Courage Healthcare 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this newly registered 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

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.

Learning Culture

The provider did not always have a proactive and positive culture of safety based on openness and honesty. 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.

The provider did not yet have a strong learning culture embedded across the service. Systems were relatively new and had not been in place long enough to demonstrate sustained learning or service-wide changes in practice. Incidents had more recently been reported and analysed to ensure action was taken to mitigate future risks. This limited assurance that risks would be prevented from recurring. A healthcare professional told us that accidents and incidents were shared with them regularly.

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

Safe systems to support people across pathways and during transitions were not consistently effective. Risk information was not always clearly documented or shared, which increased the risk of gaps in care, particularly during hospital admissions or when care arrangements changed. This meant staff and external professionals did not always have access to clear, up-to-date information to support safe decision-making.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff had received safeguarding training and could describe how to raise concerns. However, safeguarding systems were not always supported by clear and complete records. Information relating to restrictions and legal safeguards was inconsistently documented, which reduced assurance that people were always protected from abuse and improper treatment in line with legislation. For example, when people’s care included the need for physical intervention, this guidance was not clearly documented within their care plans.

The provider did not 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.

Some people could display high levels of anxiety and distress. Although people had detailed positive behaviour support plans (PBS) in place, these did not include information on what physical interventions had been prescribed for people. There was no information within people’s care plans about which interventions had been prescribed and how to complete these safely. Although care records demonstrated these were used appropriately, the lack of detailed guidance for staff to follow placed people at risk of poor care through inconsistent approaches. Other risks to people had not been consistently assessed and mitigated, for example the risk of constipation. Where people were supported by multiple providers risk mitigation was not always in place for sufficiently detailed to inform staff how to reduce risks to people.

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

People received care and support in an environment which met their needs. One person could become distressed during personal care. Staff identified their bathroom was too small for staff to support them safely and advocated for the installation of a new bathroom. Staff supported this person by showing them a video of how the new bathroom would look to familiarise them to the new space. The provider ensured that people were supported to ensure the safety and upkeep of their environment. If there were issues the provider supported people to contact their landlords to report them, and ensure action was taken in a timely way.

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.

There were not enough staff to deliver the care to people supported and ensure that staff were not working excessive hours. Staffing arrangements did not always support safe care. Staff worked extended periods without sufficient rest days. Staff supported people who could become very distressed, and physical intervention was used. This increased the risk of staff fatigue and increased the risk of staff not responding positively to people.

Staff training records evidenced that staff had receiving training in relevant subjects including basic life support and supporting people to reduce distress. Staff had also received training on how to ensure that physical intervention was completed safely and in line with guidance. Staff were recruited following safe recruitment practices.

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.

Infection prevention and control practices were generally safe. Staff had received training, and audits were completed to monitor compliance. We received feedback that staff wore the relevant personal protective equipment (PPE) when providing support to people. Audits on infection prevention and control measures were completed, but lacked detail and did not always include action plans to address concerns.

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

Some people were prescribed medicines on an ‘as and when’ basis, for example pain relief or medicine for constipation relief. Although there was generic information relation to ‘as and when’ medication there was not specific protocols in place for each medicine, for example to inform staff when to administer it, or how frequently it could be administered in a 24 hour period. This reduced assurance that medicines would be consistently administered safely and in line with prescribing guidance. When people were supported by more than one provider, access to medicines administrations records (MAR) had not been provided to Courage healthcare staff. This increased the risk of people not receiving medicines when needed. The provider had not worked with other providers to ensure staff had access to the information needed to support people.

MAR included references to Stopping over medication of people with a learning disability and autistic people (STOMP), and staff were aware of risks relating to over medicating people. STOMP is a national programme to stop the inappropriate prescribing of psychotropic medications. Where people were prescribed medicines to manage their moods, these were not relied on by staff as a method of providing support. Medicines were administered by trained staff, and records were maintained.