Quality 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.

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.

We found the provider to be in breach of 1 legal regulation in relation to recruitment.

This service scored 62 (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 registered manager told us there had been no accidents and incidents; however, they were aware that any lessons learnt would be used to improve the quality of service and relayed to staff to embed good practice. For example, records showed best practice was being relayed during staff meetings in relation to people’s safety and reporting and recording of accidents and incidents. Care records included prompts for staff in relation to maintaining people’s safety and reporting of incidents. Staff were aware of actions to take in such instances including recording incidents and informing the registered manager.

The registered manager was aware of their responsibility to notify relevant healthcare professionals, CQC and submission of statutory notifications of any significant events at the service. .

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. A relative told us, “[Person] was discharged from hospital. The company were most helpful when they arranged care.”

There was a collaborative approach which was organised with staff and relevant healthcare professionals during people’s care journey. A healthcare professional told us for a person who was awaiting hospital discharge, “Their care was cancelled several times. The agency accommodated the cancellations and put the care on hold until discharged. We also requested an increase in care provision once the person was home as their health deteriorated, again the care agency accommodated this.”

The provider worked with people and healthcare partners to understand what being safe meant to them and concentrated on improving people’s lives while protecting their right to live in safety, abuse, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Relatives told us they felt people were safe using the service. A relative told us, “The carers use a key safe to enter the property and there have been no issues with safety concerns.” Another relative told us, “The way in which the care has been organised by the manager provides me with great peace of mind, knowing [person] is safe.”

There were systems to protect people from the risk of abuse. Whistleblowing and safeguarding adults and children’s policies were in place to report potential abuse. Staff had completed safeguarding training and were aware of reporting procedures to follow if they had any concerns.

The provider worked with people to understand and manage risks. Risk assessments provided information on how to minimise risks and maintain people’s safety in accordance with people’s needs. Risk assessments included the level of risk and covered areas such as moving and handling, personal care, skin integrity, mobility, medication, infection control, end of life care, choking and emotional wellbeing. These included preventative actions to minimise risks and measures for staff on how to support people safely. This helped ensure people were supported to take responsible risks as part of their daily lifestyle with the minimum necessary restrictions.

Relatives told us staff were aware of people’s needs and provided them with the support they needed to keep them safe from harm. A relative told us, “The carers handle [person] very well as they are bedbound. They use slide sheets and manoeuvre [person] gently in bed for personal care. Their skin is checked and they will apply barrier cream. They reposition [person] comfortably in bed and use pillows to ensure their comfort. Another relative told us, “[Person] has a hospital bed and they check the mattress pressure. [Person’s] skin is beautiful and intact. They use slide sheets to move and reposition [person].”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risk assessments had been undertaken to help ensure risks within the environment were assessed and ensure people were supported in a safe, clean and clutter free environment and that equipment was safe for use. A relative told us, “An assessment of the home environment was conducted for health and safety reasons and written in a very detailed care plan. The carer was aware of where the fuse boxes, water taps etc were to make sure [person] is always kept safe in an emergency.” Another relative told us, “The live in carer manages all [person’s] care needs as well as the domestic side and keeps the home immaculate.”

The provider did not make sure recruitment processes were operated effectively and consistently to ensure safe recruitment. We reviewed 7 staff files. In all the staff files, we found full education and employment histories had not been listed and there was no satisfactory written explanation of gaps in employment and education.

For 5 staff members the disclosure and baring services (DBS) check acquired at the time of recruitment were undertaken by a previous employer. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions. Providers must be able to demonstrate sound reasons for not obtaining a full DBS check before a person takes up post. For all 5 staff members, there were no reasons recorded as to why a full DBS check could not be obtained by the provider at the time of recruitment and potential risks assessed.

For 4 staff members, a job offer and start date was confirmed before ensuring all checks including references and right to work eligibility were completed.

We could not be assured of the quality and accuracy of references acquired which verified the employment history, skills and conduct in previous roles. For 3 staff members, references were obtained from companies that were not listed on their application form as part of their employment history and did not contain any company headed correspondence to demonstrate authenticity of any previous organisations worked for.

We raised these issues with the registered manager and care manager who were receptive to the feedback. Immediately after our feedback, the care manager sent us an action plan which outlined the actions they would be taking to address these issues which included reinforcing recruitment processes so right to work checks are completed in a timely manner, strengthening the application process so full education and employment histories are listed, the introduction of a mandatory recruitment checklist, an immediate audit of existing recruitment records followed by regular recruitment audits and a designated staff member to ensure recruitment clearance before staff they start with the service. We will follow up these actions at the next assessment.

Systems were in place to help ensure appropriate staffing levels were in place. Staff received training suitable for their role and were appropriately matched to people they supported. A relative told us, “The company choose carers for [person] that would suit them.” Care and support were provided by a stable and regular workforce that people and relatives were familiar with. Staff told us call visits were planned well which ensured peer support where needed and appropriate rest breaks to support staff wellbeing.

The provider assessed and managed the risk of infection. Procedures were in place to ensure people were protected from infection. The service had an infection control policy in place. Relatives told us staff always wore PPE when supporting people with personal care. A relative told us, “They wear their gloves and aprons and dispose of them hygienically.” Another relative told us, “They [staff] will do a bed bath and use different coloured flannels to wash different parts of their body. They change the water in the bowl. They are very tidy workers and keep the place in order.”

Staff had received infection control training and had access to personal protective equipment [PPE] when needed. A staff member told us, “I have access to gloves, masks and shoe covers.”

The provider made sure that medicines and treatments were safe. Medicines administration records (MARs) showed people received their medicines as prescribed. A relative told us, “The carers give [person] prescribed tablets and there have been no errors.” Another relative told us, “Medication is given accurately as it comes in blister packs.”

Medicines audits were carried out to ensure any shortfalls were identified and followed up. Records showed staff had completed medicines training and their competency was checked to ensure they were competent and administered medicines safely.