Prospect Health Living Care Services Limited

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• 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 good.

This meant people were safe and protected from avoidable harm.

This service scored 66 (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. Due to the size of the service and the infrequency of incidents and accidents, incident follow-up was completed on an individual basis; however, the registered manager recognised that, particularly as the service expanded, more robust service level oversight would be required to identify and monitor recurring themes and trends. The registered manager was open and transparent and demonstrated commitment to drive improvement at the service.

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. People’s needs were assessed before support commenced with involvement of both people and, where appropriate, their families. Records showed that the service worked with other professionals to promote safe transitions between services including on discharge from hospital.

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 registered manager was aware of their duty to report any concerns to the local authority and CQC but had no recent safeguarding incidents that met the threshold for reporting. Other events requiring notification to CQC had been reported appropriately. People and their relatives told us they felt safe with the support provided by the service. One relative told us, “Excellent care. No issues whatsoever. So thorough.” Staff had completed training in safeguarding and the provider’s policy guided staff about how to recognise and report abuse. Staff told us they felt confident to raise concerns if they felt people were at risk and that action would be taken. One staff member told us, “I would follow safeguarding procedures immediately, reporting concerns to my manager, documenting accurately, and escalating if necessary. The safety of the individual is always the priority.” The principles of the Mental Capacity Act 2005 (MCA) were understood by the registered manager and there were processes in place to review people’s capacity in line with the MCA. Some further detail needed adding to some care plans about capacity and some staff needed to complete training.The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). We found the service overall was working within the principles of the MCA.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Overall risks were assessed and mitigated to keep people safe and risk assessments provided guidance for staff ensure people received safe and responsive care and support. However, while current staff were knowledgeable, the care plan and risk assessment for 1 person needed additional detail to guide staff on the type and consistency of food that were suitable for the revised level of modified diet prescribed by the speech and language therapist. References to the new level also needed updating in all areas of the care plan. The registered manager actioned this immediately.

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 environment was assessed prior to support starting and any concerns noted by staff on visits were promptly reported. However, while checks were completed, more robust recording of ongoing environmental checks and equipment servicing dates were required to safeguard both people and staff. The registered manager agreed to implement a system for recording checks completed and explore adding automated service alerts to their electronic system.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff completed an induction on commencement of employment and ongoing training and refreshers to enable them to carry out their role effectively. However, some staff had not yet completed mandatory training in key areas, including safeguarding and the Mental Capacity Act 2005. An action plan was in place to address this with deadlines set for staff. Recruitment procedures were established to ensure that people were supported by staff who were appropriately qualified and assessed as suitable to work with others; however, these procedures required further strengthening around employment history to fully ensure safe recruitment practices. We reviewed electronic records of visits completed and queried some call details with the provider who provided explanations for anomalies found. No concerns were raised by either people, families or staff about call times or consistency. One relative told us, “Yes, we have the same carers. Spot on (re call times). Most of the time they’ll go above and beyond and may stay extra and stay over for 10-15 minutes.” A person told us, “I have 2 carers and they are always on time.” Staff told us they felt supported in their roles and received regular support and supervision. One staff member told us, “I received regular supervision, 1-1 meetings and attend staff meetings where we discuss updates, concerns and improvements. This helps me stay supported and informed.”

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 received training on infection, prevention and control (IPC). No concerns were raised by staff, people or families about the availability of personal protective equipment (PPE) or management of infection. One person told us, “I can’t fault them. They [staff] vacuum and dust.”

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 were trained in medicines administration, and their competency had been assessed. People were supported by staff who followed systems and processes to administer, record and store medicines safely. People and their families raised no concerns regarding administration of their medicines. One relative told us, “[Name of relative] has a NOMAD (Monitored Dosage System), so everything is set out and they just dispense. The pharmacy incorrectly put medicines in the NOMAD, and they rang straight away to tell me.”