Archived: Florence Care and Consultancy Service 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 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.

We found no evidence that people using the service had been harmed however, we identified 2 breaches of the legal regulations in relation to this key question because of the way the provider managed risk and trained, supported and monitored staff.

This represented a breach of regulation 12 and 18 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can find more details of our concerns in the evidence category findings below.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness and honesty. They 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.

The registered manager did not have a proactive culture of routinely identifying and learning lessons when things had gone wrong to continuously improve. For example, the provider did not have systems in place to regularly conduct audits and checks on the quality and safety of the service they provided and to analyse their performance.

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.

Information was obtained from people using the service, and others involved in their care, about service users individual needs and risks they might face. This was used to develop individualised care and risk management plans to ensure people received safe and appropriate care and support from the moment they started receiving a home care service from this provider.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

The registered manager and staff understood how to safeguard people. They knew how to recognise and report abuse. The registered manager told us they would work with the relevant external health and social agencies when a concern was raised and take appropriate action as and when required to protect people from further risk of harm.

The service 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. Care records included risk assessments and service users likes and dislikes.

Staff were knowledgeable about the risks faced by people they cared for and managed them well. Staff said if the health of service users they supported declined, they would help them access the relevant healthcare services.

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

A health and safety risk assessment, including a fire safety one, had not been carried out on the home environment of service users. Furthermore, the registered manager was not conducting regular in-person visits of the service users home, contrary to recognised best quality assurance practice and the providers own quality monitoring procedures. This meant the registered manager was not always identifying and mitigating potential environmental health and safety risks, including fire safety issues, the person using the service and their live-in care staff might face.

The service did not make sure staff received effective support, supervision and development. They did not always make sure there were enough qualified, skilled and experienced staff.

Staff were not always suitably trained and supported. Staff did not have sufficient opportunities to routinely reflect on their working practices and professional development. For example, not all staff had had their overall work performance appraised, and their working practices routinely observed by the registered manager for over 12 months. This was in contrary to recognised best staff support practices and the providers own staff appraisal and monitoring policies and procedures. In addition, although the staff were trained, this was sometimes provided by the registered manager, whose own training was not always up to date.

However, staff had received 6 formal individual supervision meetings with the registered manager in the last 18 months.

People using the service also received continuity of care and support from the same small group of live-in staff who were familiar with their needs, wishes and daily routines. Newly employed staff were subject to a probationary review and records showed staff received an induction to their role. The provider operated safe recruitment practices and only suitably ‘fit’ staff were employed to work for this home care agency.

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 were supported to live in a clean, hygienic environment.

Staff had received relevant infection control and food hygiene training, which meant they knew the processes to follow to minimise the risk and spread of infection. Staff had access to resources and equipment to help them reduce infection risks. Personal protective equipment [PPE] was available in the office for staff to collect and the Registered Manager informed us that [PPE] was delivered to the service users address to ensure equipment was always available. People told us staff always wore appropriate [PPE] when they supported them with any personal care.

The service did not always make sure staff authorised to manage medicines remained competent to do so safely. The service did make sure medicines met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Staff authorised to manage medicines on behalf of people receiving a home care service had received safe management of medicines training. However, staff competency to continue managing medicines safely had not been assessed by the registered manager for over 2 years. This contradicted recognised best medicines practice and the providers own safe management of medicines and staff training policies and procedures.

This staff competency issue notwithstanding medicines records showed us the people using the service consistently received their prescribed medicines as and when they should. Care plans included detailed guidance for staff about people’s needs and preferences relating to administration of their prescribed medicines.