CREATIVE CARE HOME 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 registered service. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there were limited assurances about safety. There was an increased risk that people could be harmed. There was breach of the regulation safe care and treatment which included medicines.

This service scored 44 (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. Lessons were not always learnt to continually identify and embed good practice.

There were no records of any accident or incidents occurring at the service. Discussions about good practice were reflected in staff supervision meetings.

During our assessment concerns were identified with the assessment of risk, medicines and staff training. These concerns were not identified by the provider due to a lack of robust monitoring systems and a lack of robust oversight. This meant opportunities for learning and improvement were missed.

The provider did not always maintain safe systems of care. They did not always ensure information about people’s needs was sufficient to ensure continuity of care, when people moved between different services or needed support from different health care partners.

An assessment of people’s needs took place on referral to the service and care plans were developed with the person and/or their representatives. Information to staff on people’s health needs and risks was not sufficient to ensure staff had adequate guidance on how to mitigate safety risks. For example, people’s risks had not been properly assessed in respect of nutrition, falls, skin integrity, mobility and moving and handling. Shortfalls in assessment and care planning impacted on the provider’s ability to share accurate and up to date information on people’s needs with different services.

The registered manager and staff had regular contact with the people they supported and knew their needs well. People were also supported by the same staff team which ensured people experienced continuity of care.

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 whilst protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People and their relatives told us staff were kind and caring. They told us they always felt safe with staff.

No safeguarding incidents had been reported at the service. There were appropriate safeguarding and whistleblowing policies in place to guide staff practice. Staff were knowledgeable about how to protect people and respond to incidents of possible abuse. The registered manager was aware of their reporting responsibilities to the Local Authority and CQC should abuse occur or be reported.

The provider did always work well with people to understand and manage risks. Staff did not always have adequate information on people’s risks or guidance to ensure people’s care was safe, supportive and enabled people to do the things that mattered to them.

People’s needs and risks were not adequately assessed and staff lacked guidance on how to mitigate some of the risks related to their health and welfare. For example, staff lacked information on people’s health conditions, the impact these conditions had on people’s lives, the signs and symptoms to spot in the event of ill-health and the action to take.

Some people had individual risks associated with falls, skin integrity, nutrition, mobility and moving and handling. No adequate assessment of these risks had been completed. This meant staff lacked guidance on the level of risk and how to mitigate these risks during the delivery of personal care. Safe working procedures were not followed in respect of the use of moving and handling equipment, such as a hoist. No proper assessment or risk management plan was in place to advise staff how to safely use this equipment to mitigate the risk of avoidable harm. Where guidance had been stated it had not always been followed.

The provider failed to carry out regular environmental risk assessments of people’s homes to ensure the home environment and the equipment in use during the delivery of personal care was safe and fit for purpose.

The provider failed to carry out regular environmental risk assessments of people’s homes and the equipment in use for example, moving and handling equipment to ensure the home environment and the equipment used during the delivery of personal care was safe and fit for purpose.

The provider made sure there were a sufficient number of staff to support people. The provider did not ensure however staff employed had completed adequate training to do their job role to ensure they had the skills and competencies to provide safe and effective care.

The same staff members supported people with their personal care each day, which enabled staff to build positive relationships with the people they supported. It also meant people experienced continuity of care.

Staff members received a brief induction to the service which included shadowing an experienced member of staff. Records showed this induction lasted for approximately one week before the new staff member was allowed to work unsupervised with people.

Staff members involved in people’s care were permitted to work unsupervised without completing all of the provider’s mandatory training programme or the Care Certificate recommended by CQC and Skills for Care. This meant the provider could not be assured new staff had the necessary up to date skills and competencies to undertake the role expected of them.

For example, some staff supporting people had not completed training in moving and handling, medicine administration, food safety, basic life support, dementia, mental capacity act, infection control and prevention, safeguarding, equality and diversity, health and safety or first aid before supporting people on their own. The registered manager had also not completed all of the required training for their job role.

Spot checks on staff practice were completed, and staff had received supervision. No staff employed at the service at the time of our assessment were due an appraisal.

The provider managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us staff wore personal protective equipment (PPE) when providing support with personal care. Staff told us they had access to adequate supplies of PPE and clinical waste bins to safely dispose of waste and PPE. Staff were knowledgeable about what PPE to use.

The provider had an infection control and prevention policy (IPC) in place.

The provider did not have an effective system or process in place to account for medicines and to ensure people received their medicines safely and as prescribed.

The management of medicines did not follow best practice guidance issued by the Royal Pharmaceutical Society, the National Institute of Heath and Care Excellence (NICE), CQC or the provider’s own medicines policy. There were no effective processes in place to ensure medicines were given correctly. There were no systems in place to ensure records in relation to medicines were accurate, up to date and correctly maintained.

Information in people’s care plans with regards to what medicines they were prescribed did not always correspond with the medicines specified on their medicine administration records (MAR). Medicine records were not maintained correctly and showed gaps in the administration of medicines which suggested people did not always receive the medicines they needed to keep them safe and well. The times medicines were administered were not recorded. This meant it was impossible to tell if medicines had been given at the right time or with the correct time interval between doses. Entries made on people’s medicine records were not always clear and it was difficult to tell what date and how many doses of the medicine had been given on any given day. Guidance on how to administer some medicines was unclear. For example, there was a lack of suitable directions for staff to follow when administering ‘when required’ medicines such as prescribed creams, painkillers or medicines with a variable dose.

There was a lack of clarity over who was responsible for administering medicines. For example, staff or family or when it was both, which party was responsible for administering which medicine at which time. This increased the risk of medicine errors and omissions being made.

Some staff administering medicines had not completed medicine administration training prior to being allowed to administer medicines. Competency checks of the safety of staff to administer medicines were completed by the registered manager, who had not had their own competency to administer medicines safely, checked.

These shortfalls placed people at significant risk of medicine related harm.