Efficiency Health and Homecare Services - Malmesbury

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 service since it registered on 5 January 2024. This key question has been rated Inadequate. 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 provider was in breach of a legal regulation in relation to the safe care and treatment and staffing.

This service scored 31 (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. The provider did not have systems in place to monitor concerns and compliments. This meant lessons could not be learnt to continually identify and embed improvement.

Incident forms had been completed when incidents occurred. However, there was incomplete information about people’s possible injuries and ongoing actions were not recorded. There were records of people at risk of falls but staff had not completed falls training. This meant lessons could not be learnt from incidents to improve practice.

People had creams and were supported with these, but they were not included on people’s medication administration records (MAR). This meant that people’s creams might not have been administered correctly.

One person complained that staff did not know how to support them when they had a seizure and said staff did not have adequate knowledge and resources to keep them safe. This meant that the person was at risk of harm while being supported.

Staff had not completed all mandatory training and there was a gap in knowledge of supporting older persons. This meant that people were put at risk. Of the 7 staff we spoke to, none were sure of the induction process with some saying it was one day and others stating it was for 2 days.

The provider could not demonstrate any examples of working well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. The care plans we viewed did not show people’s seizures were recorded and did not contain risk assessments that ensured people were safe. This meant that the provider could not be assured how many seizures a person was experiencing and if there was a way to mitigate the risk of seizures.

The provider did not always make sure there was continuity of care, including when staff moved between different services. People received support that they were unfamiliar with. This meant that people’s preferences were not always considered.

We requested examples of how and when the provider had worked with partnership organisations, but these examples were not sent to us. We asked for contact details of any professionals that the provider had worked with, but we did not receive these.

People did not have documents to support them to safely transition into other services in line with the service’s approach to care planning procedure. This meant that if care was transferred, people’s preferred ways of being supported and any risks relating to epilepsy and falls would not be readily available to professionals. This meant people were at risk of harm and unsafe treatment.

The provider did not always take steps to safeguard people. We found medication errors which had not been followed up. The medication audits we saw were inconsistent and did not always demonstrate lessons learnt which meant people were not safeguarded against this happening again.

Moving and handling risks had not been thoroughly assessed for people meaning both people and staff could be at risk of injury.

We asked to see the safeguarding policy, but this was not provided. Three out of twelve staff were not up to date with their safeguarding training. This meant staff may not have known how to keep people safe.

Some staff we spoke to were not able to tell us about the safeguarding procedure. Some staff did tell us if they had concerns, they would raise these with the care coordinator or team leader.

Only 4 out of 11 staff had completed duty of care training. This meant that staff could not assure themselves of their responsibilities.

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

Risks to people’s safety had not always been identified so that management plans could be produced. This meant staff did not have guidance needed to support people safely. One person had a diagnosis of epilepsy. There was no risk management plan for this person for staff to know what to do should the person experience a seizure.

Another person’s care plan noted they took blood thinning medication. There was no risk management plan for staff to know what the risk of bleeding was if they fell. Where risk management plans were available for some risks, we found information to be missing.

We did not see evidence that people were involved in completing or reviewing their care planning. This meant that the provider could not be assured that people had involvement in their risk management and were happy with the measures in place.

The provider did not always detect and control potential risks in the care environment. There were no environmental risk assessments in place for people’s homes. The risk of fire had not been assessed where people used emollient creams.

The provider did not always make sure equipment supported the delivery of safe care. One person’s care plan stated that they mobilised independently but the risk assessment stated that they used a walking aid. Another person had use of a wheelchair, again this had not been risk assessed. This meant people’s mobility within their environment had not been properly assessed and there was no guidance to support staff.

The provider offered use of a vehicle. The risks of using this vehicle had not been properly assessed. There were no policies or risk assessments in place. This meant that in the event of an emergency there was no protocol in place to inform staff of what to do.

The provider had not assessed the fire risks to people within their own homes. The provider’s fire policy stated that the evacuation risks should be assessed for each person. The provider had not undertaken this risk assessment. This meant that if a fire did occur then staff would not know what to do and people may not be evacuated safely. There were no personal emergency evacuation procedures available to ensure people were able to leave their homes if a fire occurred. There was no fire log in place for the office environment meaning the provider could not monitor and be assured that staff would know what to do in the event of a fire.

Only one member of staff had completed fire safety.

We saw that most staff had received moving and handling training.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Some staff’s right to work documents had expired. The provider’s sponsorship licence had been suspended. The provider did not always work well to provide safe care that met people’s individual needs. Some staff supporting people with epilepsy had not received training to support them with seizure management.

Some staff supporting people assessed as being at risk of falls had not received the provider’s recommended training. Seven out of twelve had not completed this training. This meant that people at risk of falls were not receiving safe support.

There were enough staff to cover care packages. However, some people told us their care worker was late or did not arrive at all.

The provider did not follow legislation regarding recruitment of staff. We reviewed 7 staff files. None of these files contained enough information to ensure staff had been recruited safely and the provider had not risk assessed their own processes with regards to staff recruitment.

Some staff’s right to work documents had expired. This meant the provider could not be assured they were working to current legislation.

The provider had not ensured all staff had a full employment history recorded. Gaps in employment could not be explained. This meant that the provider could not be assured that they were employing fit and proper persons.

One member of staff started employment with the service before the date of their DBS issue certificate. This meant that people were not safe as enhanced checks had not been completed before offering employment and the risk of this had not been assessed by the provider.

Staff received training on infection prevention and control and were provided with personal protective equipment (PPE). Staff told us they had the PPE they needed and received additional stock in a timely manner.

The provider did not assess and manage the risk of infection. The infection prevention and control risk assessments that were in place for people did not contain sufficient information to ensure risk of infection was mitigated. The provider acknowledged that measures needed to be taken and gave examples such as cleaning cutlery but the provider had no audits to monitor the effectiveness of infection prevention control measures. An infection prevention control policy was available to staff. However, it had not assessed the risk related to infection prevention control in line with their policy. This meant that people could be exposed to the risk of infection.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning how they should receive their medicines. The records did not contain the information needed for medication administration records (MAR). This meant staff did not have information on why a medicine was prescribed, the prescribed dose for a medicine or when to administer all medicines.

We found staff were supporting people with creams and emollients but these were not listed on the MAR. This meant the provider could not be assured people had their medicines as prescribed or that they were receiving them. There was conflicting information in care planning documents. One document stated a person took their medicine independently and another document stated for the same person they required support with some medicines.

Some people were prescribed invasive medicines. The provider told us they had been supporting people with these medicines but the provider’s training record showed no staff had the training to ensure this could be done safely. The provider had not sought the required training from a healthcare professional for the administration of this invasive medicine. This meant that people were not receiving safe care.