Upscale Care Limited

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 newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 had a positive and open learning culture that supported safe care. The registered manager described using incidents as learning opportunities rather than for blame, with learning shared through supervision and staff meetings. Staff confirmed they felt able to raise concerns and understood how to report incidents, accidents and changes in people’s needs. One staff member told us, “If there are any incidents at work or if someone has a fall, I will inform management and call paramedics”.

The registered manager implemented a lessons learnt log, detailing areas identified for improvement, immediate action taken, lessons learnt, changes made, outcome and root cause analysis. This demonstrated a commitment to continuous learning to ensure lessons were embedded into future practice.

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.

Systems were in place to manage safety, incidents and escalation appropriately. The registered manager described clear expectations for staff to recognise deterioration, seek medical support and escalate concerns to emergency services when required. Staff interviews confirmed this understanding, with staff describing contacting emergency services first in serious situations and informing management and families promptly.

Care plans included guidance on emergency response and involvement of family members, and people were supported to remain safe during daily activities such as mobility and personal care.

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.

The provider had safeguarding systems in place to protect people from abuse. The registered manager demonstrated a clear understanding of safeguarding responsibilities, including recognising abuse, reporting concerns to the local authority and notifying CQC where required. Staff confirmed they had received safeguarding training and felt confident to raise concerns. One staff member told us, “I feel able to raise concerns – whatever we do, we document it”.

People and relatives told us they felt safe receiving care. One relative said, “Yes definitely” when asked if their family member felt safe with carers. However, evidence of safeguarding oversight relied mainly on verbal assurance, and some staff were unable to recall specific safeguarding training dates. This meant assurance systems, while effective, were not yet fully embedded.

The registered manager understood their responsibility in relation to Deprivation of Liberty Safeguards (DoLS). No one currently using the service was subject to DoLS.

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.

People were involved in decisions about their care and how risks were managed. Risk assessments were in place for areas such as mobility, bathing and medicines, and staff understood their role in supporting people while promoting independence.

People and relatives felt confident in staff knowledge and communication around risks. Relatives described staff respecting people’s choices and encouraging independence while providing supervision where needed. A family member told us, “They support my [relative], but [relative] still has [their] independence. If [relative] asks for additional help [staff] will give it.”

Staff described using care plans and daily records to manage risks such as falls, mobility and pain, and to escalate changes when needed. We made the registered manager aware of inconsistencies within care plans and risk assessments, which was immediately addressed by them.

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 in their own homes, and environmental risks were assessed as part of care planning. Environmental risk assessments were in place, and staff described supporting people safely during activities such as bathing, mobility and transfers. Staff confirmed they followed guidance to reduce risks, such as ensuring safe footwear and monitoring fatigue and pain. Relatives reported staff were attentive and responsive to safety needs, and there were no concerns raised about unsafe practice in people’s homes.

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.

Recruitment checks were appropriately carried out by the service and records showed an application form, interview documentation, identification, right to work and disclosure and barring service check (DBS) were in place. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Gaps identified during the assessment were discussed with the registered manager who took immediate action to address these, alongside a lessons learnt process and measures put in place to ensure audits were more robust and comprehensive.

The provider had sufficient staffing arrangements in place to meet people’s needs, by a regular staff team who knew them well. People reported staff were reliable and arrived on time. A family member told us, “Yes. All the time. Sometimes [staff] even come early. Never had a problem”. Staff also confirmed staffing levels were adequate and met people’s needs. A staff member commented, “Yes, I have enough time to provide care.”

The registered manager told us, staffing numbers were based on people’s levels of need and regular reviews of care provided. Although the provider did not use a formal dependency tool to determine staffing requirements, management was developing a tool to enable them to manage the business as it grows.

Staff completed mandatory and refresher training in various subjects, such as health and safety, first aid, moving and handling and safeguarding. Staff received an induction, supervision, and said they felt supported by the registered manager. Records confirmed this.

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.

The provider had infection prevention and control systems in place. Staff received Infection prevention control training and demonstrated understanding of personal protective equipment (PPE) use and disposal. One staff member told us, “As we get to the property, we do PPE. When we finish, we will wrap [PPE] and throw them in the bin outside”. The registered manager monitored compliance through spot checks and supervision.

Infection prevention and control practices were applied consistently in people’s homes and reduced the risk of infection. When asked relatives confirmed staff wore PPE during their visits, one relative said, “Yes, they [staff] do.”

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.

The registered manager updated medicine records to reflect where medicines support was provided by the service and where people and their relatives managed medicine independently. The service provided medicines support through prompting only, with people remaining independent where possible

Staff received training and had their competencies assessed to administer medicines safely. Care plans and medicine risk assessments described responsibilities clearly, and medicines were stored safely in people’s homes. Staff confirmed they recorded support using medicines administration charts and daily notes, and relatives confirmed staff did not administer medicines, records confirmed this. We made the registered manager aware of gaps in recording details of prescribed medicines and use of body maps for application of topical cream