A3 Care Ltd

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 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 were aware of process to report safety events.There was a system in place for recording accidents and incidents. There had not been any incidents or accidents. The registered manager said if something happened it would be investigated, and they would ensure people were safe. The issue would then be discussed within the team and ways to prevent it recurring would be identified and implemented.They said, “We would do the reflection of the incident; what happened; what action plans we would have to put in place. We are not a blaming culture company…we always support staff and for us to learn from it. Being open and non-judgemental is the key.”The person and their relative said, “No accidents or incidents to report but I feel that the staff would act appropriately and deal with any concerns; very good at communicating with me” and “No I have had no accidents or falls but I am sure the staff would manage any incidents appropriately and inform my [relative].”

Staff told us about the process of reporting and recording events. Staff confirmed there had been no accidents or incidents. Therefore, staff said they had not had a chance to discuss any lessons learned. The registered manager was clear about their role in regard to the duty of candour. We discussed duty of candour and what incidents were required to be notified to the Care Quality Commission. The provider had a policy for actions that staff should take in situations where the duty of candour would apply.

The provider worked with the person 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 and if people would need to move between different services.The person and relative were involved in the planning and reviewing of their care and informed and supported by the registered manager and the staff team. The relative told us, “No problem with accessing other professionals, staff will communicate with me and I usually take [person] to [medical appointments].” The registered manager told us about working together with the person and their family. They told us the family would also inform them if there was anything to know from the health appointments.

The provider understood what being safe meant to people and the best way to achieve that. Staff concentrated on improving the persons live while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.The person was kept safe from avoidable harm because the registered manager and the staff knew them well and understood how to protect them from abuse.The person told us they felt safe when receiving care. The relative agreed the person was safe when receiving care and liked the staff who supported them. They said, “I feel very safe with the staff that visit me, certainly no abuse of any kind, they are very respectful and do what I say and ask for, always my choices, they do the right thing” and “Yes, I feel that [the person] is kept safe, never any sign of any form of abuse or safeguarding concerns.”The registered manager understood their responsibilities in regard to safeguarding people and reporting concerns to external professionals accordingly such as the local authority, police and the Care Quality Commission. Staff were aware of how to recognise abuse and protect people from the risk of abuse. Staff knew how to report concerns and were confident the registered manager would act on any concerns reported to ensure people's safety.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. When people receive care and treatment in their own homes an application must be made to the Court of Protection for them to authorise people to be deprived of their liberty. At the time of inspection, no one was deprived of their liberty or had any restrictions placed on them. The person said, “I don’t like to feel restricted, and I agreed to having carers and they do what I want them to do, not the other way round.”

The provider worked with the person to understand and manage risks by thinking holistically. Staff provided care to meet the person’s needs that was safe, supportive and enabled the person to do the things that mattered to them.The registered manager and staff assessed and reviewed the risks to the person’s personal safety and put plans in place to minimise these risks. The person's support plan had information and guidelines to help staff provide care in a safe and person-centred way, based on their needs and the support they required. The person and relative said, “The carers help [the person] manage risk, [person] uses a stick when walking, no falls. Staff do reassure [person] when they ask about [their family] and forgets that [family member] has passed away, I have heard them reassure [person] in a kind and caring manner, good communication” and “I receive personal care to include a shower or wash which I prefer. [Staff] support my mobility when walking with my stick. They help to reassure me when I get anxious or forgetful as per my care plan instructions, they are very good, and I like them.”The service had business continuity plans to ensure the service could continue in the event of an emergency. There was an on-call system in place for staff should they need help and advice and staff confirmed this.

The provider detected and controlled potential risks in the care environment. They made sure any equipment, facilities and technology supported the delivery of safe care.The service supported the person and relative to oversee and manage potential risks in the home environment. The registered manager said they reviewed and discussed any risks and mitigation relating to person’s homes and equipment they wanted to use to ensure safety, independence and privacy. The person added, “Staff are supportive, listen to me and help as necessary…so my voice is heard.” Staff noted if they were worried about the person, they would report this to the registered manager and family to ensure timely response. Both staff and the registered manager supported and protected the person safely without any restrictions or use of restraint. As part of the care plan, the service carried out a health and safety assessment of the environment to ensure the person, their family and staff were safe while carrying on the regulated activity.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, some of the recruitment checks were not always completed in a timely manner. The registered manager followed recruitment procedures to ensure the person was supported by staff who were of good character, suitable for their role and had appropriate experience. We found minor queries such as 1 gap in employment and if staff health checks were completed. We also found that the right to work checks were not completed before staff started working with people. We discussed these with the registered manager who provided information as needed.

The registered manager and staff worked together well to provide safe care that met the persons individual needs. The person and their relative confirmed they had regular staff coming to support them and completed all the care and support needed. They were complimentary of staff’s support. They said, “The staff always arrive and leave on time. One [staff] was delayed once but [they] phoned to tell us. Initially we had 2 staff members visit at a time which could include the manager but now we have one at a time” and “[Staff] are always on time and often stay beyond their allocated hours even waiting until my [relative] arrives. [Staff] never give me the impression of being in a rush. Staff always complete all the tasks I require of them and use their initiative for other jobs. If late they would let me know but this has only ever happened once.”

Staff confirmed there was enough time to complete the tasks on the visits. Where needed, the registered manager also covered absences to ensure support was not compromised.The person and their relative thought staff had the training and skills they needed when supporting them. They said, “I think the staff are well trained, definitely have good skills, I can’t ask for more. Any new staff get an induction and shadow another member of staff or the manager” and “Yes, I feel the staff are well trained…Any new staff have been introduced to us by the manager or a long-term carer; they would shadow initially.” Staff felt they received training that equipped them with the knowledge they needed to support the person. The registered manager had a system for monitoring staff training to ensure training was up to date including spot checks to monitor staff members’ practice and performance. The registered manager said they encouraged staff to inform them if they needed more training.

The service assessed and managed the risk of infection. Staff were provided with and used personal protective equipment to prevent the spread of infection. Any other infections would be reported to the registered manager to ensure timely response and support to the person. Staff were trained in infection control and followed the provider's policies and procedures on this.

The person and their relative confirmed this and said staff wore the protective equipment while supporting them. They said, “My home is kept very clean and tidy, hygiene is good, staff wear gloves and wash their hands with gel, they are well trained in this area” and “Yes, I do feel staff are aware of infection control, they wear gloves and masks if necessary but I don’t want him to feel intimidated by them wearing a mask, hygiene is good.”

The provider needed to make some further improvements to the management of medicines. The person was supported by staff to receive and store their medicines. However, the completion of some of the medicines management records needed reviewing and improving according to provider's policy and current best practice guidance. For example, the person used one topical medicine as homely remedy. This is medicine is purchased over the counter rather being prescribed. The registered manager did not ensure a record of administration was in place for this. According to the provider’s policy, this should be recorded on the medicines administration record (MAR) chart. Any medicine given by a relative should be recorded on the MAR chart however this has not been completed. One of the staff started applying the topical medicine before their competency was assessed. Policy noted staff must have training and competency checked before giving medicines. There was a potential risk to safely manage medicines. We considered this under the well-led domain. After the site visit the registered manager provided further information of remedial actions taken to ensure safe management of medicine was maintained, monitored and risks reduced. This included review of polices and audits, staff refresher training, and spot checks.