Cheshire Support 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 people were protected from abuse and avoidable harm.

This is the first comprehensive assessment 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.

The provider was in breach of the legal regulations in relation to safe care and treatment and staffing.

This service scored 50 (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. Lessons were not always learnt to continually identify and embed good practice. There was a system in place to record accident and incidents. While we were assured the necessary action was taken immediately following incidents to ensure people’s safety and wellbeing, we found the necessary follow up actions were not always completed. For example, where records detailed a person had incidents involving their continence aid, we found no evidence their care plan and risk assessment had been updated to reflect changes to the risk level. In addition, lessons learnt were not always well recorded. Further improvement was needed to ensure information about incidents was used to make overall improvements to the service people received.

The provider did not always implement effective processes to maintain safe systems of care. The provider did not always effectively monitor people’s care calls, and they did not always make sure there were effective contingency plans to ensure continuity of care. For example, staffing contingency plans were not robust and call data showed office staff were covering a significant number of care calls. We were not assured leaders had developed effective plans to ensure calls would be covered if additional emergencies occurred. This increased the risk of people receiving a disrupted service during staffing emergencies. We found records maintained in relation to people’s needs, risks and care were not always reflective of people’s current needs to ensure a safe and positive transition to other services if needed.

However, the registered manager was responsive to our findings. They shared details of how they were recruiting additional senior staff to strengthen contingency plans for staffing emergencies. They told us this was necessary to ease pressure on existing office staff and to ensure care was uninterrupted for people.

The provider had effective systems in place to respond to and report safeguarding concerns. Staff understood their safeguarding responsibilities and could describe in detail the action they would take if they felt someone was at risk of abuse or harm. When safeguarding incidents occurred, our overall review of records assured us the provider had shared concerns with the local authority appropriately. People and their relatives told us they felt safe in the care of staff. Comments included, “We feel safe knowing they are taking care of [Person]” and “The carers are very nice, I feel safe with them.”

However, we identified not all staff had completed safeguarding training at a frequency deemed necessary by the provider. The registered manager was responsive and took action to ensure all staff completed safeguarding training by the time the assessment concluded.

The provider did not work well with people to understand and manage risks. Records did not demonstrate risks to people's health, safety and welfare were robustly assessed. Risk assessments were either not completed or not detailed enough to guide staff on how to safely support people. For example, some people had individual risks associated with skin integrity, mobility, nutrition and hydration and moving and handling which had not been appropriately assessed. In addition, for several people living with long term health conditions, no risk assessments were completed to guide staff on how these conditions affected people’s day-to-day and what staff should do to mitigate the risk. There was a risk people would receive unsafe care due to a widespread failure to adequately assess people’s individual risks and develop effective care plans to guide staff.

The registered manager took our concerns seriously and assured us of the action they were taking to undertake reviews with people and develop effective care plans. We saw evidence work to improve the quality of the records was underway before the conclusion of our assessment.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.The provider failed to consistently carry out regular environmental risk assessments of people’s homes. Records did not always assure us environmental risks had been adequately assessed and mitigated and equipment in use during the delivery of personal care was safe and fit for purpose. However, we found no evidence of harm as a result of these shortfalls.

The provider did not always implement effective systems to ensure sufficient staff were deployed to cover both the emergency and the routine work of the service. While no missed care calls were identified, the call data showed the effective deployment of staff was not well managed. For example, the data showed concerns in areas such as punctuality and a lack of travel time leading to calls being crammed. Where people required the support from two staff, we saw they did not always arrive at the same time. This increased the risk that people may not be cared for safely. Staff working in the community told us they had a lot of calls to complete and described how this negatively affected their work life balance and overall wellbeing. Similarly, office staff described the impact the emergency call cover had on their wellbeing and described how this impacted on their day-to-day governance roles.

Staff recruitment was not always carried out safely. For example, not all references from previous health and social care employments had been sought for staff. This meant the provider did not have the necessary assurances about staff conduct in previous roles working with vulnerable people. The provider had a mandatory training and induction programme for all staff to complete. Records relating to staff induction were poorly maintained and leaders lacked full oversight of the completion of mandatory training. The registered manager had already identified some of these shortfalls, however, we identified improvement was not timely.

We shared our findings with the registered manager, and they committed to improving staffing oversight. By the end of the assessment, we were assured increased auditing of care calls was taking place and the number of calls completed by office staff had reduced which allowed them more time to focus on their main role and responsibilities.

People and their relatives told us they were supported by a consistent team of staff, and they felt confident staff had the required skills to care for them safely.

The provider mostly implemented effective processes to detect and manage the risk of infection. While some care plans contained basic information about infection prevention measures, these could be further developed to guide staff on the specific action they needed to take to reduce risk in this area.

However, staff had undertaken training in the prevention of infection, and they told us they had access to plenty of PPE. People and relatives told us staff wore PPE when completing their personal care and they felt confident they followed effective hygiene practice to reduce the risk of cross contamination.

The provider did not make sure medicines and treatments were safe and there was an increased risk people’s needs would not be met. For example, where staff were supporting people with medicines, we found widespread failures in relation to the providers ability to assess and plan for people’s medicines support. For several people receiving medicines support, we found no medication support plans or risk assessments were in place to guide staff on how to mitigate medicines related risk. By failing to develop effective care plans and risk assessments, this increased the risk of people not being supported effectively in line with their needs and preferences and increased the risk of medicines related harm.

Staff responsible for the management and administration of medication did not always receive training and assessments of their competency in line with best practice guidance. For example, for 2 staff no competency assessment could be produced and records showed they were not always following safe medicines administration principles. There was an increased risk people would be at risk of medicines related harm as records did not assure us staff had the necessary skills and knowledge to deliver this support safely.

We shared our findings with the registered manager and provided resources to guide safe medicines practice. They took responsive action to complete robust medicines competency assessments with staff during our assessment.