Tring Care 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 people were not always safe and protected from avoidable harm.

The service was in breach of legal regulation in relation to people’s safe care and treatment.
 

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 registered managers told us that although there had not been any incidents, accidents, complaints or safeguarding’s they would always share them with staff if they occurred so that the service could continually improve and develop positive outcomes for people.
The registered managers told us they shared information with staff and keep them up to date with lessons learnt and best practises. The service is moving to an electronic care system, and the process had already begun when we inspected. The registered managers told us that the new system will help to improve oversight and safety within the service.

A family member told us that staff show a “willingness to learn”.
 

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.

Staff told us they read through care plans and that they knew people well.
The family member told us that they had an initial assessment and participated in the compilation of their care plan. It was a new service for them but they had their first review scheduled.
 

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 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.
Staff told us how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. A staff member told us, “I am aware of how to identify harm or abuse and was informed during induction that I can report any concerns directly to the registered managers or to CQC if needed.” The registered managers said, “We speak to the client about safeguarding. We have a phone number to call and explain to [care worker] on what to do. There are people that the client can speak to. If I suspected a safeguarding with [person] I would speak to [them]. I would report it to the local authority immediately.”

The person using the service explained, “I do feel safe and comfortable with the staff. There have not been any problems with my care.”
 

The provider did not always work well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments included information on what to do to mitigate risk but some key areas were also not included. For example, there was not a risk assessment for emollients although it stated in the care plan that they support the person with emollient based creams. Emollient creams, used for dry skin, pose a significant fire risk because residue builds up on clothing and bedding, making them highly flammable, causing rapid, intense, fires if exposed to ignition sources. Anyone receiving care who uses emollients must have a risk assessment in place.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risk assessments we looked at reflected this including people's environment risk assessments.

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 registered managers had processes in place to ensure all staff received an induction and staff we spoke to confirmed this. Appropriate checks were in place before staff started work including providing full work histories, references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.
 

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.

Staff had infection control training, and the family member told us that staff always where their gloves and aprons where appropriate.
 

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

Staff had medication training. Staff had not yet had any spot checks or competencies related to medication. The registered managers said they are planning to conduct spot checks.
It was unclear in care plans if people were or were not being supported with medication. This could lead to confusion for staff about what they should be supporting people with, meaning people are supported incorrectly with their medication.

During our inspection we found there were no medication administration records in place for medication and creams that staff were supporting a person with. We fed this back to the registered managers who were not aware these needed to be in place. Medication records were implemented immediately following our feedback. Medication audits had not yet taken place at the time of our inspection.