CRM Healthcare Solutions 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment at the service.

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 provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported concerns using the electronic care records, this was monitored and managed at all times, with action taken in a timely manner by the clinical lead. Any areas for improvement or lessons learned were shared with staff in staff meetings, supervisions or 1-minute written guides produced by the registered manager.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They did not always make sure there was documented continuity of care, including when people moved between different services.

The provider ensured that they worked closely with other healthcare professionals that supported people in their own homes, especially following a change in the person’s needs or time spent in hospital. The provider told us they would not accept a care package at short notice, as they wanted to ensure their assessment process was robust and they were confident they could meet the person’s needs. However, care records did not always reflect the current needs of the person and guidance for staff was not up to date. Staff told us that care plans or handovers where not always available when supporting new clients which left staff without essential information on how best to support the person. Initial assessment documents carried out by the social worker were not readily available to the provider or care staff.

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 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.

The provider had a Safeguarding policy in place, but this lacked detail and needed additional information such as the Local Authority contact details. Staff had received training and told us they felt competent in this area. People and their relatives told us they felt safe and had no concerns. One relative said, “My relative is kept very safe, and safeguarding is the top priority.”

The provider did not always work well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were not always in place or did not clearly outline the current risks and how these would be mitigated. Risk assessments that were in place were not always person-centred or reviewed regularly. For example, we saw how one person had a choking incident, was at continued risk of choking and was being fed inappropriately by staff. There was insufficient guidance in the care plan for staff on how they should be safely feeding the person and the risk had not been appropriately assessed or mitigated. The provider took immediate action to reduce the risk when this was raised to them.

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

The provider had not always completed environmental risk assessments to identify and address any risks in the person’s property which may impact the person or staff visiting the person’s home. Essential information staff would need in an emergency was not always readily available in care records.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, evidence of safe recruitment was not always available.Gaps in employment were not always explored and the provider had not always been able to obtain professional references for staff as part of their recruitment checks; due to previous employers no longer operating. Whilst additional and extended observations were carried out, more needed to be done to ensure the good character of those employed.

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.

The provider had systems in place to ensure that staff always had adequate access to personal protective equipment (PPE). One relative told us, “They have very high standards of hygiene both personal and domestic. The PPE is on as soon as they walk in the front door. They have covers on their feet, aprons on and disposable gloves. They change the gloves and aprons from personal care to domestic care”.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning.

We found medicines where not always given as directed, for example, medicines that should be given with food or before food were not always administered as required. PRN protocols were not always in place; these contain guidance for staff to follow for medications given to people “as and when required”. Medication care plans and risk assessments did not contain sufficient information.

Where staff had made medicines errors and a refresher of their medicines training and competency check had been identified as needed, this had not taken place.

The provider had not followed their own medicines policy in terms of carrying out audits and had relied heavily on the electronic medicines records system to identify discrepancies and errors which meant that issues found as part of the inspection had not been identified.