Community Clinical 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 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.

Systems were in place to record accidents and incidents with actions addressed promptly. Learning from such events was shared with staff immediately where required and discussed at regular supervision sessions.

Improvements to the service included the development of a night monitoring system in response to concerns about staff sleeping on shift. Staff working at night were required to respond to an hourly text message. This was monitored each morning, and failure to respond within a 5 minute window was followed up with staff concerned. The registered manager told us that where staff had not responded immediately, they were generally providing personal care. Concerns about staff sleeping on shift had significantly reduced since the introduction of the system.

Families confirmed concerns were generally addressed promptly and changes made to their satisfaction, although some reported inconsistent follow-up or feedback.

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.

The provider worked effectively with partners to ensure continuity of care. Transitions were planned collaboratively with families and professionals, often starting in hospital. Care plans included specialist guidance, and professionals told us the service worked in partnership to ensure safe discharge and ongoing care. A professional told us staff had shadowed care in a children’s hospital, so they were aware of individual needs prior to discharge.

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.

There were effective safeguarding systems to protect children from abuse and neglect. Staff had received training and understood their responsibilities, including reporting concerns promptly. The provider had appropriately reported concerns to the local authority and the CQC. We looked at recent safeguarding records. There was a clear audit trail. Relatives generally felt their family members were safe and that the provider took its safeguarding duties seriously.

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.

Risks were assessed, regularly reviewed and managed with involvement from families and professionals. Risk assessments were detailed and care plans included clear guidance for staff on reducing risk and responding to changes. Care plans also included information on children’s mood, communication and responses to care to support safe delivery. Families confirmed they had been involved in agreeing their children’s risk assessments.

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

Children were cared for in safe environments within their own homes. Environmental and lone working risk assessments were in place, and care plans provided clear guidance on the safe use of equipment such as ventilators and feeding systems. Equipment and technology were used appropriately to meet people’s needs. Feedback from family members confirmed staff supported their children safely at home, although this relied on consistent adherence to guidance contained within the care plans and risk assessments.

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.

Staffing arrangements were generally safe, with robust recruitment checks and appropriate training and competency assessments in place. Staff received regular supervision from a manager.

Specialist training was provided to ensure children’s needs were met, for example tracheostomy and ventilator care for children requiring support with breathing, and gastrostomy care where children who were unable to swallow were provided with nutrition, hydration and medicines via a tube.

Staff spoke positively about the training and support they received. They told us they did not have to wait to discuss concerns and had access to support and advice from a manager at any time of day or night.

Families said they usually had regular carers who were on time and familiar with children’s needs. However, a couple of parents described inconsistencies in staffing, including gaps in cover and variable skill levels, which could impact continuity of care. The registered manager advised this sometimes happens with unplanned absence, such as staff sickness, and where this was the case, they liaised closely with parents and commissioners, where appropriate to ensure such absence were effectively covered.

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 effective infection prevention and control systems. Staff received training, and policies and guidance were in place to support safe practice. They confirmed they understood the importance of ensuring risk of infection was reduced as much as possible, Families confirmed that sufficient personal protective equipment (PPE) was supplied and used appropriately by staff. During our inspection we observed PPE being prepared and sent to family homes by a regular courier service.

The provider did not always make sure that records of medicines and treatments were fully completed.

Medicines administration was generally safe. However, although most medicines administration records (MARs) were completed correctly, we identified unexplained gaps in one child’s MAR chart that had not been identified through audit processes. Action was taken during the inspection to address this immediately, including introducing improved MAR documentation charts, and guidance for staff on correct completion of these.

Staff had received training on safe administration of medicines, including specialist training where medicines were administered vis gastrostomy tubes. Children’s care plans included information about their prescribed medicines and detailed person-centred guidance on medicines administration. Where parents were involved in medicines administration this was recorded in the care plans and on the MAR charts.