Rapid Improvement Care Agency

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. At our last assessment we rated this key question good. At this assessment, the rating has remained 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 investigated and reported safety events, although lessons were not always learnt to continually identify and embed good practice.

People were encouraged and supported to raise safety concerns with managers and staff. They understood the importance of reporting safety concerns. Systems were in place to support staff to report and record safety concerns and events when they arose. Any safety concerns or incidents that did occur were investigated.

However, the registered manager told us they were aware they needed to develop a more effective and proactive approach to monitoring and continuously improving the quality and safety of their community care at home services.

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.

Managers and staff gathered information about people’s individual needs and wishes, and risks to their safety, prior to people receiving a supported living or home care service from this provider. This information was used to develop person-centred care and risk management plans. These were shared with staff to help them provide safe and appropriate care to people from the moment they started receiving personal care at home.

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 told us they or their relative felt safe with their regular carers. One person said, “I feel safe with my carers who I like.” A relative added, “I know my [family member] is safe with the carers who visit her at home.”

Managers and staff understood how to safeguard people. They knew how to recognise and report abuse and were able to articulate how they would spot signs if people were at risk of abuse or harm. A member of staff told us, “I make sure people are safeguarded by following the company’s safeguarding policies and procedures at all times. If I have any concerns, I report them immediately to my line manager or safeguarding lead and complete the appropriate incident or safeguarding forms.”

Managers worked proactively with the relevant community-based care professionals and agencies, when a concern was raised, and took appropriate action to safeguard people from further risk. A community-based care professional told us, “Managers and staff have dealt with allegations of abuse and neglect professionally and focused on maintaining the safety and wellbeing of my client, and co-operated with safeguarding inquiries in a transparent manner.”

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). Staff understood people’s capacity to make decisions about their care and support using people’s preferred method of communication. Managers and staff had received Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) training.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Systems were in place to ensure risks people might face were routinely assessed, monitored and reviewed. People’s care records contained sufficiently detailed information for staff to follow. This ensured risks people might face were mitigated, so people remained safe when taking part in activities of daily life. One person told us, “They [staff] know I am at risk of falling and do everything they can to keep me safe.”

Managers and staff were fully aware of the potential risks people might face and the steps they needed to take to reduce or safely manage them. Staff described how they balanced risk with independence, enabling people to undertake tasks for themselves whilst remaining safe. Risk assessments and management plans were reviewed at regular intervals and updated according to reflect any changes in people’s needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Detailed risk assessments conducted on people’s own home ensured these environments were safe places for people to live and work. The office-based managers and supervisors routinely conducted in-person monitoring visits to the homes of people who received care at home which ensured they were able to identify and mitigate any potential environmental health and safety risks.

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.

Home care visits were well-organised by the office-based coordinators. The provider used an electronic call monitoring [ECM] to manage staffs home visits. The ECM logged the exact times staff arrive and leave the home of people they support and automatically notified the office-based managers and staff in real time if care staff were running late, left early or missed a visit. People told us staff were usually punctual and had enough time to complete all the tasks they were expected to during each of their home care visits. One person said, “They [staff] come on time and stay the right amount of time. If they are ever running late they will ring and let us know.” A relative added, “Are regular carers are really good and their punctuality excellent. They are also really obliging and flexible when it comes to changing the home visit schedule when we request it.” Similarly, staff confirmed they were happy with the way their home visits were coordinated. A staff member told us, “In general, are home visits are coordinated fairly well by the staff in the office. Travel times between calls are considered, so I am able to arrive on time and complete all my allocated tasks properly.”

People received continuity of care from the same group of staff who were familiar with their personal care needs, wishes and daily routines. A relative told us, “What pleases us most about this agency is my [family member] receiving consistently good care from the same group of carers who know her well.” A community-based care professional added, “The provider recognises how important it is for my client to receive care and support at home from a designated and stable staff team who are familiar with her wishes and daily routines.” Staff also described supporting the same individuals. A member of staff said, “It’s one of the best things about working for this agency is that we have our own regular people we visit. They know and trust me and I know their likes and routines. I have built a good working relationship with all the people I regularly support. It means I notice straight away if something is different or wrong.”

Staff were supported to continually improve in their role. They received a mixture of e-learning and in-person practical and theoretical training and competency-based assessments.

Staff had ongoing opportunities to reflect on their working practices and to identify any further training, learning or support they might need. Staff had regular individual and group meetings with their line managers, supervisors and fellow co-workers. In addition, field supervisors routinely conducted monitoring visits to observe staff working practices to help them identify what staff did well and what they might do better. A member of staff said, “I receive regular supervision with my manager and attend some team meetings. I feel able to raise issues and to ask for support whenever I need it.”

The provider operated safe recruitment practices and only suitable staff were employed to work as home care staff. Recruitment processes included appropriate checks, induction and probation.

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.

The provider operated effective systems to help prevent and control infection. Staff had received relevant infection control and food hygiene training and had access to resources and equipment to help them reduce the risk of infections spreading. People told us staff followed good hygiene practices and used personal protective equipment (PPE) when needed. A relative told us, “They [staff] wear a mask and gloves when providing my [family member] with any personal care and are always very professional.” Staff reported they had consistent access to enough PPE. A staff member told us, “PPE is available when we need it, including gloves, masks, and hand sanitiser. We are encouraged to follow infection prevention and control procedures at all times.” Senior staff routinely observed staff working practices to check they were following safe infection control and hygiene practices when they supported people.

The provider did not always ensure staff follow relevant national guidelines around the recording of administered medicines. The provider ensured people received their medicines that met their needs, capacities and preferences. They always involved people in planning, including when changes happened.

Staff did not always follow relevant national guidelines around the recording of administered medicines. Medicines administration records [MAR] sheets were not always correctly signed by staff who had administered people their prescribed medicines. We found multiple gaps where staff had failed to sign a MAR sheet correctly after administering medicines or in one instance had used of ticks instead of staff’s initials.

We found people had not been harmed as result of these record failures, but it has placed people at risk of harm. We discussed this records issues with the registered manager who agreed to review how staff maintained medicines records and improve their practice.

Medicines stocks and balances showed people consistently received their medicines as prescribed. Care records contained detailed guidance for staff about how people needed and preferred their prescribed medicines to be administered including, detailed risk assessments and protocols for the administration of prescribed routine and ‘as required’ medicines.

Staff received medicines training and their competency to continue managing medicines safely was routinely assessed by their line managers. How safely staff managed people’s medicines were routinely observed by senior staff as part of their regular quality monitoring spot check visits.