Vitality Plus Care Ltd

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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. 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 59 (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. Lessons were not always learnt to continually identify and embed good practice.

Some concerns from the last assessment of the service had still not been resolved. These related to care plans and risk assessments that were not sufficiently detailed or kept up to date. Although the provider took action to address the shortfalls we identified during this assessment, it was unclear whether these improvements would have been made without our intervention. The provider’s most recent internal audit had recognised that some care plans and risk assessments required review and had highlighted specific areas needing further attention.

However, the provider had improved their reporting practices and was now notifying the relevant statutory organisations when required. The registered manager and staff described the learning they had taken from a recent safeguarding incident, which had led to an increase in staff appropriately escalating concerns. We also found that the provider had introduced a more effective system for monitoring and overseeing staff training.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always make sure there was continuity of care, including when people moved between different services.

Some care plans and risk assessments still lacked sufficient detail, particularly regarding peoples diagnosed conditions, such as diabetes. As a result, essential information may not have been immediately available to other professionals in an emergency. One partner told us, “I flagged issues with the registered manager about the care records, as they were not always clear with the details.”

A partners told us communication from the provider was sometimes delayed, which meant they were not always promptly informed about changes in people’s needs.

However, people told us initial assessments had been completed. One person commented, “It was a hospital referral to the service, and my [Relative] sorted it out with the manager, they came to see me and everything I needed was discussed in great detail and my care plan was done.”

We saw the provider had a hospital passport available for people with a learning disability or autistic people, if they needed it for hospital admission. Having a hospital passport is in line with Right support, Right care, Right culture guidance.

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.

People told us they felt safe using the service. One relative commented, “I know [Person] is safe with them all, also I know that dignity is maintained at all times as when I am there, I can hear the carers speaking to [Person] and involving them in what they are doing.”

Staff received annual safeguarding training for both adults and children. They demonstrated clear understanding of how to escalate safeguarding concerns and who these should be reported to.

Systems were still in place to keep people safe from abuse, including regular discussions during team meetings and supervisions. There was a safeguarding log with actions and outcomes and a safeguarding policy available.

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.

Some risks for people had still not always been identified and there was a lack of information for staff to follow in relation to people with specific diagnosed conditions. For example, one person had two diagnosed health conditions, but there were no separate care plans detailing how each condition should be managed. Although the health conditions were noted within the main care plan and some risks mitigated, the information was not comprehensive. For another person, key information about early warning signs linked to their mental health diagnosis was missing, leaving staff without clear guidance. We found no evidence that people had come to harm because of these gaps, and the provider subsequently updated the relevant documentation and shared the amendments with us.

However, people told us that staff supported them to manage their risks, and staff were able to describe how they managed specific risks for people. We also saw examples of care plans and risk assessments which included detailed and comprehensive guidance to support safe care.

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

Environmental risk assessments were completed for each person, identifying any hazards that required monitoring or action. People told us they had access to the equipment they needed to remain safe, and this was reflected within their care plans. Staff also had access to lone-working risk assessments, and a log‑in/log‑out system was in place to monitor staff whereabouts for safety purposes. Staff were able to describe the visual checks they carried out before using equipment to ensure it was safe to operate.

The provider maintained an equipment log detailing what equipment people used and when it was due for servicing. They also followed up with external organisations on people’s behalf to ensure equipment remained safe and in good working order.

The provider did not always make sure staff were recruited effectively.

Although staff recruitment checks had improved since the previous assessment, we continued to identify some shortfalls. For three staff members, it was unclear whether they had started their roles before their Disclosure and Barring Service (DBS) checks had been obtained, due to conflicting information within their recruitment files. The provider assured us the staff had only been undertaking their induction and had not begun delivering care. We accepted this explanation, as the recorded start dates and DBS completion dates were close together. The registered manager confirmed they would ensure recruitment records were clearer in future.

We also found that one staff member had only one character reference in place. However, there was evidence that the provider had attempted to obtain a professional reference from a previous manager, and a risk assessment had been completed to support this decision.

However, people told us staff were well trained. One comment included, “Yes, I do feel the carers are well trained, [Person’s] condition can change sometimes daily, and all of the carers know how to deal with the changes which is good.” People also said they received support from two staff where this was required for manual handling purposes.

Staff had completed training relevant to their roles and told us they were now receiving regular supervisions and support. To strengthen oversight, the registered manager had introduced additional spot checks, which were detailed and included feedback from people using the service.

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.

People told us staff used personal protective equipment (PPE) to reduce the risk of infection and maintain good hygiene practices. One person said, “Yes the carers do wear gloves and aprons, but I don’t like them to wear masks because I like to see their face; this doesn’t seem to be a problem to the carers.”

Staff we spoke with demonstrated a clear understanding of how to use and dispose of PPE correctly. Recent spot checks carried out by the registered manager included direct observations of staff practice and recorded any actions required or outcomes identified.

An up‑to‑date infection prevention and control policy was in place to guide staff.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicine support plans were now in place; however, we noted some inconsistencies in documentation. For example, one person’s care plan stated that staff should administer their medicines, while their risk assessment indicated staff should not administer medicines and only provide verbal prompts. This inconsistency created a risk of staff following incorrect guidance. The registered manager provided an explanation and updated the documents during the assessment to ensure they reflected the correct approach.

We also saw that one person did not have a body map or risk assessment in place for the application of a pain‑relief gel. This meant staff did not have clear guidance on safe application. The registered manager explained that the person had capacity and directed staff when support was needed. The provider confirmed they would introduce a body map and risk assessment.

The same person had a known allergy to certain medicines, although the allergy was clearly recorded, there was no information outlining what actions staff should take if the person was exposed to the allergen.

Another person’s side effects for two medicines were also not documented. This meant staff did not have the necessary information to recognise or respond promptly to potential adverse reactions.

The provider addressed these gaps during the assessment.

However, despite these shortfalls, people told us staff supported them safely with their medicines. Staff demonstrated a clear understanding of their responsibilities, including what to look out for when supporting people with medicines. Regular competency assessments were being completed. Medicine assessments were detailed, and information was available clarifying who was responsible for ordering medicines.