In Caring Hands Wells

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.

The service was in breach of legal regulations in relation to safe care and treatment and fit and proper persons employed.

This service scored 53 (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. Managers 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. Staff had raised concerns of a similar nature during several team meetings. These concerns were not appropriately escalated. We found that not all incidents were recorded and investigated appropriately. This meant safety events were not always analysed and monitored. This placed people at risk of avoidable harm.

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.

Preadmission assessments were carried out before commencing care. One relative told us, "In Caring Hands worked really hard to understand the afternoon routines. They [staff] worked with family before taking on the care." One staff member told us, "We worked with [person’s] parents." This meant people experienced safe admissions to the service.

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 and free from avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff received training in safeguarding and were knowledgeable about abuse and neglect, however they did not always take action to reduce risks to people. This meant prevention was not always prioritised leaving people at risk of harm. We found not all safeguarding concerns were appropriately reported to the Local Authority and requested that 1 referral was made. This demonstrated that safeguarding procedure was not always understood and followed.

The registered manager told us that where appropriate people had community Deprivation of Liberty Safeguards (DoLS) in place, or that these have been applied for. DoLS refer to a legal safeguard used when a person needs to be cared for under restrictions to protect them from harm.

The provider did not work well with people to understand and manage risks. We found that not all risks to people were assessed. For example, people were supported with using transport, but risks associated were not assessed. Whilst people had care plans in place, they did not include specific risk assessments associated with medical conditions. For example, when accessing the community, swimming and whilst receiving personal care. Falls risk assessments did not include information about risks on stairs.

People who were at risk of choking did not have appropriate guidance in place regarding how staff should respond to certain circumstances. People at risk of poor fluid intake did not have clear guidance in place, including appropriate escalation routes. Staff did not complete fluid charts, limiting effective monitoring. People at risk of constipation did not have bowel monitoring charts and it was unclear when staff should escalate concerns.

This meant people could not always be assured that appropriate risk mitigation was in place to protect them from harm. The registered manager implemented bowel monitoring charts during the assessment.

The provider detected and controlled potential risks in the care environment. Environmental risk assessments were completed, outlining hazards to people and staff. This included protocols on reporting issues.

The provider did not make sure there were robust recruitment systems in place. Staff were not always safely recruited in line with best practice.

We found that reasons for leaving previous roles in care were not recorded for 2 staff, and for 1 staff member a reference was missing. This meant the provider could not demonstrate all appropriate recruitment checks had been completed.

Staff completed induction and on-going training. Staff were generally positive about training. However, staff were not signed off as competent by an appropriate health care professional to administer a certain type of medicine. This placed people at risk of not receiving their medicines safely. The registered manager told us they would review training arrangements.

The provider assessed and managed the risk of infection. The provider had an infection control policy and procedure in place that could be accessed by staff. Staff received infection control training. Staff had access to personal protective equipment (PPE). One staff member told us, "We have plenty of PPE, it's kept in the office to be picked up." This helped to minimise risks to people.

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

Medicines were not always managed safely. People did not always receive their medicines as prescribed. Some medicines required staff to complete competency assessments before administration. However, these had not always been implemented, which meant the provider could not be assured staff had the necessary skills to administer these medicines safely. This placed people at risk of harm.

We found as required medicine (PRN) protocols did not always provide clear guidance for staff. For example, when administering medicine with a varied dose regime, it was unclear how much should be administered. Some people were prescribed more than 1 type of pain relief without guidance on when each medicine should be administered. One persons’ care plan did not clearly outline alternative reasons for displaying behaviours which may be associated with pain. This did not support consistent decision making and placed people at risk of harm.

Some high-risk medicines were not risk assessed. This meant potential side effects may not be identified or responded to appropriately.

People had their medicines mixed with food or fluids without documented guidance from an appropriate prescriber. This meant people could not always be assured they received their medicines safely and in line with best practice.

The registered manager immediately acted on our feedback; however, these shortfalls were not independently identified.