Hippo Care Limited

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• 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 since it was registered. This key question has been rated 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.

The service was in breach of 1 legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed safely.

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 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. However, other systems in place to identify trends, for instance audits, were not identifying the concerns we had.

Quality spot checks carried out on staff did not identify the concerns people and their relatives told us about staff not wearing uniforms or not having identification on them.

However, we found systems were in place to monitor and analyse accidents and incidents to prevent a re-occurrence. Staff told us they knew how to report accidents and incidents and had confidence in management to take any follow up action. One member of staff told us, “I feel confident raising safety concerns because the manager and supervisors always take action. Investigations are fair and thorough. I usually receive a debrief during supervision or through a follow-up call, explaining what was learned and what improvements will be made to support both staff and clients.”

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 ensure people were referred to third parties and community professionals when needed. Some people told us they managed their own medical appointments or had support from family. Staff told us they knew what to look out for when people became unwell. One member of staff told us “I look for changes such as reduced appetite, confusion, difficulty breathing, or sudden mood changes.” In addition, they told us “Recently, I noticed a client was unusually weak and not eating. I contacted the office immediately, which resulted in a GP visit and early intervention. My actions prevented further deterioration.”

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.

Systems were in place to recognise and report abuse or potential abuse. Staff received training. One member of staff told us, “I feel confident raising safeguarding issues. On any occasions concerns were escalated, the registered manager took immediate action, ensured protection measures were put in place, and followed reporting procedures.”

The provider did not work well with people to understand and manage risks. Risk assessments were either not always in place or did not provide clear instruction to staff on how to support people to mitigate harm.

Systems were in place to assess and monitor risk to mitigate harm, however, these were not always robust.

People were not always supported by staff to manage and reduce the risks posed to them as a result of their medical condition. This was because staff were not always aware of people’s medical conditions or guidance was lacking or contradictory.

Risk assessments did not always provide enough detail for staff to ensure people received safe care and support. People were not always supported by staff who had up to date information available to them regarding the risk of them falling. We found care plans and risk assessments regarding people’s mobility were not always completed in full and contained broad statements or inaccurate information. For instance, one person’s care plan stated, Use safe manual handling techniques, with no additional guidance. Another person’s care plan stated, “Reposition [person] gently, using proper support and handling aids” with no clarification what “proper” meant.

People who had been diagnosed with diabetes, had care plans in place, however they did not always contain enough information about the individual and their usual blood sugar levels. We found other people had either equipment or conditions which presented risks to them. The risk assessments completed were not adequate to mitigate potential harm to people. For instance, people who used equipment to keep them safe in bed, did not routinely have risk assessments in place to highlight the risk of entrapment or harm.

We found risk assessments were not routinely in place for people who were deemed at high risk of falls.

We found no evidence that people had been harmed however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at potential risk of harm.

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.

There were systems in place to carry out an assessment of the risks within people’s homes, however, they did not always consider fire hazards caused by medicines.

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.

We found staff recruitment files contained full and robust checks, as required, including a Disclosure and Barring Service check (DBS). The DBS checks for criminal convictions and inclusion on lists of people who would be unsuitable to work with people at risk.

Systems were in place to monitor staff training, skills and experience. However, some people told us they felt staff were not as trained and skilled as they would expect. Comments included, “The carers [Staff] are young and what would be nice is that they had basic training…like introducing themselves and asking how I am” and “Sometimes they look lost. It’s not my job to explain everything to them.” Another person told us, “The new carers need to be more pro-active.”

Staff told us they felt well supported in their roles and received appropriate training, supervision, and guidance to carry out their duties effectively. Staff told us, “I feel fully supported by the leadership team, they are approachable, responsive, and always provide guidance when needed” and “I feel well supported by supervisors and the registered manager, whenever I contact the office with a concern, I receive professional and respectful guidance.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The provider supplied personal protective equipment (PPE) for staff, however, the feedback we received from people was this was not always used or available. Comments from people included, “We have to keep gloves here as they don’t always bring their own” and “One [staff] doesn’t dispose of the gloves in the bin and needs a lot of prompting.” In addition, we received feedback from people about infection risk due to lack of uniforms worn by staff. Comments from people and relatives included, “No uniforms worn. Never seen anyone wearing a uniform of any kind, always own clothes” and “No uniform, we worry about cross contamination, family wear masks due to worry and risk of cross contamination. Carer does wash hands on arrival though as she is aware on our views of cross contamination.” The provider’s policy was very clear, it stated all staff should wear a Hippo Care Limited uniform. We have provided this feedback to the provider to ensure staff are aware of the policy and expectations.

Some people were more positive about staff and they told us, “They [staff] wear PPE. Gloves, aprons and masks if they have a cold. They wash hands before and after gloves go on and off.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found staff supported people with medicines and failed to ensure they followed national guidance to ensure risk of administering medicines were minimised. For instance, we found staff were applying prescribed creams without any record of what the cream was prescribed for and how it should be administered. In addition, risks associated with those creams were not always clearly recorded.

It was not always clear from people’s care plans and records, what level of support they required from staff with their prescribed medicines.

We found care plans referred to people prescribed medicines, but these did not always record on a medicine administration record (MAR). For instance, one person’s care plan stated they were prescribed paracetamol, however, this was not listed on the MAR.

We found information about medicine allergies were not always clear and had the potential to cause harm. One person’s care plan stated they had allergies to medicines in one part of their care plan and in another part, stated none. This was confusing for the reader.

Systems were in place to monitor and audit medicine management, however, they did not identify the issues we found.

However, people were supported by staff who had received training in the safe administration of medicines. People and their relatives told us they had no concerns with how people received their medicines.