1-2-1 Live In Care 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

This was the first assessment of the service since their registration with CQC.

We found that the service has failed to effectively implement systems to assess and mitigate risk to the health, safety and welfare of people using the service and the management of their medicines. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found that the service had failed to consistently follow safe recruitment practices. This was a breach of regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

In addition, the service failed to ensure staff did receive effective and sufficient supervision and training to enable them to carry out their roles. This was a breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Some improvements were also needed in relation to systems related to the analysis of accidents and incidents.

People told us they felt safe while supported by staff and staff were aware of how to report safeguarding concerns, however they required further information on where to escalate any concerns outside of the organisation.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives did not share any concerns in relation to this area. They felt that when they raised any concerns, these had been addressed without delay.

Staff knew how to report incidents and accidents to their managers. They had access to an on-call system which provided support outside office hours. Some staff told us that team meetings were sometimes taking place.

The service had a system in place for staff to report and record accidents and incidents, however these had not been effectively analysed, meaning opportunities might have been missed to use this information to minimise the potential risk to people from future accidents and incidents. For example, falls were being quantified however records did not indicate if these had been analysed for possible trends and whether action had been taken to reduce the risk. Meetings were taking place within the management team and a handover process was in place for individual clients when staff changed over. The service had started to implement virtual team meetings for staff and the registered manager told us that e-mail correspondence and memos were being sent to staff when they needed to communicate updates.

People and their relatives did not share any concerns in this area. One person told us, “My care package will be reviewed probably when I come out of hospital.” One relative told us, “The care package is evaluated as dad`s health changes.”

Staff and the management team provided us with examples of how they worked with health and social care professionals to support people’s needs.

Feedback for professionals we contacted was positive. One health and social care professional told us; “The assessment work with my service user, her family and the nursing home was also exceptionally professional. We received the assessment, costings and prospective starts dates in good time to allow the service user to be able to come out of respite quickly and settle back into her home with a live in carer. The whole process was seamless and if I was in need of the process in the future, I wouldn’t hesitate to use 1-2-1 as my first port of call”.

The service had systems in place for assessment when people started their care package and to review people’s care at regular intervals or when needed.

Where appropriate people’s families were involved and informed of developments and changes. Staff worked with external professionals, for example community nurses, GPs and occupational therapists, sharing information to ensure people’s care needs were met.

There were systems in place to support people during transitions, for example, hospital admissions and discharges.

People and their relatives told us they felt safe when supported by the staff.

Staff had access to the providers safeguarding and whistleblowing polices to guide them in the actions they should take if there was a concerns or allegation of abuse. They knew and were confident they could escalate concerns outside of the organisation; however, they were not always sure where exactly to escalate these concerns.

Systems were in place which safeguarded people from harm and abuse. Staff had been trained in safeguarding.

The service had a safeguarding policy in place which included both adults and children, however these did not provide staff with local arrangements of where concerns could be escalated. We discussed this with the registered manager who was going to consider providing staff with the necessary information for contacting the local authority of the area they worked in.

People and their relatives were positive about the support received from staff. One relative told us., “ Oh Yes, they know her and they know all about her.” Another relative told us, “He has a hoist, a self-reclining chair and a `sara steady` and they all know what to do.”

Staff were aware of people’s risk and how to support them safely. They provided examples of risks related to the heath and needs of the people they supported and discussed how they would support them to minimise these risks. Staff were knowledgeable about the support needs of the individual people they were supporting.

However, because the service did not always provide robust guidance to staff through people’s care documentation, there was a risk people would not be supported safely to manage risks related to their health and support needs.

The service had identified people's personal risks as part of their initial assessment, this included risks in relation to falls and skin pressure care. However, people's records did not have guidance for staff to assist them in managing people's specific health risks safely. This put people at risk of not receiving the appropriate care. Other examples included there being no assessments and support guidelines for people who had health appliances in place, who required support with delegated nursing tasks or who lived with medical conditions. Therefore, staff may not fully understand how to support people safely, including how to identify concerns. People who required support with moving and handling tasks or their mobility had risk assessments in place, however these were not always providing staff with robust and up to date information in relation to people’s requirements. This meant the service had failed to effectively implement systems to assess and mitigate risk to the health, safety and welfare of people using the service. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff told us that every time there was a change in staff, a thorough handover was taking place and the deputy manager told us that they also asked the staff if the care documentation was up to date at that point. The registered manager introduced a system of weekly updates from the clients and carers to the office to ensure all clients and staff had a communication line and any issues were prioritised as required and records updated.

People and their relatives did not share any concerns in relation to the way they are supported to maintain their environment safe. One relative told us, “They even inspected my house to see how safe it was, we have no complaints there with respecting my home.”

