Clarissa's Home Healthcare Services LTD

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 assessment we rated this key question requires improvement. At this assessment the rating has remained 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 regulations in relation to safe care and treatment and fit and proper persons employed.

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 did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

The provider did not have effective oversight of accidents, incidents and concerns. Information was incomplete and records did not always provide clear and accurate information regarding actions taken to prevent a recurrence and any lessons learnt. For example, records did not always show learning had been shared with staff to help improve practice and embed high quality care. Systems and processes were ineffective in identifying themes and trends to improve on practice to keep people safe.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Staff ensured there was continuity of care, including when people moved between different services. Staff told us they received information when people were new to the service. The registered manager told us they worked with people and their relatives to support safe transitions to alternative services, such as care homes and would accompany people if needed.

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 have effective oversight of safeguarding. For example, these did not show who had managerial oversight and whether the care plans and risk assessments had been updated. For 1 person, the log stated, "aggressive behaviour," however, there was no information recorded on how staff could support the person when displaying behaviours that challenge. This meant the provider could not be assured people were consistently protected from avoidable abuse and harm.

The provider failed to consistently work in line with the Mental Capacity Act 2005. For example, 1 person had a mental capacity assessment in place. However, the registered manager confirmed the person did not lack capacity. Therefore, it was unclear why a mental capacity assessment had been completed. Staff told us if they had concerns, they would report them to the manager or safeguarding lead. People told us they felt safe. People’s relatives told us people felt safe. The provider reported safeguarding concerns to the local authority.

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. People were not offered opportunities to be involved with planning and making decisions around risks to them. For example, care records lacked guidance and were not person-centred. For 1 person, staff were instructed to give the person a “good wash” either in bed or on the commode. There were no instructions for staff on how to mobilise the person safely. There were no instructions for staff on how to support the person with their oral care. For another person who was at risk of falls and required support with their mobility, the instructions for staff were to, “supervise” and, “support as required.” This guidance lacked detail, such as the levels of support and supervision the person required. One person’s care records instructed staff to check the pressure points.” However, there was no guidance for staff about how to check the person’s pressure points. The provider failed to manage emollient creams safely. Emollient creams pose a recognised fire safety risk. The provider had failed to consistently assess this risk. This meant the provider could not be assured they were doing all that was practicable to manage risks associated with flammable creams. People told us staff were aware of their healthcare needs. However, the care records lacked important information to ensure staff could support people consistently and safely.

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.

For example, care records included guidance for staff to ensure carbon monoxide detectors were in good working order and to test the smoke alarm. However, there were no instructions for staff on how to action this. This meant people were at risk in the event of a fire. The action plans in relation to hoists and lifts were unclear. For example, there was no guidance to support staff on what actions should be taken and who was responsible for implementing the actions.

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. As a result of changes to their training provider, staff had been unable to log-in and access training. This had resulted in some staff having out-of-date training. The registered manager confirmed all staff now had access and were completing any outstanding training. However, the provider had not acted to mitigate potential risks of staff not having relevant, up to date training.

Staff were not always recruited safely. We identified shortfalls in the recruitment and induction processes. For example, we found gaps in application forms and induction records, while staff spot checks, competencies and supervisions were not always completed. The provider had records of proof of identity for staff and the interview questions asked during the recruitment process were relevant to the role applied for. The registered manager told us they, “Will look at getting training on staff recruitment and staff files.” The registered manager told us they agreed with the discrepancies.

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 understood how to prevent and control the spread of infection. Staff told us they always had enough personal protective equipment (PPE), and they wore gloves, masks and aprons when delivering personal care or when there was a risk of infection. People and relatives told us staff wore their uniform, gloves and a person told us, "They change them all the time."

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.

One person was placed at risk of harm due to unsafe communication systems. Staff were responsible for administering the person’s medicine on an ad-hoc basis. When support was needed, this was communicated via text message. However, the provider did not have a system in place in the event of undelivered communication. For example, if a text was undeliverable and the message was not received by the provider. This placed the person at risk of not receiving their medicine as prescribed. In response to our feedback the registered manager told us they would review the current process and implement changes

Guidance for staff regarding the management of medicines was inconsistent and conflicting. For example, guidance for 1 person instructed staff to offer analgesia and apply prescribed creams. However, the person's care records stated the relative administered all medicines. For another person, the care records stated they did not take PRN medicine. However, the care records instructed staff to give paracetamol to the person when required during the day. For another person, the care records stated they had a PRN medicine, but the records did not contain enough information to support staff to safely administer the PRN medicine. Records did not always reflect people’s needs, and the provider could not be assured staff had access to the correct information to manage medicines consistently and safely.