Top4Care Services 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 – 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 69 (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 leaders investigated safety events. Leaders and staff learnt lessons from incidents and used these to identify and embed good practice.

Records showed incidents, accidents and complaints were documented. When incidents occurred, staff and leaders ensured people received timely support from other health care professionals. Complaints were investigated and used to reinforce person-centred care. Staff received training in incident reporting and emergency first aid. Policies supported openness and learning.

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.

Records showed that pre-assessment of people’s needs considered risks, such as life history and behaviours that may place a person or others at risk. The registered manager completed care plans with people that reflected their goals, preferences and support needs. Immediate actions identified through the assessment process, including support to access financial benefits, were acted upon. The registered manager also obtained information from health care professionals to promote continuity of care.

Leaders ensured staff received up to date information through care plans and communication systems. Relatives were included in the pre-assessment process, one told us, “Splendid the way it was done. We went to see 3 other places. We knew this was the right one for him. He was comfortable. It’s a pleasure to see him settled.”

The provider did not always work with relevant professionals to ensure restrictions on people's liberty were recognised.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). This is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We found that people were subject to varying levels of supervision and support. The provider had assessed risks associated with people leaving the service and had implemented measures to keep people safe. However, records did not demonstrate whether care arrangements required legal authorisation in line with the current legal framework. This meant that the provider could not evidence that restrictions were appropriately assessed and reviewed through relevant legal processes. Following our feedback, the provider has contacted the relevant professionals and local authority representatives to discuss whether applications are required. This helped to support ongoing consideration of people's rights whilst ensuring appropriate measures remained in place to promote their safety.

However, people told us they felt safe and were supported by staff who knew them well. Staff received training and understood their responsibilities to protect people from the risk of abuse. They were able to describe action they would take if they had concerns.

People were supported to understand their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Relatives told us the provider responded appropriately when safeguarding concerns were raised. They said the registered manager listened to people and worked with those involved to agree actions that reflected people’s wishes and promoted their safety. The provider worked collaboratively with external agencies and had systems in place to respond to safeguarding concerns.

The provider worked with people to understand and manage risks while taking account of their individual needs, preferences and circumstances. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care plans and daily records showed risks were assessed and managed. Following incidents, staff worked with people to review and update risk assessments where required. People were encouraged to reflect on what had happened and were involved in discussions about how risks could be reduced whilst maintaining their independence. Staff demonstrated a balanced approach to ensure safety measures were appropriate and reflected positive risk taking.

The provider communicated regularly with relatives, who were able to contact the provider directly to raise concerns or provide feedback. Reviews were carried out through ongoing communication. Relatives told us, “[Registered manager] listens to the staff and they listen to [them]. They explain what’s going on and why they are doing something” and “The staff send me observations to my phone, or they call me to discuss it.”

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

The provider had effective systems to monitor the safety of the properties. Environmental risk assessments considered fire safety, access arrangements and hazards within the home, such as sharp objects. Care plans detailed emergency information and evacuation considerations. Staff completed training in health and safety, moving and handling, and fire safety. These arrangements helped reduce risks within the service.

The provider supported people to maintain their tenancy agreements and worked with them to manage household tasks. Relatives told us, “The home is clean, tidy and well organised” and “The bedroom is beautiful. His bed is made before he goes out and the room is kept tidy.” This supported our observations that the environment was clean, organised and well maintained."

The provider made sure there were enough 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.

The provider operated safe recruitment procedures and carried out pre-employment checks to ensure staff were suitable for their roles. Staff received training relevant to their responsibilities and were supported through supervisions. Records showed leaders regularly monitored training completion to ensure staff maintained the knowledge and skills required for their roles.

Care plans identified the funded support hours people were assessed as requiring. The provider ensured staffing was planned to ensure these needs were met. Relatives told us staff knew people well. One relative told us, “They know he is non-verbal. They know them. They always want to go back and go home relaxed. So yes, the staff are trained to support him.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading.

Staff received training and followed hygiene practices, including handwashing and use of personal protective equipment (PPE). Food was stored, prepared and handled safely. We observed staff supporting people to understand the importance of personal hygiene and infection control in a way that promoted their independence and choice. PPE was available across the premises.

The provider ensured there were clear procedures for managing infection illnesses, including reporting concerns and seeking advice from healthcare professionals.

The provider’s oversight of medicines management was not always effective. We found that some medicines which were no longer required remained in storage and were not clearly labelled to indicate they had been discontinued or awaiting disposal. This increased the risk of confusion and reduced assurance that medicines were managed in line with best practice. Since the assessment, the provider has undertaken an audit of medicines and disposed of unused medicines.

Staff received medicines training, however we found that competency assessments had not been completed annually for all staff responsible for administering medicines. This meant the provider could not be assured all staff remained competent to undertake medicines-related tasks safely. Since the assessment, the registered manager has completed competency assessments for staff.

Medicines audits had not been completed in 6 months. This meant leaders had not identified concerns we found regarding medicines storage, disposal and staff competencies.

People received support with medicines and records demonstrated these were administered as prescribed. We found no evidence that people had been harmed, however these shortfalls increased the risk of medicines not being managed safely.