete their ‘train the trainer’ qualification.

There were sufficient staff employed to undertake care calls. However, some people and relatives told us they were not entirely satisfied with the service because staff did not always stay for the full duration of the care call. One relative told us, “I have CCTV and have seen staff stay only for 6 minutes when they should stay for 30 minutes.” We have further reported on the provider’s care call monitoring in the well led section of this report.

Staff were recruited safely and received an induction which included a period of shadowing an experienced staff member. Staff received training which consisted of face-to-face sessions and some online learning. Some staff completed additional training pertinent to people’s individual needs. This included stoma care, catheter care, diabetes care, dementia and epilepsy.

Staff received regular supervisions and had personal development plans was in place.

Regular spot checks on staff were carried out to ensure staff followed their learning and had the skills for their role.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff had been trained in infection prevention and control and had personal protective equipment (PPE) available to them which they used. Some staff did not consistently follow their learning in removing outdoor coats when on care calls.

We received some negative feedback from people and relatives about some staff not tidying people’s kitchen surfaces and appliances after meal preparation. One relative told us, “Staff leave kitchen surfaces dirty, and dirty marks on the microwave.” The staff member with delegated responsibility in undertaking staff ‘spot checks’ and assessing staff competency agreed they had found some staff did not adequately clean kitchen surfaces. They told us, “This can be a problem, I try to tell staff to clean it up.”

These issues posed risks of cross infection which could potentially lead to people becoming unwell.

However, care plans gave staff guidance to follow regarding the safe disposal of PPE and used continence products. Catheter risk assessments included details about the safe disposal of used catheter bags and steps to take to minimise the spread of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Staff had been trained in the safe handling of medicines. However, the staff member with delegated responsibility in assessing staff competency did not have a ‘train the trainer’ qualification in the safe handling of medicines. The provider had not robustly assessed their skill and knowledge prior to delegating this task. This meant that staff may be signed off as competent when some skills had not been assessed thoroughly.

We saw most people’s electronic Medication Administration Records (eMARs) showed they had received their medication as prescribed, However, the quality assurance staff member pointed out a few eMARs were missing signatures to demonstrate people had been given their medicine as prescribed and we could not be assured people consistently received their medicines as prescribed. The quality assurance staff member had noted these omissions, however, timely actions had not always been taken to address these. This meant the provider could not be assured people were consistently receiving their medicines as prescribed, which posed an increased risk to people. The quality assurance staff member told they would try to contact staff on the same day in the future if they noted any omissions in records.

Some people had medicines via a transdermal (skin) patch and we found no effective ‘skin rotation’ record was in place to ensure the manufacturer’s directions were followed. Staff spoken with were unaware of the need for ‘skin rest’ times. This meant we were not assured people prescribed transdermal patches were receiving their medicines in a safe way. This is further reported on in our well led section of this report.

Some people had ‘when required’ (PRN) medicines which included pain relief and creams. PRN protocols were in place but would have benefitted from more detail to ensure staff had all the information they needed. Body maps were in place for cream applications to a person’s skin.