Caring@Home 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 – 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.

The service was in continued breach of legal regulation in relation to safe care and treatment at the service.

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 demonstrated a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns relating to safety, and safety-related events were reported and investigated. Learning from incidents was used to identify risks and embed good practice.

Systems were in place to record learning identified through feedback, complaints, and incidents. We saw staff meeting minutes which evidenced that information was shared to support improvement. One member of staff reported receiving additional support and training following an incident and people we spoke with did not raise any concerns about the service.

The provider worked in partnership with people and healthcare professionals to establish and maintain safe systems of care, where safety was appropriately managed and monitored. They ensured continuity of care, including during transitions between different services.

Systems were in place to assess and monitor new packages of care. The provider completed home visits to assess people’s needs, and people told us they received “extremely thorough” assessments. We also saw evidence of a health passport, which contained vital information for autistic people and people with learning disabilities, or complex needs in the event of a hospital admission.

Staff spoken with demonstrated a good understanding of the needs of the people they supported.

The provider worked effectively with people and healthcare partners to understand what safety meant to them and how this could be achieved. They focused on improving people’s lives and protecting their right to live safely, free from bullying, harassment, abuse, discrimination, avoidable harm, and neglect.

The provider had systems in place to record and monitor safeguarding concerns and a safeguarding policy to guide staff in responding appropriately to potential risks.

Staff had received safeguarding training and demonstrated a good understanding of their responsibilities in protecting people from abuse, harm, and neglect. Staff we spoke to were able to recognise safeguarding concerns and understood the appropriate procedures for reporting and escalating issues when necessary.

The provider did not always work effectively with people to understand and manage risks. Staff did not consistently provide care that was safe, supportive or enabled people to do the things that mattered to them.

For example, where people were supported to apply emollient‑based creams, there was no information in place to inform people or staff of the associated risks or the measures required to mitigate those risks. This meant the provider lacked assurance that safe care and treatment was consistently delivered, placing people at risk of harm. This was raised with the nominated individual on the day who took action to implement this across the service.

However, people and their relatives spoke positively about the care provided. One person told us, “It’s a delicate balance for [staff]. Nothing can be perfect, but [relative] engages well with carers, and the risks are well managed.”

Staff spoken with during the inspection demonstrated a good understanding of people’s individual needs and associated risks and were able to explain how these risks were assessed, monitored and managed in practice.

The provider did not always effectively identify and manage risks within the care environment and did not consistently ensure that equipment, facilities, and safety systems supported the delivery of safe care.

We identified gaps in the provider’s approach to managing risks associated with lone working for live-in staff. There was no clear guidance provided to the staff members regarding emergency procedures or responsibility for monitoring and testing smoke and carbon monoxide alarms. This meant, the provider could not be fully assured that appropriate systems were in place to identify and respond promptly to risks, which could place both the person receiving care and the staff member at risk of harm.

However, the provider had completed an environmental risk assessment, and records showed that checks of moving and handling equipment and electrical appliances were carried out. Moving and handling risk assessments were in place, including a specific assessment for the use of a mobile hoist.

People told us they had access to the equipment they needed, and staff demonstrated an understanding of how to manage risks associated with the equipment in use.

The provider did not always ensure there were sufficient numbers of appropriately qualified, skilled, and experienced staff to meet people’s needs. In addition, staff did not always receive appropriate competency checks and ongoing development to support them in consistently delivering safe, person-centred care.

On the day of the inspection, staff files did not contain complete induction documentation. This information was requested, and the nominated individual agreed to submit it for off-site review.

The documentation provided showed that “shadow shift competency assessments” had been completed by peers. These assessments covered areas such as medication administration and moving and handling, with peers required to determine whether staff had achieved a pass or fail outcome. However, those undertaking the assessments did not hold the appropriate qualifications to assess competency. As a result, the provider could not be assured that staff were competent or had the necessary skills to consistently deliver safe care.Supervision records were not fully aligned with the provider's policy.

Despite these concerns, people using the service did not raise issues regarding staffing levels and spoke positively about the consistency and punctuality of staff.

The provider assessed and managed the risk of infection effectively. Systems were in place to identify, detect, and control infection risks, with appropriate arrangements to escalate and share concerns with relevant agencies when required.

We saw evidence that compliance with personal protective equipment (PPE) was monitored through staff practice observations. People spoke positively about infection prevention and control practices and told us, “They wear aprons and gloves when they need to.”

Staff confirmed they had consistent access to appropriate PPE, including gloves, aprons, masks, hand sanitiser, and shoe covers. They demonstrated a good understanding of hand hygiene and the correct use of PPE to reduce the risk of infection and prevent the spread of illness.

The provider did not ensure that medicines and treatments were safe or met people’s needs, capacities, and preferences.

People who were prescribed medicines to be taken as required (PRN) “did not have sufficient guidance in place to support staff to administer these medicines safely and consistently. This issue was raised on the day of inspection, and the nominated individual took immediate action to update the required information. However, this meant the provider could not be assured that medicines had been consistently administered safely and in line with best practice prior to this action.

We also found that staff were completing blood glucose monitoring without having received appropriate training or documented competency sign‑off. This further limited assurance that medicines‑related practices were being carried out safely and by staff with the necessary skills and oversight.

Despite these findings, people using the service and their relatives spoke positively about the support they received with medicines. One person told us, “Staff have had specific training for all [relative’s] medicines.” Staff also told us they had received medicines training and regular competency checks to support safe practice.