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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 inspection for this newly registered service.

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.

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.

There was a system in place to ensure accidents and incidents were reported, recorded and actioned.

Staff understood how to escalate concerns and felt able to raise issues.

The registered manager told us how information of concern raised by relatives about staff’s use of mobile phones and access to the management team had been used to provide additional training to staff and to make changes to ensure the management team were accessible throughout the week.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

Processes were in place to assess people before they started care, including assessments and involvement of families and professionals. However, we found inconsistencies in the level of detail in these assessments. We discussed this with the registered manager, and they told us the changes in documentation were due to changes the management team had made with the view of improving it.

During our inspection, we found care plans, risk assessment and medicines records were not always complete or detailed. This meant that staff did not always have full information before initial visits, and these inconsistencies posed risks during emergencies and transitions in care.

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 was clear on their responsibilities under safeguarding children and adults and knew who to report any concerns. Staff had received training in safeguarding children and adults told us they would report any safeguarding concerns to their line managers.

Safeguarding concerns had been identified by staff, and these had been discussed with the relevant local authorities, however the provider had not informed the CQC, in line with their regulatory responsibilities. We raised this with the registered manager, and the notifications were submitted while the inspection was taking place.

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.

Risk assessments were not always in place or detailed. This included a lack of environmental risk assessments or assessments linked to people's care. For example, we found a person who was being supported required a high level of support with ensuring their environment was safe and to manage their behaviour. The initial documentation we reviewed lack essential details about how to manage these risks. Another person was supported at home and there were known risks to staff linked to passive smoking; this has not been assessed by the provider and appropriate measures put in place. We discussed these issues with the provider, and after our visit we reviewed evidence confirming risk assessments had been reviewed and put in place. Although we did not identify harm had occurred, people and care staff had been exposed to avoidable risks due to a lack of effective systems to assess, monitor and improve the quality and safety of the service provided.

The provider did not always detect and control potential risks in the care environment.

Environmental risk assessments were not recorded during initial assessments, which meant there was no evidence that risks to people and staff were assessed and plans put in place to manage these.

Staff were trained to use equipment safely.

The provider 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.

Feedback from people and relatives was mixed in relation to staff’s punctuality. Comments included, “The carers sometimes turn up on time. If they are ever late, they usually stay a little bit longer. When they are late, we normally get informed beforehand”; “There were a few challenges with one of the carers. This particular carer was always late and never informed me and this was our main carer. As a result, my relative became distressed, especially when sometimes this carer didn’t turn up at all”.We discussed these concerns with the registered manager. They provided us with details about incidents of missed or late calls linked to a specific member of staff, and the actions taken to prevent this happening again. The registered manager also told us about their ongoing work to source an alternative call monitoring system to allow a more robust system to alert management of any concerns. Additional checks were put in place until the new system was implemented.

People and relatives told us they felt staff were well trained and competent. Their comments included, “I feel the carers are well trained and know their working role very well” and “The carer seemed trained.” However, in our review of the provider’s training policy and training records, we saw examples that the provider was not following their own policy requirements. For example, staff who supported children were required to have additional training around children’s first aid and enhanced training. We found evidence that one staff did not have first aid training up to date and there was limited evidence that showed that the enhanced training listed in the provider’s policy had been completed by staff. We also found evidence that not allstaff had received training to meet the specific needs of people such as mental health or end of life care. We discussed this with the provider and after our inspection the provider told us staff had been booked to receive the required training.

Most aspects of recruitment were completed in a safe way, however, we found a lack of evidence of the provider recording and exploring gaps in employment or education of staff.

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. Staff had received infection control and food hygiene training and had access to Personal Protective Equipment [PPE] such as disposable gloves and aprons.

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.

Medication was not always safely managed. The provider did not always keep detailed and accurate medication records. A person was being supported by staff, who requires prompting with medication. A medication administration record was not in place and daily notes made by staff did not show this support was always being completed. We shared these concerns with the registered manager, and they told us action would be taken in relation to this issue.

During our site visit, the provider told us they completed medication competency assessments with staff, but no records were kept; after our inspection we reviewed evidence of medication competency assessments completed and recorded.

Medication audits had not been effective in identifying these issues.