Congratulation Quality Care Also known as Congratulation Quality Care And Cleaning Services Limited

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. There was an increased risk that people could be harmed.

We found the provider to be in breach of 2 legal regulations in relation to safe care and treatment and recruitment.

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 culture of safety and to identify and embed good practice. Systems were in place to respond and monitor accidents and incidents if and when they occurred. The nominated individual told us there had been no accidents and incidents; however, they were aware that any lessons learnt would be used to improve the quality of service and relayed to staff to embed good practice. For example, records showed best practice was being relayed during staff meetings in relation to people’s safety and reporting and recording of accidents and incidents. A staff member told us, “If there was an incident, we would contact the company, record it and if it was an emergency, we would call 999.” The nominated individual was aware of their responsibility to notify relevant healthcare professionals, CQC and submission of statutory notifications of any significant events at the service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. Systems were in place to ensure continuity of care. Care and support was planned and organised with people, relatives and relevant healthcare professionals in ways that ensured continuity and managed to keep people safe during their care journey.

The provider worked with people and healthcare partners to understand what being safe meant. People and relatives told us they felt safe using the service. A relative told us “I and family members are often there at the same time as the carers, so we know they deliver safe care. It is always one of two carers that come, which means [person] is comfortable with them.”

There were systems to protect people from the risk of abuse. There were safeguarding and whistleblowing policies in place to report potential abuse. The nominated individual told us there had been no safeguarding concerns. Staff had completed safeguarding training and were aware of the different types of abuse and reporting procedures to follow if they had any concerns. A staff member told us, “Safeguarding is about protecting the vulnerable against abuse, I would tell the manager, record it and report it.”

The provider did not work well with people to understand and manage risks. Risks to people were assessed and identified, however risk assessments did not always contain sufficient detail on how to minimise risks and maintain people’s safety in accordance with people’s specific needs.

The mobility risk assessments for both people identified risk factors of arthritis of knees and hips, sight problems, confusion and disorientation. However, there was limited information detailing what risks these conditions presented. The assessments for both people stated they required support to negotiate stairs and get into or get up from bed, however there was no further information detailing any potential risks and how this was to be managed safely.

Both people required the use of mobility aids such as a walking stick and quad and zimmer frame, however there was limited information indicating the risks of using such aids. Care records used language such as ‘support and monitor whilst I mobilise’ with limited information detailing what this meant.

Care records for both people indicated some support was needed whilst out in the community including the use of a wheelchair, however there was limited information detailing what measures were in place to reduce the risk and maintain people’s safety whilst out in the community.

Care records stated people were at risk of self neglect and poor hygiene, however, there was no risk assessment in place for these identified risks.

Risk assessments were also not in place for people’s specific conditions such as diabetes. Records showed staff completed daily blood sugar level readings for one person, however records did not show what the normal blood sugar levels should be for staff to appropriately monitor. A relative told us “[Person] is diabetic and has a monitoring device on their arm. Carers scan the reading and prepare the insulin pen, then [person] administers it themselves as they [staff] cannot do so.” We raised this with the nominated individual during the assessment, who told us they would seek advice from the GP regarding the blood sugar levels and update care records accordingly to ensure this was safely monitored.

The person also required eye drops to be administered, however there was no risk assessment and guidance in place to ensure this was done safely. Although staff had completed medicines training, staff had not completed the appropriate training for administering eyedrops. We raised this with the nominated individual who told us they would arrange this training straight away.

The provider detected potential risks in the care environment to support delivery of safe care. Processes were in place to ensure risks within the environment were assessed and monitored. Assessments of people’s home environment were carried out covering areas such as clutter, home security and fire safety to ensure people were supported in a safe environment.

The provider did not make sure there were skilled and experienced staff. Recruitment processes were not always operated effectively and consistently to ensure staff were of good character and had the competence necessary for their roles.

Recruitment checks were not robust. In all the staff files, we found full education and employment histories had not always been listed and no satisfactory written explanation of gaps in employment and education.

For all 4 staff members, a job offer was made before ensuring they were of good character and authenticity of any previous organisations worked for. For example, for 2 staff members the disclosure and baring services (DBS) checks acquired at the time of recruitment were undertaken by previous employers. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions. Providers must be able to demonstrate sound reasons for not obtaining a full DBS check before a person take and also demonstrate they have assessed any potential risk. For both staff members, there were no reasons recorded as to why a full DBS check could not be obtained by the provider at the time of recruitment and potential risks assessed.

For all 4 staff members, references were obtained from organisations that were not detailed in their employment histories.

We also found interview forms detailed the questions used and answers provided by applicants. However, the forms did not detail the staff member conducting the interview. One interview form detailed a staff name, however there was no further information showing who the staff member was and their position within the service which demonstrated they were an appropriate person to undertake staff recruitment.

There was no information which showed how staff had been assessed and confirmed as being suitable and competent for the roles applied for and on what basis a staff member was offered a job within the service.

We raised these issues with the nominated individual who was receptive to the feedback. They told us they would implement the necessary measures to ensure consistency and robustness for future recruitment.

The provider assessed and managed infection prevention to ensure people were protected from the risk of infection. The service had an infection control policy in place. Staff had received infection control training. Monthly infection control audits had been undertaken to ensure safe infection control practices were implemented and staff had access to personal protective equipment [PPE] when needed. A staff member told us “Yes, we have PPE. They [the service] provide us with everything, gloves, face masks, aprons and shoe covers.” People and relatives told us staff always wore PPE when supporting them with personal care. A relative told us, “They [staff] wear aprons and gloves as necessary.”

The provider did not always make sure that medicines and treatments were safe. People and relatives spoke positively about the support they received with their medicines. A relative told us, “The medicines are handled and recorded very well; they have always double-checked with me when there has been any change to meds.”

Despite the positive feedback, we found medicines records did not always fully reflect the support people received. Care records contained limited information on how their medicines were to be administered. For example, one person’s care records stated, ‘Carer will administer my medication,’ however there was limited information detailing how this should be done.

Medicines administration records (MARs) contained no unexplained gaps and recorded medicines as being administered. However, the times of when the medicines were administered were not recorded on the MAR. We raised this with the nominated individual who told us and records showed the times medicines administered were electronically recorded as part of the daily records completed by staff. The nominated individual told us, they were now able to access the electronic MAR sheet version which they will use and would reflect the times medicines were administered to people. We will follow this up at the next assessment.

Staff had completed medicines training. Medicines audits were carried out to ensure any discrepancies and/or gaps in recording on people’s MARs were identified and followed up. However, these had not been effective as they did not identify the shortfalls we found at this assessment.