Advantage Healthcare West Midlands

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.

At our last assessment we rated this key question Good. At this assessment the rating has remained Good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Medication audit processes had not identified some of the recording concerns we found during this assessment. However, during the assessment management evidenced strong safeguarding measure in place to mitigate any risks or harm to come to people.

Evidence of a positive learning culture across the service was seen. Learning from incidents, safeguarding concerns, complaints and audits was shared locally and across the wider organisation to support improvements in people’s care.

The provider had in place a Provider Improvement Plan process, enabling learning from quality reviews and compliance audits to be put together at a provider level and turned into branch-level action plans.

Management responded appropriately to concerns and undertook reactive supervision of staff where concerns had been identified. Complaints were investigated thoroughly and there was evidence that feedback and lessons learnt were used to inform service improvements.

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.

However, improvements were required to ensure all care pathways were fully documented and consistently implemented. During the review of care records, it was not always clear who held responsibility for certain aspects of care, particularly medication administration between family members and care staff. We also identified examples where treatments, including creams, nebuliser support and saline administration, were not consistently reflected within care plans or supporting documentation. This increased the risk of staff working outside agreed care arrangements.

The provider had systems in place to support safe transitions into services and the ongoing management of care packages. People were supported through assessments, meet-and-greet processes and communication with families to help ensure staff understood people's and children’s needs before care commenced. The provider also had clearly defined roles within people’s care packages, including care professionals, nurses and case managers, providing oversight and clinical support where required.

There were effective escalation arrangements to support people safely. The service operated a structured on-call system, consisting of schedulers, managers, nurses and senior management escalation routes. In addition, a dedicated Rapid Response Team, made up of specially trained staff, was available to support people with complex health needs and respond to changes in care requirements.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s and children’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Relatives and people told us they all felt they could report concerns and felt the complaint would be dealt with appropriately. The provider shared concerns quickly and appropriately.

The provider had clear safeguarding systems in place to protect children and adults from abuse and avoidable harm. Safeguarding policies were comprehensive and covered key areas including child exploitation, neglect, consent, advocacy, adverse childhood experiences (ACEs), modern slavery and professional boundaries. Staff responsibilities were clearly defined within the policies.

There was evidence of a proactive approach to safeguarding, with lessons learned shared across the organisation to strengthen practice. For example, following a safeguarding concern regarding the sharing of people and staff’s information, clear guidance and processes were introduced to reduce the risk of recurrence.

Staff had access to safeguarding guidance, escalation pathways and management support. Records reviewed demonstrated safeguarding concerns and issues were recognised and acted upon appropriately and in a timely manner.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s and children’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Responsibilities for managing some risks were not always clearly documented. In particular, care plans did not consistently identify whether family members or care staff were responsible for administering medicines and some treatment instructions were not always clearly reflected within care plans. This created a risk of inconsistent practice and reduced assurance that everyone involved understood their role in managing identified risks.

People and, where appropriate, their relatives were involved in planning and reviewing care to help ensure risks were managed in a way which reflected their individual needs and preferences. The provider utilised assessment processes, care planning discussions and meet-and-greet arrangements to support safe delivery of care packages and establish positive relationships with families.

There was evidence of efforts to make information accessible and inclusive. For example, children were involved in discussions about their care through the use of a visual picture and story book, built up around children’s care and who will be supporting them. This was called the “Little Blue Book”, and translation tools were available to support people whose first language was not English. Communication aids specific to individuals were also used to help staff understand and respond to people's needs safely.

Feedback from relatives indicated experienced and consistent staff built trusting relationships and helped families feel reassured that risks were being understood and managed appropriately.

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

The provider had systems in place to ensure equipment and care environments were safe for people receiving care. Risk assessments and care plans included guidance for the safe use of specialist equipment, including hoists and moving and handling systems. Equipment certification processes were in place, and staff were required to complete mandatory safety checks as part of care delivery.

For children and people with complex needs, care plans contained individualised information to help staff understand environmental risks and safely support people within their homes.

Communication tools and personalised information were also provided to staff before commencing care packages to help ensure care was delivered safely and consistently.

The provider had processes to monitor environmental safety through quality audits, nurse oversight and management checks. Staff also had access to clinical support and escalation routes should environmental risks or equipment concerns be identified.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider had safe recruitment processes in place, including employment history checks, references, identification verification and Disclosure and Barring Service (DBS) processes. Staff completed a structured induction, mandatory training and competency assessments, with nurses providing oversight and sign-off for clinical tasks.

There were effective arrangements to support staff, including supervision, bespoke clinical training and access to an internal Rapid Response Team for people with complex needs. This was a team of staff specifically employed to be available to step in to support people and children with their complex needs.

Feedback from relatives was mixed. Whilst families consistently praised caring and committed staff, concerns were raised regarding staff turnover, and the impact this had on continuity of care.

Management responded appropriately to any performance concerns through regular supervisions. However, supervision records did not always clearly evidence actions, responsibilities or follow-up arrangements, limiting assurance improvements had been fully embedded and improved.

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.

The provider had systems in place to support safe infection prevention and control practices. Staff received mandatory training and infection control risks were considered within care planning and clinical support arrangements.

Where people had complex healthcare needs, nurses provided oversight, training and competency assessments to other staff, to help ensure care was delivered safely. Staff also had access to policies, guidance and specialist support when required.

No concerns were identified regarding infection prevention and control during this assessment.

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.

Medication administration records (MAR) did not always provide clear assurance that people’s medicines were being administered as prescribed. We found discrepancies between prescribed administration times and recorded administration times on MAR charts, which had not been identified through routine medication audits. During the assessment the management team investigated these errors and found the source to be the electronic system in use was not effective in recording the appropriate data across all documentation. The provider evidenced action they were taking to resolve this concern.

Some people needed their medicine only “as required”, such as pain relief. These are called PRN medicines. PRN protocols were not always sufficiently detailed and did not consistently include clear guidance on the maximum doses, expected outcomes or escalation requirements. We also identified inconsistencies between care plans and supporting clinical records, such as differing medication dosages and unclear guidance regarding treatments including creams, nebulisers and saline administration. The management team took immediate action during this assessment and provided assurance of how they ensured people were safeguarded from potential harm. Also, the actions they were taking to improve records.

Some records did not clearly identify whether responsibility for medication administration sat with family members or care staff. This increased the risk of confusion and inconsistent practice. Whilst management had identified some of these concerns and were responsive to feedback, further work is required to strengthen medicines governance, record keeping and audit processes to ensure safe and consistent medicines management.

Staff received mandatory medicines training alongside bespoke clinical training before being signed off as competent to administer medicines. Medication safety alerts and learning communications were also regularly shared across the organisation by the quality assurance lead.