Josh's Care Company 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.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider promoted a culture of continuous improvement, of openness where opportunities for improvement were shared.

The provider carried out a monthly accident and incident analysis where themes and patterns were identified for, for example, seizures, choking, medicine errors and falls. Actions were identified to mitigate risk and recommendations made. For example, in response to potential harm from choking, updated training for staff covering emergency response and safe feeding practices including a review of swallowing risk assessments and mealtime protocols was implemented. Risk levels for individuals were also identified and recommendations made. For example, where a high incidence of seizures was identified, actions were completed, including reviews of seizure management plans, checks of medicine administration timings and a check for rescue medication readiness in order to mitigate the risk of harm to people experiencing seizure activity. The provider completed audits, records of which identified when recommendation actions were completed.

Staff understood the process for reporting any accidents, incidents and concerns and expected input and support from the leadership team to ensure best practice. One member of staff told us, “If we have any problems all the management team are so supportive. I feel comfortable to raise anything and know I will get the support to deal with the situation.”

People knew who to contact if they had any concerns. One person told us. “I know who to talk to if I need to. There is no problem in speaking to someone, I know the names of all the nurses and managers. The one problem I have had was very quickly resolved.” Another member of staff told us, “If I have any concerns, I will go to the manager and the team. We are like a family. There is always someone there, I can talk to any member of the team. It feels like we work together”.

Learning opportunities were recorded, actioned and shared by the provider. An annual review of the lessons learned was reflected upon and shared with stakeholders.

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.

The provider implemented comprehensive pre-admission procedures to ensure safe, person-centred care. The process included a review of the referral information, including the identified care needs by competent senior staff, involving the person, their relatives and professionals. The provider prepared a team of staff with the appropriate knowledge and skills to support the person. The provider worked with the person, their family and specialist health care professionals to ensure continuity of safe care. A professional who worked with the service told us “They [the provider] have worked alongside key professionals in the NHS to ensure care plans remain exceptionally safe and up to date”.

Each care package was monitored monthly by a member of staff with the skills and knowledge to be able to maintain clinical oversight of the person’s complex care needs. The care plan contained up to date, detailed information which was accessible to everyone involved in the care of the person. One professional involved in the care for a person told us, “I have supported the provider by providing individualised training due to the patient's unique management plan.”

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.

People were safe and knew how to raise concerns about abuse or neglect. Staff understood how to ensure people were protected from abuse and neglect. Staff were comfortable to raise any concerns and were confident any concerns raised would be dealt with appropriately by senior staff. Lessons learned from safeguarding issues were shared with stakeholders and improvements made to improve outcomes for people. One professional who worked with the service told us, “The care agency has shown a consistent exceptionally safe and highly effective and evidence-based standard of care along with a genuine desire to help and care for people and their families”.

The provider shared concerns appropriately, ensuring the relevant agencies were informed.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had developed a thorough risk assessment document. This was completed by staff with the appropriate knowledge and skills with the person and/or their representative with input from professionals involved in the person’s care. This information informed care plans which provided staff with the information necessary to support people to keep safe.

Staff knew people well and had access to a person’s care plan which was kept up to date with all current information. Risk management strategies were person centred, regular reviews ensured they remained effective and responsive to people’s changing needs. The provider implemented a monthly review of people’s care records. People were involved in these reviews, to identify any changes or updates. People were supported to identify the goals which were important to them and the provider empowered them to achieve these. For example, providing support to a person to pursue a new sport to help improve their health and well-being.

People were supported to make decisions to balance the areas of risk in their lives to improve their well-being. For example, a person had chosen to not follow the guidance for the use of a therapy, this was discussed with the person and the person’s decision recorded so all staff supporting them were aware of the potential additional risks and how to respond to this.

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

The provider completed an assessment of people’s homes with them. Staff understood their responsibilities to report any safety concerns and did so as required. Monthly checks of the equipment and premises were carried out. Concerns raised and any issues identified were acted upon. The provider responded to any queries from people or their families in relation to their home and the equipment they used. One person told us, “They [staff] do everything to keep me safe. They check all the equipment is working, including my chair and arranged to get the hoist fixed.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff were recruited safely and trained to be competent to support people with complex needs. The provider developed a talent acquisition team to implement their person-centred recruitment policy. The provider gave people the opportunity to be involved in the process to recruit staff for their care team. The provider invited people to develop their individual job description to meet their needs and be an ongoing part of the process to employ the right staff for them. Newly recruited staff were invited to meet and greets with people with the aim of people being able to choose staff to support them. Ongoing support was provided by senior staff to the person, their family and staff team to ensure the continued delivery of safe care to meet the person’s needs. One person told us, “I have more staff in my team now, they [the provider] went above and beyond. I did meet and greets with staff, it was my decision who to choose, now I have people who I feel most comfortable with.”

The provider developed a programme of specialised training and induction prioritising face to face learning with e-learning being a supplementary element to the training provisions. The provider had gone through accreditation processes for all clinical training delivered by employed staff. The provider developed an on-site training suite with access to all equipment used by the people supported to ensure hands on learning in an exceptionally safe environment.

Staff were trained in clinical tasks; their competence checked prior to beginning to support a person then regularly assessed in the workplace. One member of staff told us, “We can use the training across the different packages. For example, the principle of stoma care is the same, but different for each person. We do shadow shifts to get to know people, how they communicate and where things are kept. We can then provide the correct support”.

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 were protected as much as possible from the risk of infection. Staff understood their role and responsibilities for maintaining high standards of cleanliness and hygiene in people’s own homes, as well as their own hygiene, including hand washing. Staff were provided with and used personal protective equipment (PPE), in line with recommended national guidance. The provider carried out monthly audits which included spot checks for staff handwashing, checks of PPE stocks, an observation of cleanliness and checking of cleaning records. People had no concerns relating to infection prevention and control.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were supported to manage their medicines safely. Assessments were completed to identify the support people needed to safely manage their medicines. This information was recorded in guidance in people’s care records for staff to follow to support each person to safely manage their medicines. The electronic care system used by the provider identified any missed administration of medicines and the time of medicine administration. This was monitored constantly and actions taken to ensure all medicine administration tasks were completed. The provider completed monthly audits which identified themes and trends of any errors. Recommendations were actioned to reduce the risk of errors. Staff were supported to develop and maintain best practice. One member of staff told us, “If something goes wrong, we are supported to do it correctly.”