INFINITYCARE365 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.

This is the first assessment for this 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 staff recruitment.
 

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 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 registered manager and their staff documented incidents and near misses and discussed what could be done differently to reduce the risk of reoccurrence. We saw examples of where staff had completed reflective accounts and discussions with the registered manager following a medicines error. Where appropriate, the registered manager held ‘huddles’ with the staff team so everyone could learn from incidents. A staff member said, “I am aware of an error that has been made. I recorded the evening medication by mistake but didn't administer, [registered manager] picked this up. We discussed this and I had to go back to the training.”

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. The registered manager or a member of the management team undertook pre-service assessments prior to people being supported. Most people using the service were receiving palliative care, where they were being supported by other healthcare professionals the registered manager opened channels of communication to ensure continuity. A relative commented, “[Registered manager] went to see [person] in the hospital, my sister went too and said [registered manager] was impressive. [Registered manager] took no prisoners and requested to see all documents; we got [person] out the next day.”

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. People and their relative’s told us they felt safe with staff, comments included, “We feel safe in their hands, if [person] didn’t feel 100%, we would know about. You can tell if they are anxious, and they haven’t shown any of this with the staff nor displayed any distress. [Person] would tell them to go away but has not at all with the staff here.” Staff were trained in safeguarding and followed the provider’s policy. They demonstrated an understanding of how and when to report safeguarding concerns both internally and to relevant authorities. Staff described types of abuse and what signs they would watch out for if they were concerned about a person’s safety.

The provider did not always work well with people to understand and manage risks. Whilst 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 and care plans had not always been completed. People were mostly supported to manage any risks associated with their health or equipment they required, however, we identified occasions where this had not been documented. For example, there was limited information about a person’s needs in relation to diabetes and another person’s moving and positioning risk assessment did not detail important information. However, staff knew people well and had received training in all areas when supporting individuals. Some risk assessments and care plans contained more detail, including where a person lived with Parkinson’s disease or where people had catheters in situ.

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 registered manager completed environmental risk assessments to promote the safety of people and staff, this included assessments of risk in relation to household chemicals. We saw examples where the registered manager had either contacted, or signposted people and their relatives to various professionals to review equipment. The registered manager said, “[Person] really wants a shower, we have contacted the GP for a referral for an occupational therapist for a downstairs shower room.”

The provider did not demonstrate they followed safe recruitment processes. Checks were not always completed prior to staff employment. We identified staff members did not have the required pre-employment checks in place before commencing employment. Staff employment histories were not documented, therefore, any gaps in employment were not investigated. Checks of staff character and conduct had not been explored. The registered manager told us they contacted referees for feedback on potential new staff, however, there was no documented evidence of this. We signposted the provider to our regulations and sought immediate assurances that employment checks would be carried out. Without robust pre-employment checks, people could be at risk of being supported by unsuitable staff.

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. People and their relatives told us staff respected their property and kept their homes clean. Staff were trained in how to prevent the spread of infection and used personal protective equipment appropriately. The registered manager conducted regular checks on effective handwashing. A staff member told us, “When we enter clients house, we wash our hands with soap and water, this is especially important when dealing with a catheter. We put on gloves and aprons before we do anything.”

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. Staff administered medicines in line with the prescriber’s instructions, this included where people were prescribed time specific medicines. The registered manager placed a high emphasis on safe medicine management and used their skills and knowledge to create additional forms to ensure people were administered their medicines correctly. A staff member spoke of their training and said, “My training was online and I have done medication training on my induction. [Registered manager] shows us and tells us what we are supposed to do, they watched me and signed me off. I feel confident with medication.”