Becoming Care 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 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 safe care and treatment and fit and proper persons employed.

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 did not always have a proactive and positive culture of safety based on 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.

Although the registered manager told us they reviewed accidents and incidents, they said they had no evidence that these were analysed for themes, trends, or recurring issues. We also noted from team meeting minutes that staff had reported concerns, including people requesting medicines that had not been prescribed, people regularly refusing personal care, and care staff using a hoist for 1 person when they were unwell. None of these had been recorded as formal incidents, which meant the registered manager was unable to effectively review the actions taken, identify patterns, or monitor for any ongoing concerns, increasing the risk that people’s safety may not be consistently monitored or protected.

Where there was learning, however, the registered manager shared this with staff through their staff messaging group and team meetings, and people told us they would be happy to raise any safety concerns with management.

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.

Information shared by the registered manager and staff helped support continuity of care. It enabled management to review or change people’s care plans to reflect the latest position. It also enabled people to have input from healthcare professionals, such as the GP, when they needed it as staff made referrals or passed on information on behalf of people. This meant people could be confident that the service supported them when moving between services, for example, leaving hospital to return home and commencing with a care package from Becoming Care Services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

The provider and registered manager were able to give examples of what may constitute a safeguarding concern, where they had made referrals and showed us evidence of staff having received training. A staff member told us, “Abuse comes in different forms. Our clients are low risk and are able to communicate any concerns to us. Fortunately, I’ve never seen any signs of abuse. I’d report any safeguarding concerns as I’m not in a position to make a decision regarding such concerns so that the client can receive the correct guidance and help.” A second staff member said, “If I saw something in a client that I didn’t see in the previous days, then I would raise this with management.”

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.

Information relating to people's risks lacked sufficient detail and was often generic or incomplete, meaning it did not provide clear guidance for staff. One person who was cared for in bed had inconsistencies within their records. Their Waterlow (skin integrity) assessment and moving and handling assessment contained conflicting information, with 1 section recording a history of falls and another stating there was no history of falls. In addition, the equipment and mobility aids section did not record that the person used a Zimmer frame.

We also found gaps in the care plan for another person. Their personal hygiene care plan instructed staff to work in line with the person's moving and handling care plan; however, no moving and handling care plan was in place. This meant staff did not have access to the guidance referenced within the care records to support safe and consistent care.

However, people told us they felt safe with staff with 1 person saying, “I feel very safe and confident in the care provided.” Another told us, “Absolutely safe, the carer I’ve got is absolutely amazing.” A relative said, “The ladies she has, especially the regular ones, are very, very good. I would give them 10 out of 10.”

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.

Although the registered manager told us they carried out an environmental risk assessment for people, we found this was not always the case. Upon review of 4 care plans, only 1 person’s environment had been assessed. This meant there was limited assurance that risks within people's home environments had been identified, assessed and managed appropriately to support the delivery of safe care.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

Staff were not recruited through a system that was robust and ensured that the required information was obtained prior to a staff member starting to work. We reviewed the recruitment files for 6 staff. Of those, we found 3 files had incomplete employment history, 2 did not have suitable references in place, and 4 had no evidence to demonstrate they had a right to work in the UK, although the provider did provide us with evidence for 1 of those staff after our site visit. The lack of robust recruitment processes increased the risk of unsuitable staff being employed, although staff had a Disclosure and Barring Service (DBS) check completed to help ensure they were able to work in this type of service.

The registered manager told us they had sufficient care staff to cover the care packages they currently had, although they did say that none of the staff drove, and as such, they had recruited 2 drivers to transport staff between calls. This resulted in some staff being late to their next care call, and it was an area they were working on to improve. One person told us, “The times vary depending on whether there’s traffic, which might not be their fault. Sometimes I’m not sure what time they come. However, they do all that is needed to be done so I don’t feel rushed.” A relative said, “They’ve never missed any call visits. If they are running later they will call to inform me.” Another relative commented, “They are more or less on time and they always complete all tasks before leaving.”

Although people were very happy with the care provided to them, some people reported that staff worked for long periods without a break. This related to people who had live-in care (where a carer lives in the person’s house and provides round the clock care). One person told us, “She’s here all the time… 24 hours a day for 4 weeks then normally has a week off,” although they went on to say there was 1 instance when the member of staff worked for 8 weeks before a break. This indicated the working pattern, as stated to us by the registered manager, was not always followed in practice which may result in the person receiving care from a staff member who was tired and not working at their full capacity.

Staff received induction and training prior to commencing in the role. The registered manager told us, “Senior staff will support new staff with shadowing and we carry out spot checks to check their competency prior to working alone. We send carers to a training centre to do face to face training such as moving and handling and health and safety. All staff are medication trained.” A person told us, “I feel [member of staff] has the correct training.”

The provider managed the risk of infection and took steps to prevent it spreading.

There was information in people’s care plans for staff around good hygiene practices and reminders to wear gloves and aprons when carrying out personal care. One person told us, “They keep things clean and tidy. No concerns with cleanliness.” A relative said, “They wear gloves, not aprons. They always have gloves with them.”

The registered manager told us, “Some staff use shoe covers too, particularly when it’s raining. It’s a dignity thing. We expect all staff to wear their uniform, gloves, aprons and face masks if the client wishes this. Our drivers have additional supplies in their cars so they can drop it off. We stopped staff carrying supplies in their bags, due to the infection control risks.”

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.

People did not always have clear information in their care plans relating to their medicines. This included 1 person’s care plan, which stated, ‘not known’ against the question of whether they had any allergies.

Medication care plans were generic and not specific or individualised. For example, they did not include how a person liked to take their medicines, or whether they needed to have a drink with them. One person’s medicines care plan recorded the district nurse administered the person’s medicines, but this was not the case. A further person’s care plan recorded they self-administered their medicines, but in another document, it stated staff administered the person’s medicine, although their medicine administration record (MAR) indicated they did self-administer. One person was recorded as being allergic to penicillin and yet, within the area recording ‘actions to take if allergy present’ the care plan states, ‘not specified’.

Where people had topical creams (medicines in cream format) there was no accompanying body map so it was not clear to staff where the cream should be applied, although the registered manager added a body map to people’s care plans whilst we were on site and said they would be completing these for each person who needed one.

However, our review of people’s MARs indicated people received the medicines they required and that were prescribed to them. One person told us, “[Member of staff] does all my medication. She gets the pills out of the blister pack, puts them in a cup and gives them to me.” A relative said, “They have an app where they verify the tablets that need to be administered and place the tablets in a bowl and will watch her take them.” A staff member commented, “We have an app where any medication that is administered is recorded and I check on the app to make sure I’m giving the right medication.”