Myable 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 Inadequate.

This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to safe care and treatment, safeguarding and safe staffing.

This service scored 28 (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 have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

The provider had only recorded two incidents. However, actions taken to review and analyse the incidents was not robust. Both incidents were falls relating to the same person. The provider confirmed the person did not have a care plan, and therefore this was not updated but told us they informed staff of the increased risks to the person. The provider failed to conduct a thorough investigation of what happened, meaning there was a much greater risk of the person falling or coming to significant harm again.

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

The provider failed to ensure that risks to people were documented and known through their care journeys. The provider was not proactive at identifying risks to people and ensuring risks were proactively managed. For example, people did not have complete assessments, which identified risks to people’s health and wellbeing. Where risks were identified and known these were not documented within people’s care plans and risk assessments.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

People were at significant risk of abuse and had been neglected. Care was not provided in a timely way or in line with their needs and preferences. Care calls were often provided significantly late, which left people in undignified situations, including on some occasions soiled and with wet bedding. A relative told us they that they had requested their loved one to be supported every 4 hours due to their continence needs, and concerns of the person being left soiled for prolonged periods of time. We found there were periods of nearly 12 hours where the person did not receive support. Another person did not receive their morning call, when staff supported them at the afternoon staff documented the person was ‘very thirsty.’ The provider failed to identify that this person was at risk of neglect through lack of hydration. People had not been safeguarded from the risk of abuse and were placed at increased risk of harm from skin breakdown due to neglect.

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 had not been assessed and mitigated. Care plans and risk assessments were poor and did not contain guidance for staff how to mitigate risks to people. Some people’s known risks had not been identified within their care plans. For example, one person was diabetic but there was no reference to this within their care plan. There was no guidance for staff to follow if the person became unwell through their diabetes. The provider told us, “She always goes hypo.” Other people were at risk of constipation. There was no risk assessment, care plan or bowel monitoring charts to mitigate the risks to people, meaning a higher risk of people being in extreme pain or risk of harm without this being identified or responded to. The provider told us one person was, “Always constipated.”

Other risks to people were not assessed or actions in place to reduce the risk. For example some people were at risk of skin breakdown. There was no care plan or risk assessment in place to inform staff how best to support people reduce the risk of pressure damage. The provider told us they had not implemented a care plan and that the information was “In their head.” This meant we could not be assured staff would have access to the information they needed to support people consistently or safely. One person had epilepsy. There was no care plan, risk assessment or guidance for staff to follow if the person was to have a seizure. There was a risk that staff would not be able to respond and support safely to the person in the event of a seizure without guidance or training.

Where information around risk was in place, this was very limited in detail and not specific to the person’s individual risk.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider failed to fully assess risks to people’s environment. Each persons care plan contained the same information in relation to environmental risks and was not person specific. Where people used equipment for example to help them to transfer staff were advised to check the equipment, but there was no information or guidance on how to do this or how frequently to do this. There were no records to confirm that staff did complete checks on the environment and equipment.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

People told us, and daily notes confirmed that people’s care calls were inconsistent in time. A relative told us, “[My loved one] will be waiting for the toilet for 6 hours, I have given feedback they need to come every 4 hours.” We identified one instance where the time between calls was over 15 hours. Other people also had long periods of time between calls, or no calls delivered some days.

Staff had not received the training they needed to carry out their roles. The provider told us that staff had not completed training in areas including diabetes care and catheter care, despite supporting people with these conditions. The provider told us they had not completed competency checks in areas including catheter care, diabetes, personal care and manual handling. The provider was unsure if staff had received training in epilepsy, and despite one member of staff telling us they had received training there was no training certificates to evidence that this had been completed.

Staff had not been recruited following safe recruitment practices. Some staff had completed their application forms after they started working for the service.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection prevention and control risks had not been identified and mitigated. Some people needed support with catheter care. Care plans and risk assessments did not detail the personal protective equipment (PPE) staff should wear to reduce the risk of infection when supporting people.

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.

Medicines administration was not safe. The medicines that people took were not documented on their care plan to inform staff what medicines they took and any associated risks or concerns to be aware of. The provider was not able to inform us which people, if any had prescribed creams, and where they did the provider confirmed there was no topical medicines administration record in place to document the use of the medication. People’s medication records did not contain any information regarding any allergies they had.

People’s care plans did not include information about people who lived with long term pain. There was no care plan to inform staff how to support the person with pain management, when to identify if they were in pain or who to contact should they be in significant pain. The provider told us one person was “Always in pain.” Yet there was no guidance for any steps staff could take to reduce this person’s pain.