Almag Healthcare 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.

This is the first 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.

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 based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

At the time of the inspection, the provider had limited systems and processes in place to support a robust learning and improvement culture. There were no formal procedures for monitoring or reviewing accidents, incidents, quality, complaints or learning outcomes.

The provider used an electronic system to manage and monitor care call visits. The registered manager explained that staff training was ongoing to improve the system’s effectiveness. However, during the inspection they were unable to provide any analysis of call times. This information was submitted after the inspection and confirmed that late calls had occurred. The registered manager outlined the actions taken to address these issues, but further time was needed for the improved procedures to become fully embedded and sustained.

The registered manager acknowledged improvements were required in the systems, processes, and oversight procedures. Despite this, there was no improvement plan in place to guide or support these changes. This meant there was no structured approach to ensuring improvements were identified, implemented, or sustained, increasing the risk that existing shortfalls may continue without timely action.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The provider did not have a robust and consistent pre-assessment pathway. A person who used the service and relatives told us of their experience of the provider’s pre-assessment process. Whilst some people told us they had experienced a face-to-face assessment meeting with the registered manager and or care coordinator before the care package commenced, others told us they had a poor experience. For example, people discharged from hospital had not always received a pre-assessment or had any contact with the service until their first care call. This lack of contact from the registered manager caused people anxiety. A relative said, “There was no visit or contact made with us whilst my relation was in hospital. Since the care package started, nobody from the office has been out to do any type of assessment. I've seen no care records, care plans or risk assessments.”

Guidance for staff did not consistently record important information and decisions to support continuity of care. For example, details about the person’s lasting power of attorney and end of life wishes were not consistently recorded. This meant staff did not always have access to essential information to guide safe, person‑centred care or respond appropriately in an emergency.

Furthermore, there was no procedure to share essential information with others when a person moved between settings. For example, ambulance and hospital staff. This lack of planning may have impacted a person experiencing unsafe and inconsistent care.

The provider did not consistently work 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 did not have robust systems, processes and oversight of safeguarding and actions required of them to share information quickly.

There was a lack of oversight, systems and processes that monitored for accidents, incidents and safeguarding allegations and or concerns. The provider’s safeguarding policy did not include the contact details of the local authorities safeguarding team. This may have caused a delay in safeguarding referrals being made.

Feedback from a person who used the service and relatives told us staff provided safe care. However, a concern was raised that staff did not always wear an ID badge and uniform to ensure clear identification of who was providing their care, feel confident that staff were legitimate workers, and maintain professional boundaries and safety. We shared this with the registered manager to follow up with staff. They confirmed that staff were provided with both an ID badge and uniform.

Staff had received safeguarding adults and children training. They understood their role and responsibility in supporting people from abuse and avoidable harm. A staff member said, “Safeguarding is making sure people are safe and free from harm and not taken advantage of, I make sure that people are safe at all times, if I identify any issues or concerns, I record and report this to the management team.”

At the time of the inspection, no person had a Community Deprivation of Liberty Safeguard (DoLS) in place that imposed restrictions on them for their safety.

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.

Risks associated with people’s care needs and support were not consistently assessed, planned for, or mitigated. In addition, some guidance for staff was contradictory or incomplete.

For example, where people had a catheter, staff were required to monitor and report any signs of infection. However, the indicators of infection were not documented, and staff had not received training in catheter care. Although guidance stated that fluid input and output should be monitored and recorded, there was no evidence this was taking place. We discussed this with the registered manager, who agreed to follow up.

Another person was known to be occasionally non‑compliant with their personal care. While staff guidance advised using de‑escalation and distraction techniques, no specific strategies or examples were provided. This person’s daily records over a three‑day period showed repeated refusals of personal care, yet staff had not recorded how they attempted to manage or respond to these refusals. This risk was partially mitigated by the person living with their family, but we raised the concern with the registered manager, who agreed to take action.

