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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.
 

This service scored 56 (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. Lessons were not always learnt to continually identify and embed good practice.

The provider’s processes did not demonstrate robust learning. The nominated individual shared how they maintained an overview of incidents, accidents and untoward events via an audit, however this process did not evidence any analysis or the lessons determined as having been learned. We found only one accident was recorded as having occurred in recent months. The actions recorded as taken in response to this accident, including a care plan review, had not been completed.

Staff told us they knew how to report any incidents or accidents and recognised the importance of informing senior staff should they occur. Staff support measures, such as team meetings, supervision and spot checks had been consistently completed, but it was not evident from records seen that learning was shared with staff during these opportunities.

However, people and relatives expressed no concerns with regards to safety. A person told us, “I feel very safe with them (staff).” A relative told us, “[Relative] feels safe when the carers are present and there have been no issues or incidents of any concern.”
 

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The service used an electronic system that enabled staff to access care plans, record notes and view updates from prior visits. We saw that notes completed on some visits were limited and did not always include all relevant information. We also saw that some visit notes were not being completed in a timely manner, with entries being made multiple hours after the visit ended. The nominated individual confirmed, once informed of our findings, they would address this with all staff and ensure they were aware of the need for timely entries with the quality and detail they expected.

Most people told us they had been in receipt of care from the service for some time and had no concerns. However, one relative told us, “At the beginning it took a while until the care plan was completed and the manager visiting for a review. It took a little time for the service to settle down but the staff are great.”
 

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.

People and relatives shared feelings of being safe with regards to the care and support provided by staff. A person told us, “I am safe and the company does a good job.” A relative told us, “We feel [relative] is very safe with the carers and there have been no problems at all.”

Staff confirmed they knew how to respond to and report any concern in relation to allegations of abuse and had completed safeguarding training.

The nominated individual maintained a safeguarding analysis log which detailed referrals made to the local authority, the actions taken in response and the outcome. The provider had a policy; however, this lacked details of the local safeguarding team and had not been personalised accurately with information relevant to the service. The nominated individual confirmed they would revise provider documentation and policies.
 

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

Risks to health, safety and wellbeing had not been consistently identified, assessed and recorded for all people. People’s needs were not accurately reflected in their care plans and the associated risk assessments and records contained inconsistencies. This meant that staff were not provided with accurate guidance, which could expose people to the risk of harm when receiving care and support.

We raised our concerns with the nominated individual and gave examples of where we had identified risks to people due to inconsistent care plans and guidance. They told us they were unaware of the issues found and would take action to review the care records in place. Despite our findings, most people told us staff knew how to support them safely and they had regular care staff who knew them well. One person told us, “I have 3 or 4 different carers but have got to know them well.” A relative told us, “The regular team of carers have a good routine.”

Staff told us they were aware of risks to people and consistently worked with the same people for continuity. They told us they were not involved in the assessment of risks but would inform senior staff via the office, if they had concerns or felt changes were required.
 

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, they did not always ensure care records were accurate.

Assessments of potential risks in people’s homes were completed. However, we noted they contained inaccuracies with regards to the equipment in use for people associated with their needs. For example, we found contradictory information within one person’s care records which varied from the person being in need of full assistance with their mobility, to using a walking frame, to walking independently.

Despite our findings within records, people and relatives confirmed support was given to manage risks in homes, and this included the use of equipment. One relative told us, “Recently there has been another assessment due to my [relative’s change in need]. [They have] a walker now and a wheelchair.” Another relative told us, “The carers are so good, they are managing their own risk assessments and keeping my [relative] safe on a daily basis.”

Staff told us they felt safe at work and had access to the equipment needed to support people.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. Staff received support, supervision and development; however, there was not an effective system to ensure all staff always worked together well to provide safe care that met people’s individual needs.

Systems in place failed to ensure people were receiving a timely service which was consistent with their assessed needs. We analysed the care visit data for 3 people receiving a service for a period of 14 days. We found all people were experiencing both late and early care visits, which were also consistently shorter than the duration planned. We also found where two carers were required to attend a care visit, this was frequently not logged as having happened and the data seen did not match with the planned visit times recorded in people’s care plans.

The provider used computerised care visit scheduling software to deploy staff. The nominated individual told us an analysis of care visit data was completed however, records showed that only events where staff had failed to log in or out of care visits were highlighted as a concern. There was no evidence of a review of the duration of care visits, or the timeliness of staff. The nominated individual was unaware of the issues we found during our analysis but confirmed they would complete a review.

Feedback from people and relatives differed from our findings. A person told us, “They are pretty well on time. They have not missed a call. I don’t feel at all rushed.” A relative told us, “The carers arrive on time. We have had no missed calls, and they will inform us if they are running late.” Staff feedback included concerns of not receiving sufficient hours of work, but all confirmed they had a manageable schedule and felt they were delivering timely visits.

A staff training matrix and supervision log was maintained and regular spot checks, supervision sessions and annual appraisals for staff had been provided. Staff had access to a range of training; however, some staff had not completed training relevant to the needs of people they were assigned to provide care to. The nominated individual confirmed they would complete a review of training for all staff.

Staff recruitment was safe and all essential pre-employment checks were completed prior to a staff member starting work.
 

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 and their relatives raised no concerns or issues when asked about hygiene or infection prevention and control (IPC). They told us that staff demonstrated good practice and wore personal protective equipment (PPE) when needed. A relative told us, “The carers wear their gloves and aprons and wash their hands before food and drink preparation.” Another relative told us, “Infection control is managed by PPE and scrupulous handwashing.”

The provider had a policy, and staff confirmed they knew the guidance. A member of staff told us, “We have been provided uniform and PPE like gloves, apron and mask. The office give us more if we run out.”
 

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.

People’s care plans did not accurately record their needs in relation to medicines. For one person this included a discrepancy regarding the route of medicines administration and who was responsible for their administration of medicines. We raised this with the nominated individual who confirmed the support needs of the person and provided assurances that the records would be immediately reviewed and rectified.

There were regular audits of Medicine Administration Records (MAR), with competency assessments and observations of staff practice completed. Staff completed medicines training, however the courses completed varied in content and we could not be assured from the records provided that staff deeming others competent had completed additional enhanced training. The nominated individual confirmed they would complete a review of training for all staff.

Despite our findings in relation to processes, people and relatives told us that medicines were managed safely and they had no concerns. Feedback received included, “Medication is given and there have been no errors”, “They (staff) manage medications well with no mistakes” and “They (staff) keep the medicine cupboard tidy and well organised.”