Mobile Care Services 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 good. At this assessment the rating has changed to 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 based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

The provider’s operations manager and manager of the service, who had applied to become registered with the Care Quality Commission (CQC), had a desire to learn lessons when things had gone wrong and had identified areas in need of improvements. However, opportunities were missed to put actions into place in a timely way. For example, a local authority quality monitoring visit had identified shortfalls in risk management and the operations manager’s had continued to identify concerns in their later oversight checks, but actions had not always been taken to ensure gaps were addressed and good practices embedded.

Systems were in place to record accidents and incidents, and these were investigated. However, planned lessons to be learned from these had not always been acted on in a timely way.

The provider did not always work well 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.

Information available to staff in people’s care plans was not always accurate because when changes had occurred, care plans had not always been updated. For example, 1 person’s care plan referred to their spouse providing care tasks for them, but sadly their spouse had passed away over six months ago. This meant information shared in a transition to hospital, for example, may not be correct.

The manager did work with healthcare professionals such as GP's and the district nursing team. However, the manager confirmed to us that ‘catheter passports’ had not yet been requested on behalf of those people with a catheter. As good practice, ‘catheter passports’ were promoted by the Integrated Care Board (ICB) and contain important information about a person’s catheter care.

The provider 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 shared concerns quickly and appropriately.

Staff had been trained in protecting people from the risks of abuse and understood how to report any concerns to the service manager. Staff told us they believed the manager would act on concerns, and ensure people were protected.

The manager had identified when incidents were of a safeguarding nature and had informed the Local Authority (LA) and Care Quality Commission (CQC) as legally required to do so.

Overall, people felt safe from the risks of abuse. A few people told us there had been occasions when staff had forgotten to secure their door on leaving and this left them feeling unsafe and at risk from potential abuse. We alerted the manager to this concern, and they reminded all staff to ensure they checked doors were locked when they should be.

People and relatives told us staff wore uniforms and had identity badges. This meant people could recognise those employed by the agency.

The provider did not always work well with people to understand and manage risks or provide staff with the information and guidance they needed.

Improvements were needed in risk assessments and risk management plans. One person had chosen to have bed rails in place for their safety, but no risk assessment had been completed to determine any risk of, for example, entrapment of limbs and whether ‘bumpers’ would be advised with the use of the bed rails. Following our inspection feedback, the manager assured us a full review would be completed on people with bed rails and risk assessments put into place.

Some people had Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) directives in place. Staff told us when these were in place, a ‘red flag’ appeared on a person’s electronic care plan. We reviewed 2 people’s care records that had a ‘red flag’ indicating adirective was in place. One person’s care plan had a copy of their DNACPR and informed staff where this was kept in the person’s house for quick access. However, the other person had no copy of a DNACPR and no reference to any location of the document. This meant it was unclear whether such a directive was or was not in place. The manager told us a full audit would be completed on people’s DNACPR information to ensure accurate records were in place.

The manager told us some people had damaged skin and some people’s daily care notes referred to this. For example, staff had recorded for 1 person, “skin on bottom very sore”. However, there was no body map recording the skin damage or risk management plan in place to guide staff on the daily checks and actions they should take in relation to the person’s damaged skin. The manager told us these issues would be given priority to ensure they were addressed.

One person’s care plan contained a detailed substance abuse protocol informing staff of the signs to observe for and the actions to take to keep the person and others safe.

Staff did not always have the guidance available to them in people’s plans of care records related to moving and handling equipment. For example, 1 person used a ‘Wendy-Lett’ for safe repositioning in bed, but there was no information about the safe use of this equipment. Some other people used hoists but there was very limited information for staff to refer to, when needed, in people’s care plans. The manager told us this would be added in to provide staff with more in-depth guidance.

The provider had used a generic template to inform staff about some risks related to people’s health. These had not always been personalised or completed in a safe way. For example, 1 person’s record stated they had ‘Diabetes Mellitus type 2’, but immediately beneath this statement it read ‘I have type 1 diabetes’ because pre-populated text had not been removed. This meant there was potential for confusion in information about people’s health conditions. We discussed this with the manager who told us the ‘example text’ would be removed.

The provider did not always detect and control potential risks in people’s homes. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Staff did not always ensure people’s homes were safe.

Some people had special mattresses to reduce either the risks of skin damage, or further deterioration of sore skin. People’s care plans directed staff to ‘monitor and report any concerns.’ 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 desired effects. Following our feedback, the manager told us this information would be gained and a task added for staff to complete.

People did have environmental risk assessments, which included fire safety. One person had been referred to their local fire service because “smoke alarms are in the house but do not work”. This person had a known risk of fires and near misses. However, their environmental risk assessment had not been revisited and there was no outcome recorded from the referral. The manager assured us a review would be completed.

People and relatives gave us mixed feedback on how safe staff left people’s homes and the level of respect staff showed to their homes. One person told us, “Staff always ensure the bathroom floor is clean and dry, so I don’t slip.” However, improvements were needed with some staff. One person told us, “Some carers have little respect or no respect for other’s property. Some slop water all over the place, they are rushing and become careless. One staff spilt a whole bowl of water over our new flooring.” Another person told us, “Carers have arrived wearing welly boots and have no shoes covers, it creates a mess on our carpets. I have raised it as an issue, but it isn’t resolved.”

