Closer Care Services - Main Office

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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.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the ways people’s medicines were managed safely.

This service scored 47 (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 generally promoted a proactive and positive culture of safety based on openness and honesty. Staff mostly listened to concerns about safety, and understood their responsibility to escalate safety events to the management team.

However, there was no effective process in place to monitor, analyse, or review accidents and incidents. This meant the service could not reliably identify patterns, themes, or actions to prevent a reoccurrence. As a result, opportunities for learning and improvement were missed.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Care plans were not always fully completed in relation to people’s specific health conditions. For example, one person had epilepsy, but no detailed epilepsy care plan had been put in place. Therefore, staff did not have sufficient information about the person’s knowns triggers which caused epileptic seizures. This meant accurate and essential information could not always be shared with other health professionals, particularly in an emergency.

The provider mostly worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that. However, 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.

People and their relatives told us they felt safe from the risk of abuse. People felt staff looked after them well. However, the provider’s processes had failed to ensure oversight of potential abuse indicators were considered.

We identified concerns with staff training, which meant we could not be assured staff had all of the necessary knowledge and skills to understand, identify, and report potential abuse.

Concerns were also raised around mental capacity assessments not being completed, and relevant best interest decisions not being in place which meant people who lacked capacity in some areas of care were at potential risk of having an unnecessary restriction on their daily lives by care staff as there was no information for staff to follow on how best to support the person with different aspects of their care routines.

The provider did not 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.

A number of potential risks had been identified in respect of people’s care needs. The provider had not adequately identified all of the risks, or put in place robust risk reduction measures.

One person had a diagnosis of diabetes, however, there was no specific diabetic care plan in place to guide staff on how to support the person if they became unwell with their diabetes.

Another person had been diagnosed with a medical condition, and the provider had recorded a risk reduction measure which was irrelevant to their diagnosis, and therefore, ineffective.

Where people had catheters in situ, care plan and risk assessments failed to record the symptoms of a Urinary Tract Infection (UTI), what to do in the instance the person displayed symptoms of a UTI, and who had overall responsibility for the management of the catheter including who to call in the event of a blockage.

Although there were audits of care plans and risk assessments, these were not effective in identifying the shortfalls we found.

The provider advised they were aware of shortfalls within their current care plans and risk assessments, and had identified their current digital care planning system did not offer them the flexibility they required to provide robust and person-centred details within care plans and risk assessments. They had taken the steps to begin migrating over to a new digital care planning system which offered more opportunity to personalise people’s care records.

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

Fire safety risks had not been adequately assessed and documented. We identified there was very limited information for staff to follow in the event of a fire occurring at a service user’s property. Fire risk sheets had been filled out for everyone by the registered manager, however these did not have people’s names on (so they could have belonged to anyone) and all of the questions were ticked ‘yes’, to indicate people had responded, despite evidence in 1 person’s care plan which recorded they were predominantly non-verbal, and another person’s care plan which noted the person had advanced dementia. It had not clearly been recorded if these forms had been completed with family members, and therefore, we could not be assured all people had been able to effectively understand and complete the fire risk sheet.

Environmental risk assessments had been carried out in people’s home to ensure there was no hazards such as trip hazards, uneven flooring, or poor lighting.

The provider did not 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 work together well to provide safe care that met people’s individual needs.

The majority of the workforce did not speak English as their first language. . This proved beneficial when communicating with the people they cared for, in the language the person preferred. However, the provider had not made any adjustments to ensure documents and training were understood. The registered manager agreed with our feedback in this area, and advised they would source training for staff in their preferred language, and would also start to complete competency assessments for the staff in the language the staff member was most comfortable using.

We also identified several staff were significantly behind on their online training prior to the inspection. We announced the inspection to the provider, and over the weekend prior to inspectors arriving onsite, staff had proceeded to complete the missing training. One staff member completed 39 separate training courses in 3 days, which equated to 79% of all of their mandatory training, another staff member completed 35 separate training courses in the same amount of time. Other staff members also completed high numbers of online training modules during these days. This meant we could not be assured staff had fully understood all of the training they had completed given how much training material they had reviewed in a short amount of time.

Staff records did show they had completed training for people with a learning disability or autistic people, however, when we spoke to staff, they were unable to clearly explain the training they had received, and how this improved the care they delivered.

Staff files did not demonstrate staff had been recruited safely. Recent photos had not been obtained for all staff members, and staff work history did not date back to education. We also identified issues with some references, which had been completed for staff members whose work history did not record these companies as a former employer. For example, 1 staff member had been a stay at home parent, and their application form advised they had not previously worked, however, their recruitment file contained an employment reference from another care provider.

Supervisions for some staff had been completed regularly, however, for others, appeared to be missing or sporadic.

People told us care staff usually arrived on time for each visit, and stayed for the full length of the visit time. One relative told us, “[Staff] are always on time, they are always consistent.” If staff had been held up, the registered manager would call ahead to let the person know. A relative stated, "We always get courtesy calls to say if the carers are running late, which is fine as long as we know."

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.

People and their relatives told us staff wore Personal Protective Equipment (PPE) when delivering care. One relative told us, “Hygiene, aprons, gloves, [staff] dispose of it correctly. They are very considerate and thorough.”

No concerns had been raised in respect of infection prevention and control.

The registered manager advised they had a plentiful stock of PPE which staff could come and collect at any time.

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

Most people using the service managed their own medicines. Where people required support from staff to take medicines or apply cream, concerns were identified.

Where people had been prescribed ‘as required’ medicines, protocols were not always in place to guide staff on when these should be administered, and how to do this. Where they were in place, information was generic. For example, 1 person had been prescribed 2 types of medicines to take as required. Whilst protocols were in place, the information contained within them was almost identical which meant staff were not given guidance under what circumstances to administer which type of medicine. This placed the person at increased risk of being given the wrong medicine at the wrong time.

Recording of some medicines was not clear, where people had longer hours of staff support, for example 12 hours blocks. Whilst the administration had been recorded, the time it was given was not recorded and therefore it was not clear as to the precise time within the 12 hours that the medicine had been administered. This meant staff could not ensure there had been a sufficient gap in between doses.

Staff did not always have clear guidance around the application of prescribed creams. For example, staff were supporting a person with the application of creams; however, there was limited information as to what these creams were, and a lack of clear guidance as to where they should be applied. A body map was in place, however this just said ‘apply cream’.

Competency assessments had not always been completed, and it was not clear the registered manager could be assured staff were competent to administer medicines safely.