Staff were aware of how to access information related to the any environmental risk of the home they worked in. They described to us what action they would take in case of an emergency, for example in case of a fire.

Environmental risks were assessed and as the majority of staff were working on their own in people's homes, measures were put in place to ensure personal safety. The service had an oversight of the servicing of equipment people used which was covered by health and safety regulations, however where this was out of date or information was missing, there were not always records indicating how this would be addressed. Staff were aware of the visual safety checks they should carry out before they use any equipment for moving and handling of people.

People and their relatives provided positive feedback in relation to the staff currently supporting them. Examples were also provided of the swift action taken by the management in situations when they were not satisfied with the carers they had in place.

People and their relatives considered that staff have the necessary skills and training to support their needs. Comments included; “definitely well trained”, “very well trained” and “no issues with their training at all.”

Replace with: Staff were positive about the induction they received when they started their employment with the service. Staff told us they felt they received the necessary training to carry out their job role and that their competencies had been checked. Staff felt well supported in their job role, and they were positive about the way they had been introduced to the client they were supporting. They told us that the management team were available around the clock and, for example if they needed extra training, this would be organised. The registered manager was open and honest with us in identifying that formal staff supervisions and appraisals had not been completed as per their identified process, however this was identified as an area of improvement. They explained that in some cases, person specific guidance related to nursing delegated tasks had been provided to staff by a healthcare professional. However, we did not see recorded evidence of this. We discussed with the registered manager improvements to records of staff induction to ensure all areas of training and competency checks and any follow ups were completed and records of these kept for each staff member.

Safe procedures were not always followed when new staff were recruited. Reference checks from staff's previous social care employers were not always sought to gather assurances about staff conduct.

Records did not show how the registered manager had assessed the risk to people when they were unable to obtain references or complete checks on an applicant's employment history.

We found no evidence that people had been harmed however, safe recruitment practices had not always been followed. This was a breach of regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although staff told us they knew how to support people and people were complimentary of the care they received, staff did not always receive people specific training, for example with nursing delegated tasks.

Systems were in place to provide staff with training necessary for their job role. We saw the staff’s training certificates and an overview of training they completed, however these records did not provide robust assurances, for example that all staff had received practical moving and handling training or that their competencies had been assessed as per the provider’s policy.

The service had a process in place for staff induction, however records were unclear as to whether all aspects of the induction process had been completed for all staff.

Although staff told us they felt supported by the management, records indicated that supervision and appraisals were not always carried out at the frequency established in the provider’s policy.

We found no evidence that people had been harmed, however, staff did not always receive such appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they were employed to perform. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

People and their relatives did not share any concerns in this area and confirmed staff wore protective equipment when they supported with personal care.

Staff were able to tell us how they used Personal Protective Equipment in accordance with best practice guidance.

Staff had been trained in safe infection control practices and had access to personal protective equipment (PPE).

The service has an infection control policy in place and risks in relation to this had been assessed for each person.

People and their relatives were positive about the support they received from staff with their medicines and did not raise any concerns.

Comments included, “They give her her meds, never miss and I always check as I used to be a Nurse” and “They do the meds and never miss and let me know when new tablets are required.”

Staff we spoke with were aware of safe processes of medicine administration and explained to us how they would administer when required medicines, for example pain relief, safely. Staff had awareness of the appropriate actions they would take in case people refused their medicines. However, because the service did not always provide robust guidance to staff in relation to medicines administration through people’s care documentation, there was a risk people would not be supported safely with their medicines.

People had medicines administration records (MAR) in place, however good practice was not always followed when staff transcribed people's medicines instructions onto their MAR charts.

Systems were not always in place to guide staff in safely administering 'as required' medicines. Information was not in place to guide staff in the use of these medicines.

Systems were not in place for the safe administration and recording of people's medicine patches. Information was not always recorded to guide staff in relation to the correct rotation of the patch.

For one person, a variable dose of prescribed medicine was being administered without the records showing this had been authorised by their GP. The registered manager subsequently explained that this had been agreed with the GP, however the documentation had not been updated to reflect this.

Homely remedies protocols were not in place to provide staff with information of how to support people safely with these medicines.

The service had not ensured that people's medicines profiles were robustly reflective of how they liked to take their medicines.

The service carried out audits of people’s medicine administration records. Where gaps were identified in administration, there was no evidence these errors had been investigated and action taken.

All the above shortfalls put people at risk of not receiving their medicine safely.

The provider’s medicine policy outlined systems and processed which were required to be implemented in the service, however these were yet to be functional.

We found no evidence that people had been harmed, however people's medicines were not safely managed and administered at all times. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following our feedback the provider was looking at implementing systems and processes to address these shortfalls.