Chiron Care (UK) Limited

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• 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 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. Robust recruitment procedures were not operated to ensure staff were recruited safely.

The service was in breach of 1 legal regulation in relation to fit and proper persons employed.

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 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 recorded accidents and incidents which included summaries of the incident, actions taken at the time of the incident and lessons learnt. The provider tracked the incidents to identify themes and trends. Staff told us incidents were recorded and investigated. Comments included “I feel all our incidents are investigated, if a risk is identified risk assessments are reviewed and updated to reflect this” and “I feel able and supported to raise concerns at any time, and there is an open culture where staff are encouraged to speak up without fear of blame. Incidents are investigated appropriately by the team lead and manager, focusing on learning and preventing recurrence rather than fault.”

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 carried out an assessment of people’s needs before they began to use the service which meant they were able to plan any support required for people. Not all people had hospital passports. However, one person with a hospital passport had an additional passport to guide professionals in supporting the person with their specific needs. People had personal emergency evacuation plans (PEEPs). The provider told us they worked with people and professionals and completed assessments to support people moving into a supported living accommodation that suited them best.

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 told us they received safeguarding training. Comments included, “It helps me understand how to keep myself and my residents safe. I feel very safe raising concerns at any point at my workplace” and “I apply this learning daily by remaining vigilant, recognising signs of abuse, and reporting concerns promptly. I feel confident raising safeguarding concerns.”

The provider did not always work well with people to understand and manage risks. The service completed risk assessments in relation to falls. However, we identified some of the information in relation to risk assessments were not up to date. Therefore, it was not always clear what support people required in relation to risks and this placed people at greater risk of harm. The registered manager informed us they would update the care records.

The provider did not always detect and control potential risks in the care environment. One person’s care records, who required equipment to support them with their mobility, included guidance for staff to ensure the person’s living space remained free of hazards. However, we identified not all fire extinguishers had been serviced. We acknowledged the provider took steps to rectify this. We identified risk assessments were not completed for emollient creams which pose a significant fire risk.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

We identified there were gaps in recruitment records and inconsistent information within the recruitment records. The application forms were not fully completed and there was inconsistent information between the application forms and dates of references. We identified one person’s recruitment records did not have any interview questions and interview records were not always completed. Where interview questions were asked, these were not always appropriate for the job applied for. For example, there were no questions on safeguarding. There was no evidence of relevant qualifications. Our inspection identified spot checks, observations, competencies were not completed. Induction records were not always completed. The provider did not have systems in place to identify overdue training. We acknowledge the provider has since informed us they, “have found someone to identify overdue training.” Staff told us they received supervisions and the team leader and the registered manager scheduled the rotas.

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. We did not identify any concerns with the cleanliness of the supported living homes we visited. The provider had an infection prevention and control policy.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff told us they supported people with medicines administration, monitored people for any side effects and arranged appointments with relevant professionals such as the GP. Staff also told us they ensured administration of medicines was actioned in line with guidance and polices and documenting accurately, However, we identified a “when required”, “pro re nata” (PRN) medicine for a person had not always been administered as per their PRN protocol. Staff did not record the reason for why a PRN medicine had been administered nor the efficacy of it being administered. For one person, we identified on their medication administration record sheet (MARs), there were instructions for a gel to be applied when required. However, there was no “when required”, (PRN) protocol in place. There was incorrect information in relation to medicines administration within people’s care records. For example, 1 person’s care records stated to have covert medicine as a, “back-up plan (Last Resort).” However, the provider informed us this was incorrect information and they did not support people with covert medicines. The provider did not always action medicines audits. We identified the provider did not have professional clinical oversight when administering injections. The provider has since informed us they have arranged for relevant external professionals to administer injections.