Excellence Healthcare

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 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.

The service was in breach of legal regulations in relation to safe care and treatment and staffing.

This service scored 53 (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. Lessons were not always learnt to continually identify and embed good practice.

The provider investigated concerns brought to their attention. However, there was no overarching matrix to enable the provider to track and monitor the progress of investigations. There were processes in place to analyse incidents or accidents, although records did not show lessons learnt from incidents to drive improvements, identify and embed good practice and mitigate future risks.

Staff knew people’s needs well and understood the importance of reporting any safety concerns. Staff told us managers were responsive and supportive in dealing with matters raised. Relatives knew who to contact if they had any concerns about people’s care. All relatives, we spoke with were very happy with the care their family member received. A relative told us, “My family member is really well cared for. I think staff are well trained and provide very good care.”

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.

Pre-assessment processes were in place and arrangements made for people and family members to be involved in decisions about their care. Relatives told us people received support from a consistent staff member who knew them well. A relative said, “I am fully involved in my family members care and the communication with staff and the manager is very good.”

Staff told us they were informed of people’s needs prior to providing support through care plans, risk assessments and updates directly from the provider and team leader. Staff told us good systems of communication were in place to ensure information was shared. A staff member told us, “We see the care plan and the manager will also tell us any updates or changes we need to know about.”

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 appropriately.

Relatives told us they had no concerns about their family members safety, were confident if they raised concerns they would be listened to, and appropriate actions would be taken. A relative told us, “Yes I do feel my relative receives safe care, staff know what they are doing.”

Staff told us they were confident that any concerns shared with the provider would be dealt with. Staff had received training in recognising signs of abuse and were aware of the actions they should take if they had concerns. One member of staff told us, “I have completed safeguarding training, and this is updated regularly. If I had any concerns I would speak with the manager, and I am confident concerns would be dealt with.”

The provider did not always work well with people to understand and manage risks. The provider had processes in place to enable them to identify and mitigate risks to people; however, these were not always effective.

Some care records lacked detail about how people were supported and how specific risks would be managed. This included risks in relation to people’s living environment, including potential hazards, fire safety and the use of any equipment in place to support people with their care. Moving and handling assessments were in place, they lacked detail regarding the needs of the person being supported and did not always include what the person could do for themselves to maintain their independence. Where people might show signs of distress, there was a lack of detail regarding how to prevent this or how to support the person to stay safe. Some risks in relation to meeting people’s health needs did not have all the information needed to guide staff, to support the person safely. There was a risk if people were to be supported by unfamiliar staff due to staff holidays or sickness, they would not have the information needed to support them safely.

Despite our findings there was no evidence that people had been harmed. Relatives told us staff understood the risks associated with their family member’s care and worked closely with them. A relative told us, “I think my relative is receiving the best care. The staff really listen and understand [person’s name] needs well.”

Staff were knowledgeable about the people they supported and could tell us how they would respond to ensure their safety. People had a consistent staff team who knew the risks to people and how they should be managed. The provider told us action would be taken to ensure additional guidance was in place to ensure the risks to people was sufficiently clear.

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

Although internal risk assessments were in place regarding the safety and accessibility of people’s home environments these did not include information about any potential hazards or information about any additional equipment used when providing care. Fire risk assessments had not been completed for any of the people supported by the service.

The provider told us they did monitor the safety of people’s home environments through regular spot checks. Feedback from relatives confirmed staff ensured the home environment was kept safe and free from hazards.

The provider had some systems in place to ensure there were enough qualified, skilled and experienced staff. These were not always effective.

The provider had a recruitment process in place. However, we found safe recruitment practice was not consistently followed. We looked at 4 staff files and found for 2 staff members checks had not been completed on their previous roles in health and social care. These should include checks on their conduct, ability to carry out the role, and the reason for leaving those roles. This exposed people to the risk of harm from unsuitable staff employed.

Staff told us they had completed an induction when they were first employed and felt their training was sufficient to support them to carry out their role. They told us they received regular supervision and spot checks. A staff member told us, “I think I get good support to do my role. I have completed training, and I do updates. I can speak with the manager about anything I need to. I am happy with the support I receive.” However, there was no system of assessing staff competencies. This would ensure that staff learning from training was embedded.

Relatives commented positively about the skillset of the staff. People did not experience missed or late care visits. Staff rotas were managed to ensure people’s needs were met. Staff rotas were made available to people and their relatives which meant people had information on which staff member was going to support them for each of their upcoming care visits.

The provider assessed and managed the risk of infection associated with people’s care.

Relatives told us staff attending care calls would wear appropriate personal protective equipment (PPE). A relative told us, “There are no concerns with cleanliness, they use PPE and tidy up after each care call.”

Staff confirmed the appropriate use of personal protective equipment (PPE) was monitored through regular spot checks by the management team. Staff confirmed they had completed training and always had access to supplies of PPE. The provider had supplies of PPE stored at their office and these were accessible to all staff.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Not all people were supported with their medicines; some were supported by family members and some by staff. Information was not always clear in people’s care records about the nature and level of the support they needed with medicines. For example, in some instances a family member gave the medicines, but staff needed to monitor; however, there was no information about the person’s prescribed medicines, and the possible side effects staff may need to be aware of. Some people’s medicine care plans stated staff were not providing support, but staff were directed to apply creams without clear instructions. For some people who staff did support with their medicines, there was a lack of information about how the person should be supported to take their medicines in a way that they prefer.

Staff had training on medicines management and staff said this prepared them to manage medicines safely. However, the provider had not assessed staff competence; there was no robust system in place for doing this. Competence assessments protect people from the risks associated with poor medicine management and ensure staff have the skills and knowledge to give medicines safely. The provider told us during the inspection they would be making improvements and implementing competency checks.

Feedback from a relative was positive about how staff supported their family member to take their medicines safely and effectively. A relative told us, “The staff have been really good at ensuring [persons’ name] take their tablets on time. We have no concerns.”