Firstcall 247 Limited (Gloucestershire)

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 the management of people’s medicines.
 

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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Improvements were needed to strengthen the provider’s oversight to ensure notifiable incidents were consistently submitted to the Care Quality Commission (CQC). The provider had systems for staff to report and record incidents. Managers reviewed, investigated and maintained oversight of incidents and shared learning with staff. They monitored through an incident tracker and shared with the relevant funding authorities as needed, however not all incidents had been notified to CQC.

At the time of the assessment, a new incident tracking system was being implemented to strengthen provider oversight. The system was designed to record incident events; actions taken and provide prompts for managers to consider and complete any required CQC notifications. The provider explained their plans to carry out analysis of incident data to identify trends, themes and opportunities for learning and service improvement.

Staff told us they were debriefed following events and informed of any changes to practice or procedures. This supported opportunities for shared learning from incidents and helped staff understand actions required to reduce the risk of recurrence.
 

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider worked collaboratively with local authorities, people using the service and, where appropriate, their relatives to gather information about people’s support needs before their care commenced.

People were provided with a welcome pack when they joined the service which included information about the service, the terms of their care package and relevant contact details. This helped people and their relatives understand what to expect from the service and how to raise concerns.

Initial care plans were uploaded onto the provider’s electronic care management system to inform staff of people’s support requirements. The acting manager explained any significant information or immediate risks identified during the assessment process were communicated directly to the staff team carrying out the first visit. This helped ensure staff were aware of people's needs and any actions required to keep them safe from the outset of care delivery. The provider agreed to strengthen their working practices to help mitigate potential risks where limited information was available about new people using the service until a comprehensive assessment and care planning process had been completed.
 

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Improvements were needed to strengthen the provider’s oversight to ensure notifiable safeguarding incidents were consistently submitted to CQC. The provider had implemented a new safeguarding tracker to log safeguarding incidents and events and actions including notifying CQC.

The provider had systems to support the reporting, investigation and review of safeguarding concerns and incidents. The management team and staff were aware of their responsibility to report safeguarding concerns. Information was shared with relevant funding authorities where required.

Staff confirmed and records showed, staff had completed safeguarding training. The registered manager, who was the designated safeguarding lead, completed advanced safeguarding training during the assessment process in response to our feedback received, to strengthen their knowledge and oversight of their safeguarding role and responsibilities.
 

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

People’s risks had been identified and assessed. However, we found some people’s risk management records lacked information or guidance to assist staff to understand people’s health conditions and how to mitigate their individual risks. Symptoms of people’s decline in heath and the escalation process were not always recorded. The acting manager said they regularly reviewed staff daily notes for care delivery and were alerted by the provider’s electronic care management system if staff recorded any incidents on the system.
People’s relatives reported staff mainly communicated health concerns promptly, such as infections, falls and skin issues. Some staff demonstrated a good awareness of risks when talking about the people they supported.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The provider completed environmental and lone working risk assessments to assess and monitor potential risks within people’s home environments and any safety concerns that could impact on people’s safety or the staff supporting them.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Safe recruitment practices had not always been followed. Staff’s health backgrounds and full employment history had not always been obtained. There was limited evidence of how the provider had assessed the risk of staff when they had not fully determined staff were of good conduct. However, the provider had implemented new recruitment applications to improve the recording of pre-employment and health checks.

There was limited evidence staff received regular probation meetings to ensure staff practices were in line with their expected workforce standards and values. However, staff confirmed they had been inducted in their role and had opportunities to shadow experienced colleagues during their probation period.

Staff had completed training in key subjects and said they felt trained, supported and confident in their role. One staff member said, “The training was really good. There are refresher courses. I recently did my level 2 [Health and Social Care). I get reminders when my training is expiring.”

The quality and detail of the documentation relating to staff practices required further development to demonstrate clearer evidence of staff checks and any actions required or had been followed up. However, staff said they received regular supervisions and could request support from managers. Systems were in place to regularly spot check staff practices which was confirmed by staff. Records showed staff had received supervisions and competency assessment observations of their care practices by their line managers.

Some people and their relatives raised concerns and questioned whether all staff had sufficient skills and experience to support them. Some relatives felt some staff lacked experience supporting people with complex needs, including those with limited mobility or living with dementia. People were mainly satisfied with their care call times; however, we received comments about the high number of different staff supporting people, which impacted on their continuity of care.
 

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.

Staff had access to appropriate personal protective equipment (PPE) and had completed infection prevention and control (IPC) training to support safe working practices. Managers carried out spot checks of staff IPC practices; however, records of the checks were limited. An IPC champion was in place. The provider was considering providing the IPC champion with higher level of IPC training to further strengthen their knowledge and leadership within this area.
 

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

Improvements were needed to strengthen the records of the management of people’s medicines to ensure staff had the information they required to safely administer and manage people’s medicines as prescribed.

Staff did not have access to information about the management of people’s medicines, the dosage and reasons for medicine prescription and people’s preferences in taking their medicines. Dosage and detailed instructions for the application of topical creams and associated body maps were not always recorded to guide staff. Protocols were not in place to guide staff on when to administer medicines which had been prescribed to administer ‘as required’. The lack of medicines records placed people at risk of not receiving their medicines and creams as prescribed.

Risk relating to the management of people’s prescribed medicines had not been recorded such as risks associated to flammable creams and people who self-medicate.

Medicines administration records were not always completed accurately. There was limited evidence to demonstrate the regular administration of ‘as required’ (PRN) medicines had been appropriately reviewed and escalated to ensure the medicine remained effective.

Staff had been trained in medicines management. The acting manager carried out competency assessments of staff medicines practices; however, records of the assessments were limited. The provider agreed to consider providing the acting manager responsible for assessing staff medicines competencies with higher-level medicines training to demonstrate their advanced medicines knowledge.

The provider had not ensured a robust transcription process was in place to check and verify people’s medicines had been accurately transcribed on to the provider’s care data management system.

Medicine error logs were maintained, enabling the provider to record and review medicines-related incidents.

Most people and their relatives raised no concerns about the management and administration of the medicines and application of creams; however, our findings suggested several improvements needed making.