Q Leaf 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. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained the same. 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 62 (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. Lessons were not always learnt to continually identify and embed good practice. The provider had processes in place for staff to report incidents and take action where appropriate, however these were not effective, as not all staff reported incidents formally: The provider told us that some incidents were not reported through the processes that were in place and they would hear about incidents informally, such as overhearing staff talking about incidents. One incident was not formally reported by staff regarding a GDPR (General Data Protection Regulation) breach. The provider was aware that staff were not always reporting incidents and was taking action to improve this process and ensure staff understood their responsibility to report incidents and accidents. This included reviewing daily notes and speaking with staff when they came into the office.

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 registered manager told us that continuity of staff was important for people, and they would try and always achieve this. One person told us, ‘I have one main carer who I see nearly all the time, [staff] is really good.’

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately: The registered manager understood their responsibilities in relation to safeguarding however, they had not ensured that all staff understood their safeguarding responsibilities due to incidents not always being reported.

Whilst we could not be assured that all staff understood their responsibilities around safeguarding, the staff we spoke with knew how to safeguard people from abuse. People and their relatives told us they felt safe. One person told us “I feel absolutely safe with the staff for no particular reason other than they know what they are doing.”

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. People’s care plans detailed their health risks and mitigation, and guidance was in place for staff. For example, one person had diabetes, and their care plan detailed what staff should do if their blood sugars fell too low or went too high. Information also detailed how the person might feel or present if either of these risks occurred. Another person was prescribed a medicine which meant they were at a higher risk of bleeding. Guidance was in place for staff to follow, for example, the guidance detailed what staff should do in an emergency.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People had environmental care plans in place which included what equipment the person had and how to use it. Care plans also detailed, where necessary, emergency plans for when staff might not be able to access the person’s home due to extreme weather conditions and what mitigation was in place to ensure the person would be safe.

The provider had ensured that staff felt supported to deliver safe care. We received positive feedback from staff regarding the support they received. Staff received supervisions and 1-1 meetings, and the registered manager told us staff would raise issues with them.

The provider ensured staff received training that was appropriate and relevant to their role. Staff told us they completed training in safeguarding and manual handling and were given training in more specific areas such as diabetes, where the need was identified. People told us they felt assured that staff knew how to support them. One person told us, ‘I am more than happy with staff, they know what they are doing, and they clean up after themselves.’

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’s care plans detailed information and reminders for staff in relation to infection prevention, for example to ensure commode are cleaned after each use. People told us that staff wore gloves and aprons when carrying out their personal care.

The provider failed to ensure medicines were consistently well managed. Medicines records were not always complete. One person’s medicine administration record showed there were gaps with no explanation as to whether it had been administered or not, and if not, there was no record giving a reason why it had not been administered. The registered manager told us that the medicines had been stopped but this was not documented as the electronic recording system did not have the facilities to correctly record this. Following the inspection the registered manager took action to address this by contacting the electronic system provider and requesting amendments to the codes that can be inputted by staff.

Staff told us they had completed medication training and had competency assessments. The registered manager provided records to evidence this. Where staff had not passed their medicine competency, this was followed up with further training and competence assessment until they were deemed competent to administer medicines.