Ethica Care Hemel Hempstead & St Albans

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 people’s safe care and treatment, the ways people’s medicines were managed, staff deployment and a lack of required training for staff.

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, positive and consistent culture of safety which ensured 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.

Some staff told us how they reflected and learned but, we found these were down to individuals in isolation and not part of wider service improvement.

There was limited evidence of staff debriefs or reflective conversations around sharing learning from wider incidents across the service. We were aware of several complaints, incidents and safeguarding concerns that had not been discussed with staff. Incidents had not been consistently recorded or monitored by the provider and did not have a robust system in place to review risks in the service. Subsequently shared lessons from those incidents or risks were not shared with staff. Although the newly employed manager acknowledged the need for improved recording and risk management, learning and improvement was not embedded as part of the daily culture.

Staff had not all worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They did not always ensure there was continuity of care.

Staff gave several examples of working with healthcare partners to meet people’s needs safely. We saw some examples where GP’s, district nurses, occupational therapists among other professionals were involved in reviewing people’s care. However, the provider did not always ensure there was continuity of care. Improvements were needed to ensure people’s care plans contained up to date information around areas such as continence care, pressure care, nutritional needs and management of medication. Risks to people’s health in some examples had not been assessed therefore mitigations had not always been put in place to reduce harm.

Staff spoke about communication difficulties with the office that delayed these tasks from being completed.These demonstrated that the provider’s assessment and care planning processes, together with staffing deployment meant that people did not all receive a service that ensured continuity.

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.

Staff commented that when incidents were raised either through the reporting system or a telephone call to the office, there were regular delays in responding to those. One staff member commented, “When I reported concerns or issues it’s does not gets resolved in a suitable time and I often have to chase the office.” This delay meant that people may be at risk of ongoing harm as incidents were not always investigated promptly to mitigate the risks of recurrence. For example, we found one person had missed their medicine to manage seizures for fourteen days. This was found subsequently through safeguarding investigations by the local authority to be due to inadequate checks and monitoring. The outcome of this was not shared among the staff team to aid learning and improving practise.” Both referred to the unsafe management of medicines, but the outcomes of these incidents were not promptly shared with staff, and subsequently this risk continued with errors reported throughout this inspection. There were not consistent and effective systems, processes and practices to make sure people are protected from abuse and neglect. Staff were not all made aware of these ongoing concerns therefore key safeguarding risks did not then have a clear strategic plan to address them.

During this assessment we identified incidents which required investigating further and reporting to the local authority that had not been made. For example, an incident where staff could not access a person’s property. This feedback was shared with the provider who acknowledged they had not raised this and during this inspection we noted a more robust approach to safeguarding reporting and investigating. However, it was too early for the provider to demonstrate the sustainability of the changes made, and how this helped keep people safe from harm.

People’s feedback was variable, but where people felt unease, this was in relation to the systems and processes and management of the care, not due to the approach of care staff. People frequently commented that a lack of consistency among staff and not knowing who was coming day to day caused them anxiety and worry. One relative commented, “Yes, [person] likes all the staff that visit. The actual carers are great, if it wasn’t for them [person] would not be here and they never complain about them, and [person] would definitely complain.”

People, relatives and staff told us they felt emboldened to raise any concerns to the new manager. Staff had received training and understood how to keep people safe from harm and when to report concerns. CQC received feedback that indicated improvements were needed to how care was provided at that time. The local authority had also been made aware of concerns from staff. This demonstrated that staff were aware and empowered to raise any concerns outside of the provider

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 care plans and risk assessments contained limited information about how specific risks should be managed and how to support people’s involvement in managing these risks. For example, 1 person living with dementia would refuse personal care and at times could be anxious and upset. Although these incidents continued to occur, assessments involving this person and their family had not been undertaken to understand the causes and ensure all staff supported them in a consistent manner. This would likely reduce the frequency or impact of this person’s actions towards staff. For other people, we saw examples where they had a long-term health condition, such as diabetes or sensory impairments but there was not always a risk assessment in place to mitigate those risks and identify positive ways to provide support.

There were care plans in place for example around personal care or transferring people using equipment. However, they did not contain sufficient detail to enable staff to understand and mitigate any associated risks.

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

Prior to care being provided, staff carried out an environment and safety risk assessment. This reviewed areas such as risk of trips and falls, use and maintenance of equipment such as hoists, fire and electrical risks and general condition and layout of the property.

People were supported to use a variety of aids to maintain their independence and promote their safety. For example, where people had a safety pendant to summon assistance in an emergency, staff ensured people wore these when leaving the property. Feedback demonstrated that when equipment was used, people were confident about how staff assisted them. One relative commented, “[Person] has a hoist. The carers did physio with them, and they have had the hoist for about a [length of time]. They give [Person] some pain relief beforehand [before using the hoist]. They take their time and its [Person’s] choice to get out of bed. They are very caring, I observed when they did the training and they talked to, telling [Person] what they were doing.”

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.

The service did not consistently ensure safe and effective staffing. Some people experienced late or rushed care calls, some had long gaps between visits, and rotas were often issued late or changed without notice. Some had long gaps between visits, and rotas were often issued late or changed without notice. In some cases, calls requiring two carers did not have sufficient overlap or were attended by only one staff member, meaning people did not always receive the full and safe care they had been assessed as needing.

Poor planning of travel time contributed to shortened visits and further delays, with call data showing a pattern of insufficient travel allocation and a slight deterioration in punctuality over time. Staff feedback echoed these concerns, noting client frustration when calls were missed or timings changed without communication. These issues collectively created inconsistency in care delivery and increased the risk of unmet needs.

Although core training was provided, staff lacked training in key health‑related areas such as skin integrity, pressure care, sepsis, MS. Diabetes training had been completed by 11 of the 38 staff training records reviewed. Some staff had not received recent supervision or spot checks. TUPE‑transferred staff reported receiving only online learning rather than practical training. The provider acknowledged these gaps and outlined plans to strengthen staff development, including supporting Level 3 qualifications and introducing specialist champion roles to improve expertise and practice across the team

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff undertook training in infection prevention measures and wearing the appropriate personal protective equipment [PPE] such as gloves and aprons to provide care. The manager told us staff were randomly observed to ensure they did wear PPE and follow good practice. People however gave mixed views about staff following their policy. One person said, “I must remind them to wear gloves, change their gloves. The more experienced ones, they seem more proficient.” A second person said, “They wear gloves, but no apron. No mask. I haven’t seen them wash their hands.” However, a third person commented, “Yes, they do [wear PPE]. No concerns. As far as I know [wash hands] but certainly they put their gloves on before they start, and they dispose of any matter.” This means although there was a policy in place and staff were trained, people were not always protected from the risks associated with the risk of infection.

Some people required additional support with their meal preparation. Staff therefore prepared a variety of meals for people for breakfast, lunch and dinner. However, staff had undertaken nutrition training but had not completed food safety or food hygiene training. As staff handle, prepare, cook and store food the Provider must ensure they have adequate knowledge of food hygiene to ensure food safety

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.

Care plans for people who required full support or verbal prompts to take their medication did not provide information to staff on how to support people with their medicines safely. People who were prescribed medicines to be taken at specific times, for example medicines for diabetes or Parkinsons, did not receive these at the same times daily, or with an adequate gap between administration. We identified examples where staff managed people’s medicines and stocks had run out meaning a delay in people receiving their medicine.

Staff were trained to administer and manage medicines, and senior staff would observe their competency.