Ontime Response Healthcare Ltd Norfolk

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• 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.

This service scored 62 (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 investigate and report safety events. The service had a complaints log in place. Although, we found complaints recorded on the electronic care planning system did not always reflect on the complaints logged. This meant some were missed and not always actioned. The service was not signed up to the central alerting system (CAS) which notifies providers of any safety alerts, drug alerts or medical product recalls. They were not aware of any safety alerts being distributed.

However, when we made the service aware of this, they informed us the care planning system they used was not effective and were in the process of moving over to a new system to rectify the complaints issue and they have signed up to the CAS. Complaints we did review were historical but evidenced they were investigated appropriately and lessons were learnt and shared among the workforce to learn from them and prevent them repeating.

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 had good processes in place for carrying out pre-admissions assessments on new people using the service and they submitted and escalated referrals where required.

The service supported people appropriately when they required full time care and ensured they provided a clear overview of peoples care and support needs. On 1 occasion when a person was anxious with the transition, they were supported into the new service by the staff at Ontime Response Healthcare Ltd Norfolk until they settled.

The provider did not share concerns quickly and appropriately. We reviewed the services safeguarding incidents and noted that no safeguarding concerns were reported within the last year. The service showed us a historical safeguarding concern that was reported. On discussion with the registered manager, she gave us instances where she had supported people appropriately when they were at risk of harm but had not submitted safeguarding referrals to the Local Authority (LA) or CQC when it would have been recommended. We also identified that an individual had developed pressure ulcers that were reportable due to the nature of the wound were not reported. Although measures were implemented to support this individual the service failed to identify that these concerns should have been shared. The provider acknowledged this was a shortfall.

However, people and relatives we spoke with felt the care was safe. Feedback we received was “[Person] is entirely safe with their care” and “There are no safety issues.”

Staff could tell us what safeguarding a person meant, 1 staff member told us “Safeguarding is mainly focused on protecting the ones that you take care of and making sure that they are not in an unsafe space or if they are experiencing any abuse from any member, be it staff, be it family, be it anyone. You’ve got to report and make sure that they are taken care of. Obviously if you discover something you have to report to your line manager, but in the case that it’s an emergency situation you can seek services like the police, ambulance and so forth.”

No people receiving care and support from the service had an application in place for a deprivation of liberty.

The provider did not always work well with people to understand and manage risks. We found in peoples care plans that risks were not always identified, assessed and mitigated where possible. A person that used creams that contained paraffin which is flammable; had not been risk assessed around the risk of fires.

Another person who was on a modified diet due to a risk of choking did not have a risk assessment in place around this risk and their care plan did not record the international dysphagia diet standardisation initiative (IDDSI) level that the Speech and Language Therapy (SALT) team had recommended that the person followed. While the service did not consistently support this individual with all meals, there was still an element of risk that had not been assessed. The same person was also at a high risk of their skin breaking down and this was not routinely monitored.

However, we raised these concerns with the provider, and they provided evidence of care plans and risk assessments being reviewed and informing the staff of the changes to peoples care and support needs. Other risks within people’s care and support needs had appropriate risk assessments in place.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People’s care plans had risk assessments conducted on their environment to ensure they were safe and they recorded what action staff should take in the event of an environmental emergency. They recorded the importance of checking equipment prior to using and there were measures in place to ensure that equipment had received lifting operations and lifting equipment regulations (LOLER) inspections.

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. Call logs evidenced that staff were mainly on time and staff were trained to meet the needs of people they supported. The provider had arranged re-training for staff around IDDSI levels and dysphagia as they were supporting an individual with dysphagia and training was historical. There were regular supervisions conducted with the staff and appraisals were conducted annually. People were offered the opportunity to develop; this was discussed in supervisions. We reviewed staff’s HR files and appropriate recruitment checks were conducted.

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 service carried out Infection Prevention Control (IPC) audits, and the IPC was monitored on spot checks. Staff told us they had access to plenty of personal protective equipment (PPE) and told us what the process was if they run out of PPE.

People told us that staff maintained high standards of IPC. A relative told us, “They wear PPE as appropriate” and another said, “They always leave the home clean and tidy.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The service had a robust policy in place, and it was clear for staff to follow and advised them on actions they should take. Staff were trained appropriately and their competency was assessed. Where there were concerns around a person’s ability to manage their medication appropriate mental capacity assessments were conducted. We found 1 medication risk assessment was inaccurate and the registered manager rectified this promptly.