Rapid Care

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 people’s safe care and treatment, including the ways people’s medicines were managed.

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 continued to not always have a proactive and positive culture of safety. 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.

Learning had not always been consistently applied across the service. While staff gave examples of learning following incidents or accidents, we found some incidents had occurred which had not been fully reviewed to ensure learning translated into improved practice. For example, some risk assessments and care plans had not been reviewed following incidents, and the service had missed opportunities to make changes to people’s care to prevent future recurrence. At the time of our assessment, we found the incidents reviewed had been isolated, and people had not experienced repeated issues. The provider made changes to their processes for monitoring and reviewing incidents and accidents, following the concerns raised by the inspector, to ensure safer future practice. We will check this at our next assessment.

Staff described how management shared updates, and 1 staff member told us, “My manager listens and always tries to help.” Staff meetings were used to discuss improvements, but gaps remained in how lessons were monitored and followed through.

The provider continued to work 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 when people moved between different services.

People’s needs were assessed by senior staff prior to their package of care commencing, and risk assessments and care plans were put in place at the start of their care. A staff member told us, “I do assessments. We look at referrals from the council, and then we assess and speak to people.”

People told us their care was delivered safely day-to-day, and staff understood how to support people with known risks. A relative said, “They are all so kind, caring and very helpful doing all that is needed to make our lives more bearable… When things change with [person’s] condition, we discuss it together and [person’s] care plan is altered accordingly so each of the carers knows what to do.”

Where people required support from other health or social care professionals, the service made appropriate referrals and worked in partnership to meet people’s needs, for example to occupational therapists and district nurses.

The provider continued to work 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.

People told us they felt safe with staff, with 1 person saying, “I feel very safe, the carers all know what to do for me.” People and relatives told us they trusted the staff and felt concerns would be acted on.

Staff had completed safeguarding training. They understood safeguarding and were confident to report concerns. A staff member said, “Safeguarding is making sure a person is safe from harm. I always use it in my role.” Another staff member said, “I have raised a safeguarding. I raised with my manager. I have also raised it with the council and CQC. I did receive feedback and it was dealt with thoroughly.” Safeguarding referrals were discussed during management meetings to ensure any actions and follow up were completed as required.

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

People told us they were involved in their care planning, and relatives agreed. A relative told us, “[Staff] discuss things with us and keep us updated.” The provider had focused on addressing previous concerns with some areas of risk assessment, monitoring and mitigation. Improvements were seen in some care records and task instructions, for example, around catheter care and moving and handling support.

However, some other risk assessments were missing or incomplete, such as for bedrails and skin integrity risks. This meant there was a risk that staff would not be aware of risks to people and people could be at risk of avoidable harm. We raised this concern with the provider during the assessment and immediate actions were taken to address gaps.

Some people were at increased risk of infection related to their personal care and support needs. Although the risk of infection had been considered for catheter care, this had not always been considered for skin integrity concerns, such as wounds or sores. This meant guidance was not always available to support staff to identify concerns and to outline escalation pathways. Despite this, we found no evidence of infection concerns not being highlighted or addressed.

Staff told us, “Care plans we read through and from there we can form a plan to care following the instructions.” However, several care plans lacked the personalised guidance needed to keep people safe. For example, where a person was at risk of choking, there was not sufficient guidance to enable staff to consistently support the person safely. The person had raised concerns about their food not being cut small enough during a recent care review, but this had not resulted in the guidance in their care plan being made clearer for staff to follow. This placed the person at continued risk of harm. The provider took immediate action to update the person’s records during the assessment.

Where people had specific health conditions or needs which could impact on many areas of their care, such as Parkinson’s Disease, this had not always been risk assessed, and guidance was not always in place for staff to support this. The provider addressed these concerns following the assessment.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Some environmental risks had not been assessed, such as the use of bedrails. During the assessment, we raised with the provider that there were no risk assessments for people who had bedrails in place. The provider investigated the concerns and identified that some people with bedrails did not have protective bumpers in place. They took action to make referral requests for protective bumpers and put relevant risk assessments in place.

