SSA Quality Care

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• 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 changed to 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 good governance in respect of the management of risk and records relating to medicines.

This service scored 62 (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 some systems in place to learn from events and gain feedback from people, staff and stakeholders. However, opportunities to learn from incidents, feedback, and audits were not always maximised. We found improvements could be made to ensure the systems were fully effective. We found incidents were reviewed by the registered manager on an individual basis, but there was no overview of all accidents to look at trends and prevent reoccurrence. However, the provider and registered manager responded to our feedback and made changes to their processes.

There was evidence of learning from incidents and feedback, with a culture of openness around safety. However, whist staff described feeling supported, there were some areas where follow up actions were not always timely or fully resolved. For example, one relative raised concerns about staff using mobile phones during visits and not engaging with their family member. They told us, “The carer sits on the sofa on their phone for the whole visit. She doesn’t try to engage (person) who has dementia. I haven’t raised it because I wasn’t sure who to talk to.” We have provided this feedback to the registered manager for them to take action to improve people’s experience.

Staff told us they recorded incidents on the computer system and knew to contact the office to report them. Comments from staff included, “The leaders are very supportive and action our concerns,” and “I feel okay raising safety concerns as we have been told not to keep quiet about anything unsafe.When things happen, they are usually looked into properly and sometimes we are even asked to give a statement. We normally get a little talk about what happened after, just so we are all aware and can learn from it.”

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.

People we spoke with told us generally they knew which staff would be supporting them and had some continuity of support. Comments included, “We do have our regulars (staff) and it’s normally the same friendly staff”, “On the whole it’s the same (staff)” and “There are a few (staff) we know very well.” People told us this had had a positive impact on them, with people telling us, “There are two ladies that I feel very comfortable with” and “We know each other, they (staff) are kind and chatty.”

People were supported by staff who concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they feel safe in the presence of care staff, and they were confident in the care being delivered. One person said, “I am very pleased with how I am looked after, and I do feel very safe with the carers.” Another commented, “When the carers are here, I feel that they treat me as a person.”

Staff received training in safeguarding, and appeared knowledgeable about how to recognise, report and manage concerns. We found the provider and registered manager were supportive towards staff when safeguarding concerns were raised and worked with the local authorities to protect people from abuse.

People were not routinely protected from risks posed to them. We found risk assessments were not always updated in a timely manner to ensure staff had up to date information on how to prevent harm to people, and risk assessments were not always in place.

We found risk assessments were not in place for people who were prescribed flammable creams. We spoke with the provider and registered manager about our communication to providers about the potential risk of fire for flammable creams. However, they were not aware of this communication.

Where risk assessments were written, we found these were not fully person centred and did not contain all relevant information. For instance, people who had a diagnosis of Epilepsy had risk assessments which did not identify the type of seizures they had. One person who was at risk of choking had a choking risk assessment, which did not reference the full details of their modified diet.

We found records reflected that other risk assessments should have been completed, but we found this was not always the case. For instance, one person’s records referred to a catheter risk assessment., however, this had not been written or shared with us.

Staff told us care plans provided them with sufficient information about how to manage risks to people's safety. For example, we were told, “Care plans and risk assessments outline specific risks such as falls, choking, aggression and give us clear instructions on how to manage them.I usually feel the information is detailed, though sometimes updates could be quicker.”

People were supported by a service which assessed potential risk posed by their home environment. At the service commencement an assessment of needs was carried out. This included an assessment of the person’s home. The assessment included areas such as any repair of the home required and potential risks. For example, frayed carpets and poor lighting.

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 service had robust recruitment procedures in place to ensure staff were suitable to work with people using the service. Pre-employment checks, including references and Disclosure and Barring Service (DBS) checks, were completed before staff began working. This helped to ensure the safety and well-being of people using the service.

People told us they received a staff rota. There were mixed experiences about how useful these were. Some people told us the staff rotas were not always reliable. For example, one person told us “But (it’s) not always who it states on the rota is the one that turns up. I don’t want to keep training and explaining routines all the time.” We have provided feedback to the registered manager about this.

Staff told us they felt well supported in their roles and received appropriate training, supervision, and guidance to carry out their duties effectively. Staff described a structured induction process which included key training and opportunities to shadow more experienced colleagues. One staff member told us, “My induction was good and covered policies, shadowing shifts, and key training like moving and handling, medication, and safeguarding. The training is good overall as it gives me confidence in handling different situations like emergencies.”

Staff consistently reported that they had regular supervisions and access to support from managers. They felt listened to and encouraged in their personal development. One staff member said, “We have one-on-ones every few months and I can talk about any issues. It is usually a good space to raise anything or just get support; they also are very encouraging for us to build ourselves.” Another staff member told us, “These supervisions help me feel supported and confident in my role, and they ensure I’m working to the right standards and following the service’s values.”

Supervisions also focused on staff well-being, goals, and any challenges they were facing. Staff described managers as approachable and responsive, with clear lines of support available. One comment included, “I receive regular supervision with my manager asking me about my well-being, training and goals, challenges that I’m facing whilst working or at home.”

Staff were positive about the training they received and felt it prepared them well for their roles. They told us it helped them feel confident and competent, and enhanced the quality of care they provided. One member of staff said, “The training we received was good and it helped us in numerous ways, enhancing our skills, knowledge and confidence to provide high quality care to all our service users.” Another member of staff commented, “The training I received helped me to understand the different needs of the people I support and all stakeholders, like social workers, GP and district nurses.”

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.

People told us staff followed appropriate infection control procedures, helping them to feel safe and protected during care visits. Most people we spoke with confirmed that staff consistently wore personal protective equipment (PPE) such as gloves and disposed of it appropriately after each visit. One person commented, “The carers all wear uniforms and carry ID, they (staff) are very professional at all times.” Another shared, “Most staff do wear PPE, and they wear gloves and dispose of them properly.”

A small number of people noted that not all staff consistently used PPE. However, the majority of people were reassured by the professionalism of the staff in maintaining hygiene and infection control standards. People also told us staff wore uniforms and carried identification, which contributed to a sense of safety and trust. We have provided feedback to the registered manager to ensure all staff use PPE when needed.

People were supported by staff who understood how to administer medicines safely and in line with best practice. However, we found some improvements were needed for, ‘as required’ medicines (PRN). We found the provider did not routinely follow National Institute for Health and Care Excellence (NICE) guidelines. We spoke with the registered manager and provider about this. They were receptive to our feedback and made changes to promote safer medicine practice.

People told us they felt safe receiving support with their medication, and staff were described as professional, kind and respectful. One person told us, “They administer medication, they apply cream and tablets,” another person told us, “They collect my meds (medicines) for me.” These comments reflected where support with medicines was required, staff understood their role and carried out tasks appropriately.

Staff demonstrated good knowledge of safe administration procedures, including the use of Medicines Administration Records (MAR). One staff member told us, “We support people to take medicine as prescribed, using MAR charts and double checking protocols. For example, I support some of our clients by ensuring medication is taken at the stated time, administered correctly, and I document everything.”

We found people who were prescribed time sensitive medicines were allocated care calls in a way that ensured they were supported with taking their medicines as prescribed.