QUALITY LIVING 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. This key question has been rated inadequate.

This meant people were not safe and were at risk of avoidable harm.

The service was in breach of 3 legal regulations. These were in relation to safe care and treatment due to inadequate care planning, lack of robust risk assessment and unsafe medicines management; staffing; and fit and proper persons employed at this service.

This service scored 28 (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 have a proactive and positive culture of safety. Opportunities were missed for learning to continually identify shortfalls in safety in the service and embed good practice.

The culture within the service was not focused on improving safety and learning. There was a lack of effective systems, processes and guidance for staff in relation to the management of known risks to people. Further information for staff was needed about how the risks would be managed.

However, staff told us they felt there was enough information to provide safe care. This was concerning due to the significant information which was not present in support plans and risk assessments.

There was no system in place for recording and analysing incidents. The registered manager told us that since supporting people there had been no incidents. This meant we could not be assured opportunities to drive improvements in the service would be identified from lessons learnt in relation to incidents which occurred.

The registered manager told us there had been no safeguarding alerts or concerns raised about people who used the service, so there were associated no investigations, or detailed analysis which we could review. The provider had a policy which had clear guidance on the actions they should take should safeguarding concerns arise. The registered manager told us they were aware staff training needed to be completed as just 4 of the 7 staff had completed safeguarding training; however, this had not been completed in a timely way.

Staff supervisions were not carried out regularly for all staff to aid improvements in the service and safety of people in relation to their support needs. Staff told us they could speak with the registered manager should they wish or need to about any concerns they had.

The registered manager told us, and people and their relatives confirmed, no complaints had been made about the service. We were told that compliments had been received, although these were not robustly recorded and analysed meaning good practice may not be cascaded to the staff team to support wider improvements and safety in the service.

People and relatives told us they could contact the service if they had any concerns about their care.

The provider worked with people and health system partners; however, they failed to establish and maintain safe systems of care. They did not manage or monitor people’s safety. They did not make sure there was continuity of care, including when people moved between different services.

Care plans and risk assessments held by the provider failed to demonstrate there was adequate information for robust continuity of care, including when people moved between different services. This included when people transferred to hospital due to their health conditions having deteriorated. The provider failed to maintain comprehensive records or audits of the care and support provided by staff, ensuring records and subsequent actions were clearly documented and carried out.

There were support plans in place which had been uploaded to the provider’s electronic system, we found these to be inadequate for staff to refer to should they need guidance. The provider had not taken into consideration the implications of staff not having access to complete information online.

The provider had completed pre-assessment paperwork; however, these documents lacked sufficient information in relation to the support people required, health conditions and life histories. Staff we spoke with were not aware of all of the health conditions people had or their life histories. This meant staff did not have significant and important information available to them.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

At this assessment we found the provider failed to adequately protect people from potential harm. The provider had failed to seek further advice and appropriate measures in place, to ensure the safety of 1 person who was at increased fire risk. This lack of information could have caused significant harm or even death, because guidance for staff to follow was not in place. We found a lack of guidance for staff on the management of known risks was the case for both people using the service who were receiving personal care.

The registered manager told us they had identified a change in a person’s mobility needs and had sought advice from the relevant health professionals resulting in additional equipment being provided. However, the registered manager had failed to update support plans and risk assessments regarding these changes in their mobility needs. This placed the person at risk of harm or injury due to the lack of guidance for staff.

For 1 person who was at risk of developing pressure sores the registered manager had failed to identify the risks associated with this known risk and implement systems and processes to reduce the risk. This placed the person at increased risk.

Not all staff members employed had received training in safeguarding. Two staff we spoke with could not adequately tell us what safeguarding meant or how they would escalate concerns beyond the registered manager. The training matrix indicated these staff members had completed their on-line training just 3 months earlier but could not recall what they had learnt. This meant we were not assured about the quality of their training as the registered manager had not carried out any competency assessments to ascertain their knowledge and skills afterwards.

However, people told us they felt safe with the staff supporting them.

The provider did not work well with people to understand and manage risks. Staff did not have the necessary guidance to always provide care to meet people’s needs that was safe, supportive and enabled people.

At this assessment, we found insufficient risk assessments and guidance for people who needed assistance to move safely. This included a lack of clear guidance in the safe use of equipment such as hoists, slings and slide sheets to support people safely. In addition, support plans and risk assessments for other known risks, such as fire risks, had not been developed to ensure people were safe. Risk assessments lacked clear guidance for staff to follow about how the risk should be managed. This included a lack of clarity on how to manage risks relating to people’s specific health conditions. For all the support plans we reviewed, some known risks had not been assessed at all, so there was no guidance for staff about how the risk should be managed, which had the potential to put people at increased risk of harm.

Whilst shadowing records were not detailed, staff members told us they had the opportunity to shadow experienced staff members. One staff member told us, “I had shadowing for 1 week. I shadowed a carer and the Director.” This shadowing was designed to help them get to know the person’s care needs prior to working unsupervised.

