Continuity Health Care Services PVT Limited

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 inadequate. At this assessment the rating has changed to 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 remained in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed safely.

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 promote a proactive and positive culture of safety based on openness, honesty and learning. Systems and processes were not sufficiently robust to ensure safety events were consistently identified, reported, investigated and reviewed. As a result, opportunities to learn from incidents and embed good practice were sometimes missed.

The provider did not always have effective oversight of accidents and incidents. Records were held across multiple systems and were not always accurate, complete or consistently categorised, which reduced assurance that safety events were being effectively monitored.

Accidents and incidents were not routinely analysed to identify trends, patterns or opportunities for learning. For example, falls had been recorded, but there was limited evidence of analysis to identify recurring risks or preventative actions. We also found some incidents and complaints had been incorrectly recorded or omitted from monitoring systems, which weakened management oversight.

Whilst staff were able to describe how they would respond to and report incidents, there were inconsistencies between staff and management's understanding of reporting processes. This reduced assurance that incidents were always recorded, escalated and reviewed appropriately. As a result, the provider could not consistently demonstrate incidents were used to drive learning, improve practice and reduce future risks.

The provider did not always ensure systems, pathways and transitions were safe or effectively managed, resulting in inconsistent care delivery and increased risk to people.

People and relatives reported examples where systems did not support continuity of care. For example, people reported receiving care from multiple different staff members, which increased risk where needs required specific knowledge and consistency. One person said, “One of the things we asked for was continuity, we don’t know who is coming.”

Although electronic monitoring systems and communication tools were in place to oversee care delivery and manage scheduling, these were not always effective. We identified care calls requiring 2 care workers where the second member of staff was not always recorded as attending the call. This had not been identified through the registered manager's oversight processes. As a result, we could not be assured the provider's systems were effective in monitoring care delivery or that people consistently received the planned levels of support required to meet their needs safely.

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 relatives said they felt safe. One person said, “Certainly the carers that I get are exceptional.”

Staff we spoke to understood safeguarding and how to keep people safe. Staff had received the relevant training. Staff told us what they would do in the event of an incident. One staff member said, “Any safeguarding concerns I would report to office or social worker.”

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's care plans did not consistently contain person-centred information relating to their healthcare needs. Records were not always updated to reflect changes in people's health or the risks associated with their conditions. For example, when a person became unwell as a result of a known health condition, the provider failed to review and update the person's risk assessment and care plan. This meant staff were not provided with person centred information on how to support them when their health deteriorated.

The provider had not ensured risk assessments contained sufficiently detailed guidance for staff to manage identified risks safely. For example, although a person was assessed as being at high risk of choking and aspiration, the guidance did not clearly set out the immediate actions staff should take in the event of a choking incident.

In addition, daily records demonstrated staff had not consistently followed guidance within a person's care plan regarding support with eating and drinking, despite the person being at high risk of choking. This concern had not been identified through the registered manager's oversight and was only recognised after it was raised by the inspection team. When challenged, the registered manager stated the records had been 'wrongly worded' by staff. However, this did not provide assurance that staff understood and consistently followed the recommended risk management guidance, or that effective systems were in place to identify and address such concerns in a timely manner.

As a result, people were placed at increased risk of receiving unsafe care and treatment, and the provider could not be assured risks to people's health and wellbeing were being managed consistently and effectively.

The provider detected and controlled potential risks in the care environment. They made sure equipment and facilities supported the delivery of safe care.

Staff received health and safety training and demonstrated a good awareness of how to ensure people’s home environments and mobility equipment were maintained to mitigate potential associated risks.

The provider completed observational checks of people’s home environments as part of the quality assurance checks they completed of staff.

The provider did not always make sure there were enough qualified, skilled and experienced staff. However, staff had received appropriate training, competency checks and supervision to support them in their roles.

Improvements had been made to care call times since the previous assessment, and people generally received their visits at the agreed times. However, the provider was not always able to demonstrate that people received consistent support from staff who knew them well.

Although the registered manager provided a staff rota, most people and their relatives were unaware of this and reported they did not know in advance which care workers would be visiting their home. People and relatives told us there was a lack of consistency in the staff providing care and support, which affected people's experience of the service and their ability to build familiar and trusting relationships with care staff.

We reviewed the service's electronic call monitoring (ECM) data and found some people did not consistently receive the full planned duration of care. For example, one person had 15% of calls where less than half of the planned call time was recorded as delivered. One person told us, “Just once a day they visit, [staff] are all different ones. They do the jobs in 10 or 12 minutes, and I have to pay for 30 minutes.”

Staff were recruited safely and appropriate pre-employment checks had been completed before staff commenced their roles. However, we identified in 1 staff member's recruitment file, gaps in their employment history had not been fully explored prior to them starting work with the service. This meant the provider could not fully demonstrate that all recruitment information had been robustly reviewed in line with its own procedures and safe recruitment practices.

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.

Infection prevention and control policies were in place and staff had access to the appropriate personal protective equipment (PPE). Staff had training to reduce the spread of infection.

The management team completed spot checks on staff to ensure they were providing care in line with expected care standards and the provider’s policies.

Medicines were not always managed safely. The provider’s systems and processes did not ensure people received their medicines as prescribed or in line with recognised clinical guidance, placing people at risk of avoidable harm.

Although some improvements had been made to medicines management since the last assessment, these had not yet been consistently embedded into practice. For example, transdermal patches (medicines delivered through the skin) were not always managed in accordance with best practice guidance. Records did not consistently demonstrate appropriate patch rotation, removal and application monitoring, increasing the risk of ineffective treatment, dosing errors and skin damage.

People prescribed high-risk medicines, such as anticoagulants (blood thinners), did not always have robust risk assessments in place. This meant the risks associated with these medicines had not been fully considered, documented or mitigated, and staff were not always provided with clear guidance to support people safely.

The provider had not identified that prescribed ‘as required’ (PRN) pain relief medicines were being administered for symptoms that were not included within the associated PRN protocols. This meant staff did not always have clear, person-specific guidance to support safe and consistent decision-making when administering these medicines.

Medicine records were not always updated following changes to prescribed treatments. For example, care records did not consistently reflect changes to prescribed creams and eye drops, creating a risk that people may not receive their medicines as intended. We also found medicated creams were not always applied in accordance with prescribing instructions, meaning people could not be assured they were receiving safe and effective treatment.