Caring with Dignity 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 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. The service was in breach of legal regulation in relation to safe care and treatment.

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. While accidents, incidents, and complaints were recorded and investigated, the service could not evidence learning from these events was shared or embedded systematically across the teams. One relative stated, “I don’t feel the service learns from feedback because the same issues keep happening.”

However, proportionate action was taken to address individual concerns. For example, following a complaint about staff, alternative staff were arranged, and a missed call was escalated to a supervisor with written confirmation of the agreed actions. These examples show individual concerns were responded to on a case-by-case basis, demonstrating some positive elements in safety and incident management.

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.

Staff and managers described assessment arrangements whereby new clients received a pre‑assessment, hospital passports were used when people went to hospital, and senior staff attended first visits to ensure care was delivered safely and in line with people’s needs. New staff also completed structured shadowing to ensure they understood support plans and people’s preferences before working independently.

While there were minor variations in how information updates were understood by staff, core systems for communication and oversight were established and accessible through management briefings and electronic care planning tools. Overall, the provider had frameworks in place to support safe pathways and transitions. These systems were generally effective in promoting people’s safety and continuity of care.

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.

Staff demonstrated awareness of safeguarding principles and their responsibilities, with multiple staff confirming they had completed safeguarding training and could identify signs of abuse or neglect. Staff provided practical examples of responding to safeguarding concerns, seeking medical assistance following a fall, and ensuring accurate recording and timely escalation of concerns within the electronic care system. Management carried out observations and spot checks to monitor practice and promote safe, respectful care.

Although some inconsistencies in day-to-day practice were identified, there was no evidence of widespread safeguarding failures. Overall, staff understood how to keep people safe and there were mechanisms to support the escalation of concerns.

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. Risk assessments were in place and tailored to people’s individual needs, covering areas such as moving and handling, environmental risks and medicines management. Staff described checking updates on the ‘care app’ before beginning support, and relatives confirmed the service assessed and reviewed people’s needs, particularly when health conditions changed. For example, a family member stated: “[Person] had a review yesterday and we decided [person] should live downstairs, and they supported that decision”. These practices demonstrated a person-centred approach to risk management.

Whilst in most circumstances risk assessments were completed for identified risks, there were occasional instances where documentation had not been updated as promptly as it could have been when needs changed, for example following changes in a person’s mobility. The provider acknowledged this and took action during the assessment to address and rectify the records. There was no evidence of systemic unsafe practice; however, improving the consistency and timeliness of updates would further strengthen the reliability of the systems in place. Overall, people were involved in managing risks, and arrangements were generally effective in supporting 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. The provider carried out environmental risk assessments for each person using the service, and staff were aware of the need to monitor equipment and report any concerns. Management confirmed environmental risk assessments and fire risk assessments were completed for people using the service, and specialist equipment such as hoists was regularly inspected by the local authority and carried a current safety‑check sticker. Staff also explained that when equipment concerns arose, they took swift action, such as photographing faulty items and immediately reporting them to the registered manager for follow‑up. These processes demonstrated systems to identify and address environmental risks were in place.

One family member described positive environmental oversight, explaining: “They tidy the house and make the bed, so [person] is living in a clean and safe environment.” This feedback highlights good practice.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had a formal recruitment policy with checks consistent with safe recruitment, including two professional references and enhanced Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Sampled staff files showed these processes were followed in practice.

Induction included 1–2 days in the office plus shadowing with experienced colleagues, with several staff confirming multiple shadow shifts before working independently. Management described a structured induction sequence, including shadowing, medicines competencies, and online care skills training.

Staff received regular supervision, spot checks, and ongoing support, with management working alongside them when supporting new people using the service. Routine communication was maintained through monthly senior meetings and quarterly wider staff meetings, with minutes circulated to all staff.

Relatives reported reliable rota planning and continuity, noting, “They send a weekly rota and it’s pretty consistent, so we know what’s happening.” Staff confirmed communication systems supported day-to-day coordination, including out-of-hours cover, and families described a cohesive core team, with one noting, “They all know us well and there’s a good team.”

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 confirmed gloves, aprons and masks were readily available and Personal Protective Equipment (PPE) was disposed of correctly once used, describing that it was placed into the appropriate bin after personal care tasks.

Staff reported no concerns about PPE supply, with one staff member explaining they also helped distribute PPE to colleagues and ensured appropriate stock levels were maintained. Staff further confirmed they had received training in infection prevention and control, and the provider’s policies outlined clear expectations for good hand hygiene, correct use of PPE, and safe handling and disposal of clinical waste. The evidence showed the provider had appropriate procedures in place and ensured staff were aware of their responsibilities in preventing cross‑infection.

The provider did not consistently ensure that medicines and treatments were managed safely or met people’s needs, capacities, and preferences.

During the assessment period, issues with the electronic medicines administration record system were identified. Discrepancies included medicines appearing twice with differing doses, and missing reasons for administration of ‘as required’ medicines, such as those used for pain relief. We found this across multiple dates and different people’s records. Although paper medicine administration records were introduced by the registered manager following the concerns flagged during the assessment, the system error persisted.

Staff had completed medicine management training and received supervision, and some people and relatives reported that medicines were administered on time without issue. However, observations and record checks highlighted multiple inconsistencies, meaning the provider could not reliably evidence safe medicines management.

Overall, medicines were not managed safely. Records were unreliable, staff practice was inconsistent, and medicines management required improvement to reduce risk and ensure people’s safety.