Bramble Home Care LTD - Cinderford

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. At our last assessment we rated this key question Requires Improvement. At this assessment the rating has remained 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.

This service scored 56 (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 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. However, lessons were learnt to continually identify and embed good practice.

The provider had policies and procedures for managing safety events however these had not always been effective. The new manager had been working on improving their systems and supporting staff to understand the importance of timely and clear reporting; however, we found some examples where staff had not clearly recorded important information and this meant the manager was not able to follow-up. For example, we found one staff member had reported in their daily notes a community nurse had applied a dressing but there had been no follow-up as to why the dressing was needed or a corresponding body map implemented. This meant there was a risk care needs were not updated in the individuals care records. The manager told us, “When there has been an accident, incident or complaint, staff report these and we discuss in meetings. Lessons learned are shared.”

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 service made referrals to the appropriate partners when required and in a timely manner. The service worked with people and staff to ensure there was continuity of care. The service completed an initial needs assessment before people started using the service.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, some staff did not always share concerns quickly and appropriately.

We found evidence of improvements needed to oversight of safeguarding concerns, action taken and lessons learnt. We found discrepancies in the system used by the service and found several instances where a concern was either not raised using the appropriate channels or triaged inaccurately. For example, one person who was diabetic was reported as presenting unwell and a few days later began to refuse meals, however this was not triaged as a safeguarding concern. This meant there was no protocol initiated for the individual who had a significant health condition and may have quickly deteriorated. The senior manager did complete an investigation, and appropriate referrals were made to external professionals.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Policies were in place and in line with best practice guidance; these covered common risks and conditions specific to individuals such as falls, choking and epilepsy. However, staff we spoke with gave variable feedback around having time to read information in full, to help them understand how best to support people to stay safe. One staff member told us, “I don't have time during work time to read the care plans. If I know people and I know nothing has changed, I won't read their care plan. I tend to go to the same people.” While another staff member told us, “I read them a lot in my car. I always check my care plans. I think the care plans are good. I think they are detailed enough.” There were multiple instances of equipment being used which was not in peoples care plans or equipment was referred to in multiple ways. For example, Sara Steady, Sara or simply stating ‘transferred’ without clarifying which equipment was used.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider did not always ensure health and safety checks – bed rails, mattress checks, equipment checks, environmental checks and environmental risk assessments were completed to an appropriate standard. For example, we found some environmental risk assessments did not clearly identify if there was a risk, and if so, what actions staff should take. The manager assured us these would be reviewed. We saw checks for lifting equipment had only recently been added to the service’s 6 monthly service reviews.

The service 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.

We found evidence people were recruited safely and had sufficient pre-employment checks before they started work. Staff told us they had a robust induction when they started working for the service. Staff told us, “I felt the induction training was good and I had spot checks and 3 shadow shifts” and “I had 5 days training, 3 days shadowing. All face to face. It was really good and I learnt a lot. I valued the shadowing too, especially getting used to the runs and the people.” Staff had completed training, with high percentages of completion. Staff and managers had attended an in-person induction in another branch. Supervisions were completed regularly and were not out of date. However, evidence indicated staff were not always staying for the whole length of care calls, and this had not yet been addressed by the manager at the time of the inspection. The provider’s policy stated care calls could be up to 15 minutes late, either side of the allocated time, however we found calls which were over 45 minutes, this affected about 15% of all care calls. We saw evidence of one person who had called the office and made a complaint staff weren't staying the full length of time. While only 1 person had made a formal complaint, evidence suggested this was a widespread issue.

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 an infection, prevention and control policy, carried out appropriate infection control and hazardous substances risk assessments and monitored compliance within monthly audits. We saw evidence risk assessments were developed with people and were unique to people’s individual homes, such as detailing where cleaning chemicals were stored.

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.

Staff had their competence regularly assessed around medicine management to ensure they handled and gave people their medicines safely. Checks of people’s medicine records were regularly carried out. However, records we checked showed there were gaps in people’s medicine administration records which were not fully accounted for. We also noted records for the administration of medicines prescribed with variable doses were not accurately completed to show the actual doses given. There was care-planned information available for staff to refer to about people’s medicines, but this did not provide detail about how people prefer to have their medicines given to them. There was information about some people’s known sensitivities to medicines however this was not recorded consistently across all documentation. This could have led to checks being missed and errors. Some information in care plans about people’s medicines currently prescribed for them was inaccurate and not in line with their medication charts. For some medicines prescribed for administration at the discretion of staff (PRN) there was a lack of guidance available for staff to refer to about their use. In addition, some guidance lacked sufficient detail. For some people, prescribed PRN medicines were not included on their current medication charts. When people were prescribed medicated skin patches, there was a lack of additional records showing the sites on people’s bodies where the patches were applied in rotation. This is to reduce the risk of skin reactions from the patches. Staff were unable to determine where previous patches had been applied and there were also no records confirming previous patches had been removed for additional safety.