CareCaliRaya Ltd T/A Apollo Care South Liverpool

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.

The provider was in breach of legal regulation in relation to people’s safe care and treatment which included risk management and the ways people’s medicines were managed.

This service scored 53 (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 foster a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

The provider had a system in place to record and analyse accidents and incidents. However, we identified missed opportunities to reduce the risk of harm to 2 people because incidents were not recorded on the incident log, and the registered manager was unaware these incidents had occurred.

We raised this with the registered manager who agreed to strengthen the auditing of care notes to ensure no further incidents would be overlooked.

The provider did not always work effectively to establish and maintain safe systems of care.

Safe systems were not always adopted before people were admitted to the service. The provider did not always gather the necessary information to develop effective care plans. For 1 person recently admitted, the provider failed to obtain sufficient information to ensure risks relating to their medicines support, and other individual risks in areas such as mobility and drug and alcohol misuse, were mitigated. This placed them at risk of unsafe care as staff did not have access to appropriate care plans to guide them.

Healthcare partners provided positive feedback in relation to the provider’s ability to maintain safe systems of care. A healthcare professional told us the provider was “Very responsive and open to working collaboratively” and another professional told us the registered manager was, “Available and responsive throughout the admission process."

The provider did mostly focus on improving people’s lives and protecting their right to live in safety. However, records did not always show they shared concerns quickly and appropriately. For example, we identified an incident involving moving and handling practices that had not been shared with the local authority safeguarding team for appropriate investigation. We raised this with the registered manager, and we were assured action was taken to strengthen their safeguarding systems.

The majority of people and relatives told us they felt safe when staff supported them. Comments included, "I feel very safe with [Staff].” Staff understood their safeguarding responsibility and could relay the action they would take to protect people from abuse.

The provider did not always work well with people to understand and manage risks. The provider did not always ensure individual risks were assessed and the necessary information was included in care plans to guide staff on how to keep people safe.

Where people had individual risks we found no adequate assessment of these risks had been completed. We identified shortfalls in the assessment of risk across the majority of care records we viewed. This meant staff did not have access to guidance on the level of risk or how to mitigate these risks, which placed people at increased risk of harm.

Although we identified shortfalls in relation to risk assessments, our conversations with staff found they knew people well and they could confidently describe the action they took to reduce the risk of harm when delivering care. The registered manager was receptive to our feedback and took action to improve risk assessments during and after the inspection process.

The provider had a system in place to detect and control potential risks in the care environment. We found environmental risk assessments were completed for the majority of people. For 1 person recently admitted to the service, we found no environmental risk assessment had been completed. However, we were assured the provider had identified concerns with the safety of their environment and had shared this with the local authority. This resulted in the person moving to a different premises which was more suitable for their needs.

Staff were safely recruited and deployed in sufficient numbers to meet people's needs. However, the provider did not always make sure staff received training to equip them with the necessary skills to meet people’s individual needs. For example, people had needs associated with drug and alcohol dependency and specialist equipment to assist breathing. We found staff had not completed training in these areas. We found no evidence of harm. However, the failure to ensure staff receive relevant training reduces staff’s ability to carry out their roles effectively which increases the risk of unsafe care delivery.

People told us their care calls were regular. However, we received mixed feedback from people in relation to the consistency of their staff team. Some people told us they had a regular staff team, but others told us they wanted more consistency. A person told us, “My [health condition] is different every day, if I have somebody, I see regular, they would see the difference and understand, when you are seeing different staff 4 times a day, they haven’t seen how my day has gone.” We gained permission from this person to share their concerns with the registered manager, who committed to reviewing rotas and taking action to improve consistency.

The provider assessed and managed the risk of infection. Staff followed good infection control practices and described how they used personal protective equipment (PPE) to help prevent the spread of healthcare related infections. People told us staff wore PPE when providing support with personal care.

Medicines were not always safely managed.

When people required support with medicines, they did not always have a detailed care plan in place. For example, for 1 person who required emergency medicines, no medication care plan or risk assessment had been completed, and staff had not received relevant training. This placed the person at risk of harm as staff did not have the necessary information to ensure the safe administration of this medicine.

Medicine administration records (MAR) did not always provide an accurate record of what medicines were administered. For example, for 1 person we identified staff had recorded in their care notes they were receiving a prescribed cream, but this was not reflected on the MAR. In addition, entries made on people’s medicine records were not always contemporaneous, with medicines recorded as administered much later than the time the action took place. A failure to maintain accurate records of medicines increases the risk of medicines related harm.

Not all staff currently administering medicines had their competency assessed in line with best practice guidance. This meant there was a risk medicines could be administered by staff who did not have the skills to do so safely.

The systems used to audit the medicines were ineffective as they had not identified all issues we found. We shared our findings with the registered manager who was responsive to our feedback and committed to strengthening medication auditing processes to reduce the risk to people.