Despite our findings there was no evidence people had been harmed. Staff knew people’s needs and told us they understood how to manage people’s care in a safe way. Records we looked at demonstrated people were supported by consistent staff.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider failed to carry out comprehensive environmental risk assessments of people’s homes and provide associated guidance for staff to follow. One person was prescribed highly flammable products; there were no risk assessments in place to mitigate such risks and reduce the potential for harm to both the person and staff. There was no evacuation plan in place in the event this resulted in a fire. Although support plans included an environmental assessment designed to check the safety of the service user’s home environment, these were not detailed or robust in identifying and managing the risks. The provider failed to identify and take steps to control potential risks within the environment care was delivered.

The provider did not 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 work together well to provide safe care that met people’s individual needs.

The provider's recruitment systems were inadequate and safe recruitment practices were not always followed. People were at risk of harm from receiving care and support from unsuitable staff.

Suitable references had not been obtained for 2 staff members whose recruitment files we looked at. References had not always been obtained from prospective staff's most recent employer or had been provided by people who had not been named as a referee on the staff member’s application form. This meant the provider had failed to ensure they had obtained all the information required ensuring the suitability of all staff employed. This placed people at risk as the provider did not know if staff were suitable to support vulnerable people. Where this had occurred, the provider failed to carry out a risk assessment to mitigate the potential risks this may pose.

One of the staff files which we looked at demonstrated a Disclosure and Barring Service (DBS) check had not been completed prior to staff commencing employment. The staff member’s records demonstrated they had gone into people’s homes to carry out shadowing duties without a DBS check in place. The provider had failed to carry out any risk assessments in relation to this practice. The DBS provides information about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider had failed to evidence they had explored any gaps in employment records.

The provider failed to maintain robust oversight of scheduled calls. Whilst people told us they were happy with their calls, the provider could not be assured staff were attending calls on time. We looked at call records which confirmed for some people calls were sometimes late. One relative told us, “Staff have started to come outside of the agreed times, but this has not been a problem yet.”

The training matrix indicated 4 of the 7 staff had received mandatory training; however, there were no robust competency assessments in place to demonstrate staff learning following the completion of on-line training. This meant the provider could not be assured staff had learnt and had the knowledge and skills to carry out such support. We found where specialised care equipment was in place, staff had not always been appropriately trained in the use of this.

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 failed to ensure where people used specialised equipment there were robust risk assessments and guidance in place for staff to follow. The provider told us that staff had no involvement in this; however, a relative told us that staff did clean the equipment if it was blocked. This had the potential to put people at risk of cross contamination and the increased risk of infections.

We were provided with just 1 record where a senior carer had carried out spot checks to ensure care staff were following safe practices and were adhering to the correct use and safe disposal of personal protective equipment (PPE).

Staff told us they had access to the PPE they needed to prevent and control the spread of infection and had received training. Most people and relatives we spoke with confirmed staff wore appropriate personal protective equipment (PPE).

The provider did not have an accessible infection prevention and control (IPC) policy in place on the first day of our assessment; this was put into place after the assessment commenced. This meant staff did not have access to clear information and guidance on IPC measures in place and the provider had not robustly implemented this guidance in the day-to-day support plans for people.

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

We found people were not supported to receive their medicines in a safe way. We found there were shortfalls in the safety of medicines management at this assessment.

Care plans and risk assessments contained unclear or no information to guide staff on the level of support people needed with their medicines. For example, for 1 person whose support plan stated they required oxygen there was no further information in relation to safe management of this. We found staff were recording this home oxygen therapy was working correctly but had not received guidance or training on this medical treatment and associated risks. This was unsafe and placed people at risk of not receiving their medicines, as prescribed. A staff member told us they administered 1 person’s medicines on occasions; however, we were told by the provider that none of the people using the service were supported with medicines. We found, and the provider confirmed, there was no medication administration chart (MAR) in place for these medicines. This meant staff did not have records to refer to, to ensure they were giving the correct medicines, at the correct time.

There was also a lack of information for staff members to follow for the administration of 'as required' (PRN) medicines, to ensure a consistent approach. This included the application of people’s prescribed creams which staff members were applying. Protocols and guidance for PRN medicines were not in place, and this was confirmed by the provider. Without clear protocols in place, this could result in staff not knowing when to give these medicines, leading to the potential for too much or too little medication to be given.

We found for people who were prescribed creams to treat skin conditions, these medicines were not consistently included in the person’s support plans and there were no MAR charts or body maps in place. This meant people were at risk of their skin condition deteriorating and staff did not have the information they needed to provide safe application of prescribed creams. They did not have clear instructions on when, where, or how the creams should be applied. This was of particular concern for 1 person who had skin conditions or were at risk of developing pressure sores as their prescribed creams needed to be applied to prevent further deterioration of their skin.

People and their relatives told us they were happy with the support they received with their prescribed medication namely creams.