Joy Caring Services 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 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 59 (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.

They had a process for managing incidents. A registered manager told us, “Staff are to fill in an incident report and then we investigate.” We saw these were collated in an incident tracker which showed the people and staff involved, action taken and lessons learned.

Staff confirmed information was shared with them. A staff member said, “Managers share information clearly.” However, staff described an incident we did not see on the tracker. Therefore, we were not assured all incidents were reported as required.

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.

A person had been admitted to the service recently. This had to be done at pace due to factors outside the provider’s control and was managed well. We were told by relatives, “The people were so lovely and tried their very best settling [person] down. They helped with the furniture, they were brilliant.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately.

The provider collated safeguarding concerns in a tracker. We reviewed this and saw 3 had been referred to the local authority. Whilst it showed action was taken and learning identified, none of these were reported to CQC. The provider told us, “Some of the things we notify social services, not all of them would be safeguarding concern. The social worker can resolve it.” We expect all safeguarding concerns to be notified to CQC once identified and shared the guidance with the provider to review.

Staff were trained in safeguarding.

The provider did not always work well with people to understand and manage risks.

The provider had not ensured people’s records included detailed risk assessments. Some people had complex needs and there was a lack of guidance for staff of what to monitor and who to escalate concerns to. For example, a person had all meals and medicines administered via Percutaneous Endoscopic Gastrostomy (PEG.) Their care plan stated they were at risk of choking and may need support with suctioning. There was no separate risk assessment for this, and their medicines risk assessment was generic with no mention of the PEG. This meant there was a risk people did not get the support they needed.

During our visit, we observed staff supporting the person with the PEG. Regarding suctioning they told us, “Whenever teeth cleaned or at other times if coughing/secreting. I don’t think everyone are trained but always someone on who is.”

Following our feedback, the provider told us they were making improvements to people’s risk assessments, and we saw an example of this. They told us, “All our risk assessments are now personalised, it is already beginning to happen.”

People’s relatives felt risks were managed well. They told us, “They have a good handle on [person’s] behaviours and needs in the community.”

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

People’s care and support were provided in a safe, clean, well-equipped, well-furnished, and well-maintained environment which met people's sensory and physical needs.

The provider had not ensured safe recruitment procedures were always followed. We found references and full employment history had not been obtained. We fed this back to the provider, and they provided references and explanation of some gaps. They told us they had reviewed other records to ensure there were references and recruited a new administrator who would be responsible for this in future.

The provider had a tracker to monitor staff training compliance. This had numerous gaps for the mandatory training courses, and it was unclear who needed to complete specialist courses. Some care staff supported people who had nursing care needs. It was not always clear whether the nurse who was responsible for the training and oversight of these tasks was employed by the provider, or whether the task had been delegated by a nurse outside of the service. We told the provider their arrangements with commissioners needed to be very clear for ongoing oversight and referred them to delegated healthcare activities guidance.

Staff told us they felt they had enough training for their role. Where specialist care was provided, they told us there was always a staff member on shift who had the required training.

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.

Both supported living schemes we visited were visibly clean with Personal Protective Equipment (PPE) available. We observed staff using PPE as required during our visits.

Staff had not ensured all food was labelled with dates they were opened and we found some eggs had expired. We fed this back to staff who removed them immediately.

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

The provider did not always make sure medicines were managed safely. Staff did not document people’s medicines administration well. We reviewed people’s records and found Medication Administration Record (MAR) charts had some gaps and inconsistent use of coding, making it unclear whether the medicine had been administered and if not, the reason. Following our feedback, a registered manager told us, “I noted they had run out of the new [MAR charts] which is why they had been using old [codes].”

Some people were prescribed PRN medicines, which are those administered as and when required. There were not clear protocols for staff to know when to administer these, however a registered manager told us people were able to tell them verbally if they were needed.