Eunha Healthcare 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 as 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 53 (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. The provider did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff understood how to report incidents and accidents and escalate safety concerns. However, there was limited evidence available to demonstrate these had always been followed up and investigated by the leadership team. There was also very limited evidence that actions and improvements were routinely shared with staff following each incident.

At the last inspection, significant concerns were identified across multiple areas of the service. This included the safe management of risks and staff training. Whilst some improvements to service delivery were noted, some issues remained, and the provider could not fully evidence that all lessons had been learnt.

We did see evidence of partners being made aware of safety events at the service.

People knew how to raise safety concerns and felt they would be listened to if they raised concerns.

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.

People told us that if they had been in the hospital, the discharge had gone smoothly. One relative said, “The transition was smooth.”

The provider told us that prior to a person's care package starting, they reviewed the local authorities' assessment and conducted their own pre-admission assessment to ensure they have an overview of the person's needs.

The provider mostly worked with people and healthcare partners 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 mostly shared concerns quickly and appropriately.

The provider did not work in line with the Mental Capacity Act 2005 and the associated codes of practice. The provider’s mental capacity assessments showed a blanket approach, with all people having these in place, and for the same decisions. This meant we could not be assured people's human rights were always upheld and that people were not subjected to unnecessary restrictions on their daily life.

People told us they felt safe. One person said, “I do feel safe, no concerns around any form of abuse.” Another person stated, “The service I receive is fine, I feel very safe.” Relatives echoed this feedback, with one relative telling us, “Staff are all fine, no abuse and [they] feel quite safe with them in [their] home.”

People knew how to raise a concern and mostly felt assured that appropriate action would be taken by the provider.

Staff understood how to monitor for signs of abuse and how to report these appropriately. The majority of staff had received safeguarding training. The leadership team met regularly to discuss any safeguarding concerns and review what actions needed to be taken. We saw evidence the provider held safeguarding meetings with the staff team to reinforce good practice.

The provider had an up-to-date safeguarding policy in place.

The provider did not always work well with people to understand and manage risks.

People’s care plans did not always provide sufficient guidance on how staff should safely support them with known risks around, skin integrity, smoking, medicines and health conditions. For example, where people required specific support to manage their incontinence needs, risks associated with this had not been identified, mitigated or recorded. We raised this with the provider during the inspection, and they updated people's records immediately.

People who were at increased risk of skin breakdown did not have nationally recognised tools in place to guide staff in identifying deterioration in a person's skin. Staff did not understand nationally recognised tools, and we saw evidence of several people being recorded as having areas of sore skin. One relative said, “Not much confidence in the carer's observation skills as [relative] has got an ulcer on [their] foot and a spot on [their] calf. When I asked the carers, they had no idea they were there, and they are the ones washing [relative] and applying cream.”

We also identified that where people were at increased risk of falling and were prescribed medication which increased the risk of bleeding, there was a lack of information and risk mitigation in place for staff to follow. This included specific information for staff to follow in line with national guidance, and this had exposed people to an increased risk of avoidable harm

We addressed this with the provider during the inspection, who did make amendments to their current records in a timely manner as soon as we had shared our findings.

The provider did not always detect and control potential risks in the care environment.

The provider had completed environmental risk assessments for each person using the service. However, these had not always identified all potential issues, and some risk assessments to help mitigate risks posed to people had not been completed. This was particularly an issue where people smoked, and this had been raised as a concern at the last inspection. The people we identified were at increased risk of harm due to having flammable emollient creams applied, some homes being cluttered and people who had significantly reduced mobility. We also identified people’s care records did not include guidance for staff on how to safely support people to evacuate in the event of an emergency occurring during the person's care call.

We raised our continued concerns with the provider, who acknowledged the risks posed to people and began updating care plans to reflect these risks. Whilst we noted some improvement in the updated records, guidance was still missing from some records to support staff in an emergency and further improvements needed to be imbedded.

People and their relatives told us staff had access to the correct equipment to meet people’s needs. One relative stated, “[Relative] have the right equipment. They have a hoist, hospital bed, sheets, commode.”

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.

Some people told us staff did not always stay for the full call time, they felt rushed, and tasks were, at times, left unfinished. A person stated, “They [staff] arrive on time. Sometimes I am rushed. I have to negotiate with them to get the care.” We reviewed call data as part of the inspection and found a number of occasions where staff had not stayed for the full duration of people’s care visits. For example, the data showed a person who had experienced staff staying less than half of the planned time on 69% of occasions in the 24 days prior to the inspection. However, some people and their relatives were very complimentary about the timeliness of the staff arriving to deliver their care.

Staff did not always have adequate training to deliver care safely and competently. During the inspection, we found that not all staff who regularly delivered care to people had completed sufficient training to meet people's needs. We also found that some staff were working with expired training. Following the inspection, the provider gave us evidence that staff had now completed or refreshed their mandatory training.

People told us that the staff had sufficient training to meet their needs. One relative told us, “Yes, especially they know how to use the hospital bed and hoist. They have been trained with that.”

Staff were recruited safely. The staff files we reviewed during the inspection showed an improvement from the last inspection. The provider followed appropriate recruitment processes to ensure compliance with legislation.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us staff wore Personal Protective Equipment (PPE) when they came to deliver care. A person told us, “[Staff] clean their hands and wear gloves, shoe covers as well.” A relative told us, “[Staff] put aprons on and gloves.”

Staff had access to a plentiful supply of PPE and understood the importance of wearing this. The provider told us they regularly completed spot checks to ensure staff compliance with PPE, and we saw evidence these had taken place. We also saw evidence of messages being sent to staff by the management team to regularly remind staff of the importance of ensuring they continued to wear PPE.

The majority of staff had received training in infection prevention and control.

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

One person who required a medicine dose 4 hours apart, was receiving their medicine much more frequently than the required 4-hour gap. We raised our concerns with the provider who organised an urgent review with health professionals for the person.

Staff were found to be applying some prescribed creams to people without Medicine Administration Records (MAR) being in place. The provider was working on a digital system and the leadership team were responsible for inputting people’s medicines and creams onto the electronic MAR system. The leadership team acknowledged this and gave assurances about how their systems would improve immediately in respect of this.

Some medicine care plans and risk assessments lacked critical detail to guide staff in the safe administration of medicines. We raised this with the provider who took immediate action.

One relative advised they had some concerns with their loved one’s medicine administration and advised they had found tablets missing from the blister pack, so could not be confident that their loved one had not received a double dose of their prescribed medicine.

Where people had been prescribed ‘as required’ medicines, protocols were not always in place to provide staff with clear guidance on when, and how, to administer these safely. The provider acknowledged our feedback and responded immediately with updated paperwork.

The vast majority of people received their medicines safely, and at the right time. The issues above were only identified for a small group of people using the service.