Besi Care 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 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 people could be harmed.

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 have a proactive and positive culture of safety based on openness and honesty. The provider indicated they had a process in place to log and review accidents and incidents, however, there were no organisational systems, policies or procedures in place which fully supported a learning culture based on openness.

The provider had limited numbers of service users and had not received referrals for care packages from local health and care professionals. There was limited evidence which did not assure us the provider always made sure there was continuity of care, including when people moved between different services.

The provider worked with people to understand what being safe meant to them and the best way for this to be achieved. Members of staff told us they understood how to report any concerns about safety. However, the provider did not have any organisational policies in place for members of staff to follow to keep people safe. For example, safeguarding adults, mental capacity and whistle-blowing policies were not in place. The provider was able to demonstrate they understood the principles of the Mental Capacity Act 2005 (MCA). The Mental Capacity Act 2005 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.

The provider worked with people to understand and manage risks by thinking holistically. People’s care plans were person-centred and their needs were clearly identified. Risks associated with people’s care were assessed and appropriate mitigations were in place to reduce them.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. The provider audited and reviewed care call attendances and times. However, the provider did not have any systems, policies or processes in place to assess, monitor and review risk to care environments in and around people’s homes.

The provider made sure there were enough staff to provide care and support to people. They worked together well to provide care which met people’s individual needs. Members of staff were recruited safely. Pre-employments checks were carried out to ensure care and support was delivered safely. Members of staff were supported to access a range of training and development courses.

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. Members of staff told us personal protective equipment was available and they had accessed infection prevention and control training. However, there were no organisational policies or procedures in place to support good infection prevention and control.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. The provider did not support any people with medications at the time of inspection. The provider did not have any organisational policies or procedures in place for members of staff to follow to ensure safe administration of medicines. The provider had developed a medication audit tool but this was not supported by any policies or procedures.