Alex C&C Healthcare 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 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. We found improvements were needed to the safe recruitment of staff and to the safe management of medicines. The service was in breach of legal regulations in relation to safe staffing and safe care and treatment.

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 registered manager was positive about having a culture that provided safe care to people. They liaised with health and social care professionals as and when required and they reviewed any learning and training needs in staff meetings. Incidents and concerns were documented electronically, and the registered manager reviewed these, collating a report of their findings. Details within their report confirmed any actions taken, learning, referrals and improvements needed.

The registered manager worked well with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. People’s visits were scheduled with staff who they were familiar with. Families felt the care provided by staff was good. They told us, “Exceptional, more than what we expected. Caring, nothing is too much trouble.” Other comments from a family member was, “Regular care staff. Same staff coming on the rota.” The service had a small team of care staff. Staff had the opportunity to become familiar with people and their individual needs as part of their induction. Staff we spoke with knew people well. Staff told us they gained consent from people and their families before calling a health care practitioner. The registered manager liaised with health and social care professionals as required. They also provided people and their families with support information should people and their families need this.

The registered manager worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve it. 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 provider shared concerns quickly and appropriately when required and they provided examples of when they had done this. Relatives felt the care provided to people was safe. They told us, “Yes safe care” and “Can’t fault the care.” Staff had received training in safeguarding adults and they had a good knowledge of what to do should they have any concerns.

The registered manager supported people and their individual risks. Although improvements were needed to people’s individual care plans. For example, we found care plans did not always contain all of the information staff would need to provide the support a person needed to fully meet their needs. One person’s care plan did not have all of the necessary information available to staff on what support staff might need to provide them with should they become unable to manage their diabetes care themselves. We raised this with the registered manager along with where they could access additional information and resources on diabetes care planning. Families felt there was regular care staff and that staff and the registered manager knew people well.

The registered manager undertook environmental risk assessments for people. Care plans contained important information such as any equipment the person was being supported with and information was also within their environmental risk assessment.

The provider was not undertaking safe recruitment procedures before staff visited people and starting their employment. For example, some staff did not have a Disclosure and Barring Service (DBS) check completed before commencing training and their induction within people’s homes. Therefore, there was a risk people who were not suitable to work with vulnerable people were employed. A DBS check provides information about the suitability to work with vulnerable adults. It supports employers to make safer recruitment decisions. The provider had not completed a risk assessment and these staff did not have a contract of employment. The service did not have a robust system to ensure references were provided before the staff member undertook training and an induction within people’s homes. The provider confirmed they were taking action to ensure staff had a DBS in place for the service, although not all staff had a suitable DBS in place at the time of the inspection.

The provider’s training documentation confirmed staff were completing online training within their induction and prior to supporting people with care. The registered manager confirmed this was prior to the member of staff starting their contract. The provider’s training documentation confirmed staff were provided mandatory training in manual handling, medicines administration, safeguarding adults, health and safety, infection control and person-centred care. They also provided additional training in catheter care, dementia care and autism. The registered manager confirmed they were reviewing additional training for staff. This included training on learning disability and autism which reflected current best practice. Staff’s knowledge of certain aspects of training such as equality and diversity was limited. We raised this feedback with the registered manager who confirmed following our inspection they had taken action to improve staff’s knowledge around this.

The registered manager as part of the inspection confirmed staff were provided practical training. Examples included, administration of medicines and how to use moving and handling equipment. Staff felt they had good support from the registered manager including the training and supervision provided. Staff told us, “(The registered manager) teaches us everything” and “We have supportive meetings and can also go to the office if needed.” People were asked to give feedback about staff. This was discussed within the member of staff’s supervision.

Although staff felt supported and were provided training, we were not assured the provider had a robust recruitment procedure in place that ensured staff had suitable checks commenced prior to their employment.

The registered manager assessed and managed the risk of infection. Staff confirmed they used personal protective equipment, and they had a good understanding of when to use this. The registered manager provided enhanced personal protective equipment should this be needed. Staff could collect personal protective equipment from the office as and when they needed it. The registered manager confirmed they could also supply people with certain products such as incontinence items and other products. They told us they did this in consultation with professionals and that they ensured these products were suitable and that they did not pose an infection control risk. We suggested the registered manager reviews best practice guidance if they are sharing and providing incontinence items and other products to people.

The registered manager did not ensure the service had suitable systems in place for the safe management of medicines. For example, people’s care and support plans confirmed people had prescribed medicines and topical creams. No medicines administration charts were being completed where staff were either prompting or administering medicines or applying topical creams. We raised this with the registered manager who confirmed staff were not supporting people with medicines or topical creams. After providing this feedback, the registered manager completed a risk assessment where people had prescribed topical creams. We were therefore not assured there were suitable arrangements in place to support people safely with the management of their medicines and topical creams.

However, people were supported by staff who had received training in the safe administration of medicines. Relatives confirmed staff supported with medicines. One relative told us, “Care staff support with medicines.” They confirmed staff waited for the person to take their medicines.