Archived: Creative Support – Carlisle Services

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 inspection we rated this key question good. At this assessment the rating has remained as good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

The management team discussed incidents within corporate meetings and lessons learned were recorded. Staff knew how to record and report accidents and incidents, and there was a process for escalating concerns. They knew people well and protected people from immediate risks of harm.

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. People had access to a range of health and social care professionals, as needed, including GPs, mental health nurses and social workers. Initial assessments of people’s needs had taken place, and this information, along with information from family members was used to create people’s care plans. Care plans contained detailed information on how to support people accordingly and reflected both the physical and mental health needs of people. Policies and procedures were in place to ensure a consistency of approach in the management of risk. There was a good understanding of risk management within the staff team. A person using the service told us, “Yes, I have my pendant round my neck. They made a hospital passport for me (if I have to go into hospital) so they know what medication I am on and things when I go in.”
 

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. Safeguarding processes and policies were in place and the staff we spoke with knew how to follow them. The registered manager and other staff members were able to describe what action they would take if an incident should occur. Staff received regular safeguarding training. They were aware of their responsibilities and reported changes to people’s presentation to senior leaders. A relative told us, “[Relative] is absolutely safe, she adores them [staff] all. Abuse, no never, the reverse, marvellous staff.” A person using the service told us, “I feel safe with them [staff].”
 

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. Care plans and risk assessments were in place for staff to follow. These were up-to-date and regularly reviewed. Handovers took place between shifts ensuring people’s needs were met. Risks relating to falls, medicines and malnutrition were assessed and monitored. A family member we spoke with told us, “[Relative’s name] is safe, happy, well looked after by [staff name]. We have no concerns; she is kept clean.”
 

Whilst the service was only regulated to provide personal care and not accommodation, the provider detected and controlled potential risks in the environment. They ensured that equipment, facilities, and technology supported the delivery of safe care. Staff checked that people were not at risk from environmental hazards, and regular checks and audits were undertaken. A family member told us, “[Relative] uses a wheelchair, it is great, the GP and service got her a gadget to help her stand up, [there is] safety equipment in the shower, [staff] even moved her into a better flat with a wet room, it is an amazing place.”

The provider 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.” Rotas showed sufficient staff on duty as per the provider’s staffing calculations, including use of agency staff. However, feedback from staff was that there was often not enough staff. It was also felt there was not time within the care calls to fully read care plans (especially if call times were only 15 minutes for all tasks required). Updates in the communication book could also be rushed as a result. The provider told us they had worked hard to reduce the amount of agency staff used; however, feedback was this was often still problematic. Following our assessment, the provider told us, they always aimed to use the same agency staff for continuity, ensured all agency staff received an induction and had seen no evidence that agency use affected people’s safety.

Feedback from people included that staff sometimes were not on time with their visits and one relative told us, “Some visits are not on time, some are regular carers and some agency. I feel the carers are not trained enough for [person] needs.” Another told us, “Calls can be late, but staff are on the premises which is better for him. Staff are on a rota but there a lot of agency carers which causes issues with [relative’s name] confusion if a strange face appears.”

There were policies and processes in place for staff supervision however, we did not see regular supervision meetings documented for all staff. Some supervisions and appraisals had taken place; however, these were not consistently carried out. The provider followed safe recruitment systems and processes. Staff and agency staff induction processes and mandatory training were in place. Staff were mainly up to date with training however, some bespoke training such as Parkinson’s training was not available even though people had requested this. The provider told us that this had already been identified and as a result such training was being implemented.

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 wore suitable personal protective equipment (PPE) while providing care to people. Staff had completed infection control training. The people we spoke to did not raise any issues about infection control matters.
 

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People raised no concerns about how and when they received their medicine. All medicines were stored safely, documentation completed, and staff supported people to order repeat medicines if needed. Feedback from relatives included comments that medicines administered, were signed for by staff when given and medicines were administered to people from their dosette boxes with no concerns highlighted.