The provider did not always detect and control potential risks in the environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments included the environment and equipment. However, risk mitigation actions were not sufficiently detailed to support staff and to protect people. Risk levels had not been assessed to include likelihood and severity. Control measures were too vague, and the assessment was not person centred. This meant staff did not have the clear guidance needed to manage risks safely, increasing the likelihood that hazards would go unrecognised or unaddressed and placing people at potential avoidable risk of harm.

Staff told us they had shadowed experienced care staff before working independently. The provider had a lone working policy. Staff were positive about the support and responsiveness of the registered manager, including out of hours support.

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.

Gaps in staff training were identified. Staff mandatory training consisted of 1 day covering 15 topics, refreshed annually. We raised concerns with the registered manager about the volume of training delivered in a single day, particularly for inexperienced staff. The registered manager told us they agreed and had raised this with the training provider; they were also exploring additional online training.

Mandatory training requirement on learning disabilities and autism had not been completed. People had the following care needs, but staff had not received training in these areas: end of life care, catheter care and Parkinson’s Disease. This meant staff may not have had the knowledge or skills required to meet people’s assessed needs safely, increasing the risk of unsafe or inconsistent care.

People reported they received no staff rota which they would find useful. They also advised they were not notified if care calls were delayed. Some concerns were raised how care calls at the beginning were late. However, people reported staff were unrushed and stayed for the duration of the care call. Relatives raised no concerns about staff’s competency, experience and knowledge. A relative said, “Overall I'd describe the staff as skilled, experienced and competent, some are better than others and need additional explanation of what needs doing.”

The provider completed spot checks on staff and staff had received competency assessments in some areas of care delivery. This included medicines administration and moving and handling.

Staff probation and supervision meetings had not commenced at the time of the inspection. The registered manager advised they had regular contact with staff, this was confirmed by staff, however there was no records to confirm this.

The provider had safe staff recruitment procedures. These checks were completed before staff commenced, ensuring only suitable candidates with the right skills and experience were appointed. However, some improvements were required to the provider’s systems and processes to ensure procedures were completed consistently.

The registered manager told us about late calls and the actions they had taken to make improvements. The registered manger said, “These late calls involved different service users and were not part of a repeated pattern affecting the same individuals. We take punctuality and continuity of care seriously and have been actively working to improve the service. Actions implemented include reviewing staff rotas and travel times, improving communication between staff and the office, and reinforcing the importance of reporting any delays promptly so that service users can be informed accordingly. We continue to monitor the situation closely to ensure improvements are sustained and to minimise the likelihood of future late calls.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The registered manager had provided staff with infection prevention and control training, and a supply of personal protective equipment (PPE). However, a person who used the service and relatives told us staff did not wear PPE consistently. For example, we were told some staff wore both aprons and gloves, while others wore only gloves or only aprons.

A lack of consistent PPE use meant people and staff were at increased risk of infection transmission, and staff were not following recognised infection prevention guidance designed to keep people safe. We discussed this with the registered manager who agreed to follow up with staff

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.

Medicines best practice guidance was not fully adhered to. For example, guidance for staff was missing or not sufficiently detailed. This included information of medication ordering and collecting responsibility, preference of how medicines were administered, storage details and reason for the prescribed medicines and potential side effects

Prescribed medicines known to be high risk did not have a risk assessment. This meant staff did not have the information needed to identify, monitor or mitigate the additional risks associated with these medicines, increasing the likelihood of errors or harm.

Where people had prescribed medicines to be used ‘when required’ (PRN) a PRN protocol was not in place to support staff on how to administer safely. Topical creams were not supported with the use of a body map that provided guidance to staff on site application requirements.

Where people were administered with prescribed pain relief that required 4-hour gaps between doses, we saw examples of administration times being up to 9 minutes earlier than required. This meant people were at risk of receiving medicines too close together, which could lead to reduced effectiveness or potential side effects, and demonstrated that staff were not consistently following safe administration intervals.

At the time of the inspection no person had come to harm. We discussed the above shortfalls with the registered manager who agreed to follow up.