Other equipment, such as hoists and stand aids were used appropriately. Staff told us, “Moving and handling someone, I ensure that I follow the procedure and if we need to hoist a person, I follow the procedure. I am not allowed to use the hoist on my own. Ensure the person is comfortable, they are well positioned, ensure all equipment is correct, and batteries are working.” A person told us, “They always check everything before they use it.” Staff had assessed other environmental risks for both people and the staff attending people’s care calls, including risks in people’s home environments and the risk of fire.

The provider made sure there were enough qualified, skilled and experienced staff however they had not always ensured they were suitably deployed to meet people’s needs in line with their preferences. They did not always make sure staff received effective support, supervision and development.

The provider had enough staff employed to cover the care hours they needed to deliver. However, staffing arrangements were not consistently effective. Most calls now start on time or within the accepted half hour variation. However, some calls did not last for the full duration of the call time. Not all staff were given travel time between their care calls, and some staff described pressures in some areas they covered. A staff member said, “Sometimes we don’t get enough travel time.” Another said, “It depends if the next person is close, then it is fine.” When we raised this with the provider, they told us they had identified these areas for improvement and were actively monitoring staff call time performance data and addressing concerns, as well as actively recruiting staff who could more easily cover certain areas.

The data we reviewed in relation to the services call scheduling also showed high variation in staff attending double-up calls. Some people commented that staff consistency could be improved.

Staff were recruited safely with appropriate pre-employment checks completed, including references and Disclosure and Barring Service checks. New staff received an induction, which they told us was informative. A staff member said, “It was really very smooth. I have a good manager, we did training and I shadowed people it was very helpful. When they were happy that I was ok, they left me start work.”

Staff were content with the training they had received. However, some people requested that staff complete training in relation to their specific care needs, which had not been actioned in a timely manner. Training compliance prior to the assessment had not been consistent with some areas of low completion, such as Parkinson’s disease and diabetes awareness. However, during the assessment, the provider significantly increased the training compliance and updated their processes to include more frequent oversight in this area.

At the time of the assessment, the service was behind on staff supervision. The provider was working on getting them up to date. However, staff told us they felt supported in their roles. A staff member said, “They provide guidance and support."

The provider assessed and managed the risk of infection.

Staff followed appropriate infection prevention and control (IPC) measures. People told us staff used personal protective equipment correctly and maintained hygiene standards. A person said, “[Staff were] very respectful and always clean and tidy.” Staff had completed IPC training, and daily notes demonstrated safe cleaning and personal care practices. The provider staff IPC compliance as part of their quality monitoring during spot checks on staff practice.

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

We found a repeated issue, where the provider had not followed their own Medicine Policy, as medicines were being administered without a Medicine Administration Record (MAR) in place. The provider contacted staff to ensure there were no further incidents of this and put MAR charts in place when this was raised by the inspector.

Some people who were prescribed pain relief patches were not having these administered, with the required number of rotations, in line with the manufacturer’s guidelines. This is important to reduce the risk of skin irritation. The provider updated the guidance following the assessment to ensure staff would be prompted to make the correct number of rotations.

The service had experienced some stock issues, and although the service policy stated they were not responsible for the stock of medicine, staff were responsible for administering people’s medicines as prescribed. There had not always been prompt escalation by staff for medicine stock issues, and some people had missed some of their medicines for short periods of time.

However, there had been some improvement in the way medicines were managed. There was now sufficient guidance for staff in relation to how to administer people’s prescribed creams. The provider's policy had been updated to better reflect the practice they expected from their staff. Feedback from people was now positive about how their medicines were managed. A person said, “The carers always make sure we get our tablets each day.” Staff told us they received training to administer people’s medicines. A staff member told us, “I record on the MAR chart…I would also record if people refused.” Another said, “I check the MAR chart, and we use a no touch policy. We put it into a medication pot and check the name of the person, using the right route, at the right time. I also make sure I log medicine administration in the daily log."