Improvements were needed with some staff leaving the floor space in people’s homes clear of trip hazards. One person told us, “I have poor mobility, some carers leave things in the wrong place, like a chair left out in the way, and then I cannot get my (walking) frame around it. I have tripped once.”

Improvements were also needed to ensure staff consistently left people’s home safe and secure. Some people did not feel safe in their homes when staff left because doors had not always been secured. Another person told us staff had left kitchen appliances on which posed a fire safety risk. We made the manager aware of this feedback, and they took immediate action to remind staff to turn off appliances and ensure people’s homes were left safely.

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 staff told us they were behind with updates in training to ensure their knowledge and skills remained in date. The manager confirmed to us training, checks on staff’s competence and supervisions were behind. The current situation did not ensure safe practice and posed risks of potential avoidable harm.

New staff had completed training and working alongside more experienced staff. However, not all these staff had received checks to ensure knowledge and skills from their training was embedded and they were competent to deliver care. One staff member told us, “I do not feel new staff now have the training they need or deserve, some have not had enough training on using equipment.”

One new staff member was administering medication, and using equipment including hoists to transfer people, without any competency checks having been completed. One office staff member told us, “The care team let me know if they [new staff] are alright and know what they are doing.” However, these staff were peers and not qualified to assess the competency of others. We were also told by a staff member that on occasions their concerns were not taken seriously.

One longer term staff member told us, “Sometimes there is moving and handling equipment in a person’s home and I do not know how to use it, it’s good we can phone the office, and they tell me over the phone.” This did not ensure safe practice.

The staff member, whose role included delivering staff training, told us, “Training is way behind, I am being made redundant in a few weeks, I have no idea who will then be delivering face to face training or competency checks on staff skills.” Following our inspection feedback, we further discussed our concern with the provider’s operations manager as we had not been assured there was a plan in place to ensure staff training completion and competency checks would be rectified and maintained. The provider’s operations manager agreed training and skill checks on staff were areas in need of improvement. They assured us some team leaders, remaining in post, following the restructure would be taking on this role and a further staff member would also be trained. This meant that while a plan was in place, improvements had not been made in a timely way.

We received mixed feedback from people and relatives about whether care calls took place at the agreed times, whether staff stayed for the agreed duration of the scheduled call and whether they had consistency in staff. Most people felt calls took place at the agreed times and were happy with the time staff stayed. One relative told us, “They are very punctual.” Another person told us, “They are now mostly on time, and if late, sometimes they will phone and let us know.” However, some people did not always have the same positive experiences. One person told us, “I am never sure when they will come.”

We received some comments about lateness from people and relatives. A number of staff told us they felt improvements were needed in allowing greater travelling time due to heavy traffic and road works in certain areas and this impacted on their timings.

Overall, rotas were scheduled to ensure people received care from consistent staff. This meant staff had opportunity to build good relationships with people they were caring for. Rotas reflected there were enough staff to undertake planned care calls. There were relief staff to cover planned absences, and in unexpected absences such as sickness, staff covered calls within their area to ensure consistency for people, where possible.

In the event of an emergency staffing situation, the provider did not have an effective priority system in place; that identified which calls were most important because of risks related to individual circumstances. Instead, staff would need to access each file individually to identify which people were in the greatest need of care.

The provider assessed the risk of infection, but staff did not always detect and control the risk of it spreading.

Staff had completed training in infection prevention and control. There was an infection control policy accessible for staff to refer to. However, 1 team leader told us they had needed to remind some staff on the importance of using and wearing personal protective equipment (PPE) such as gloves and aprons. This staff member told us, “I have worked alongside care staff, and they do personal care, like changing used continence pads, with no gloves on. I have explained to them why PPE is very important. I tell them we mustwash our hands on arrival to a care call, put on PPE, then wash our hands again and use new PPE for other tasks. It is a battle with a few staff to get them to use PPE.”

Most people told us staff wore PPE and did not raise any concerns to us. However, we did receive some negative feedback from people about staff. For example, 1 person told us a staff member wore the same gloves to prepare them a sandwich after emptying their commode. Other people said not all staff disposed of soiled incontinence pads in a safe way. This meant some staff were not following their training.

We received a concern from some care staff that PPE was of poor quality and tore easily. We discussed this with the service manager who agreed this had been the case, due to an error in ordering and less robust PPE had been purchased. The service manager told us they would remind care staff that newer stock was now available from the office.

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

Staff had completed training in the safe handling of medicines, but not all staff who administered medicines to people had received a ‘competency check’ to ensure they had the skills needed following their training. This included new staff to the care service, and this posed potential risks of unsafe practices.

Where people were supported with their medicines, they had electronic Medication Administration Records (eMARs) in place. Overall, these had been completed to show people received their medicines as prescribed.

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 time needed for ‘skin rest’ times. This created a risk of medicines being administered unsafely or contrary to clinical guidance. 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 to prompt accurate recording. For example, where a person could take 1 or 2 tablets, there was no record of whether 1 or 2 had been given by staff. Body maps for cream applications to a person’s skin were not always in place. The manager told us they were aware these were areas in need of improvement. Following our feedback, they told us body maps would be put into place where needed.