Archived: Borough of Lewisham

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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

During our assessment of this key question, we found concerns around the management of risks, which was an ongoing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found concerns with the provider’s recruitment processes, which was an ongoing breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found concerns with the provider’s processes for ensuring staff received appropriate training and support, which was an ongoing breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found concerns with person-centred care, which resulted in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can find more details of our concerns in the evidence category findings below.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

At the time of the inspection the provider was providing support to one person. Despite the issues we found with risk assessments and care plans, the person’s relative told us the person was receiving safe care and effective. We received comments such as, “I happy with service. [Family member] is well looked after and safe.”

Staff told us they were supported to deliver safe and effective care. We received comments such as, “I think it safe. If I had any issues I would speak to the supervisor.” However, some staff did not have a full understanding of all the risks to people’s health and wellbeing. For example many documents indicated the service user was at risk of choking due to swallow difficulties and needed food to be prepared in a specific way. Although staff did not support this element of support care some staff did not have any understanding that this was a risk for the person. Some staff also did not have a good understanding of the equipment that was in place to mitigate the risk of skin breakdown.

Due to the size of the service, feedback from partners was minimal. The local authority was not currently working in partnership with this provider due to the issues of quality identified at the last inspection. However, they told us, “The provider had engaged with them during the provider concerns process and were able to complete everything stated in the improvement plan prior to the provider concerns process coming to end.”

At the last inspection the provider was failing to ensure risks to service users were managed well to reduce them. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Not enough improvement had been made and the provider was still in breach of regulation 12.

There were a range of policies and processes about safety but these did not always enable shared learning and drive improvements. The approach to identifying and managing risks was not effective. We found the information in the risk assessments to be conflicting, and guidelines for staff were not clear.

Risk assessments did not adequately assess all the risks associated with mobility or give sufficient guidance on the moving and handling tasks being carried out by staff. The make, model and maintenance history of the moving and handling equipment being used was also not recorded. Different documents referred to various different pieces of equipment that were not in use. This lack of clarity meant the provider could not be assured the equipment was safe to use and staff had all the information to ensure they could carry out this task safely.

The risk level of risk of skin breakdown was not robustly assessed using a recognised risk assessment tool.

The use of topical skincare products and equipment had not been considered as part of the fire risk assessment, therefore the risk of fire was not adequately assessed or recorded.

We shared our concerns with the quality of the risk assessment documents during the inspection, and the registered manager sent us revised versions. Despite this, we continued to identify shortfalls and guidelines for staff which were not clear.

The failure to effectively assess and mitigate risks to people’s health and wellbeing was a continued breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

The relative of the service user told us they had been consulted about the person’s care needs and risks, however, they had not seen the care plans and risk assessments. This was contrary to records we reviewed which stated the risk assessments had been signed off by the person’s relative.

Staff told us the person’s relative monitored the care and support taking place. Staff took action to report concerns when they witnessed a decline in the person’s health. One member of staff told us, “If I have any concerns I communicate with the person’s relatives and inform the office.”

Despite evidence to show people and or their relatives were consulted about the risks we found risk assessments and care plans were not always person-centred and did not always contain accurate information. We also found discrepancies with the information about people’s sensory and communication needs and there was conflicting information about the person’s behaviours.

The risks associated with people’s health conditions were not clear. Care plans and risk assessment documents recorded health conditions but there was very little information about how these affected them and how they impacted other elements of care such as moving and handling tasks. There was also insufficient information for staff about the signs and symptoms to look out for further health concerns.

The risk assessment documents were not always reviewed and updated when people’s needs changed. During the inspection we were informed of a recent change in the person’s health that had not been documented and/or reported to the local authority.

The failure to design a person-centred care plans addressing people’s changing needs was breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

At the last inspection we found multiple issues with staff attendance times. The provider had made improvements and we received positive feedback about staff timekeeping. The family member of the person receiving care told us, “The always arrive on time and there are always 2 of them.”

Staff told us they had a thorough induction and access to ongoing training and support. One staff member told us, “We had 5 days of induction with lots of training.” Despite this positive feedback, some staff could not recall having received some elements of training such as mental capacity act training. Staff could also not remember which manager had carried out their one-to-one supervision.

Processes (1950)

At the last inspection the provider was failing to deploy staff safely which was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Despite some improvements, further issues were found and the provider remains in breach of regulation 18.

The provider’s process for insuring staff receive an adequate induction and ongoing training and support was not robust. The Registered manager had delivered training in a wide range of topics and areas. However, they have not showed that they have the skills and ability to deliver this training. Staff had not received all the relevant training required. Induction and training records for some staff pre-dated their employment.

This was a continued breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At the last inspection staff sometimes did not have sufficient travel time, which meant they were late for people’s care visits. The provider had made improvements. The person receiving care was getting their visits on time from regular staff.

At the last inspection the provider did not follow recruitment staff safely which was a breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Insufficient improvement had been made; the provider remains in breach of regulation 19.

The provider had failed to obtain a full employment history for all new staff. References provided were not always from the most recent health and social care employer and from legitimate sources.

The failure to recruit staff safely was a continued breach of Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider obtained Disclosure and Barring Service (DBS) checks for staff. DBS checks provide information about convictions and cautions held on the Police National Computer and helps employers make safe recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The person's family member confirmed staff did not provide any support with medicines.

Staff also told us they did not currently provide support with medicines.

At our last inspection the provider had failed to robustly assess the risks relating to the management of medicines. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We were not able to assess whether the provider had made sufficient improvement as staff were not providing medicine support at the time of the inspection.

During the inspection the registered manager provided a range of documents and policies showing how they would ensure people’s medicines would be managed safely. However, due to the conflicting information in care plans and risks assessments we could not be assured the provider had made sufficient improvements. Many documents contained a repeated direction for staff to administer ‘medicines using a MAR’. We found numerous examples of care plans, risk assessments, review forms and audits where this information was repeated despite this support not being delivered and staff having no responsibility to administer the person’s medicines.

We raised our concerns about the discrepancies in relation to medicines support with the registered manager and they subsequently reviewed all care plans and risk assessments and removed the errors we identified.

Although staff were not currently supporting people with medicines the provider ensured staff received training and their competency had been assessed by a competent person. However, the medicine competency assessments were not reliable as it was not clear how the assessor had been able to observe many aspects of medicine support documented on the competency form as the provider was not responsible for administering medicines at the time of the assessment.