Ability Care Solutions Ltd

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 ratedrequires 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 50 (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. Lessons were learnt to continually identify and embed good practice. There was a process in place to record accidents and incidents. One staff member told us, “Incidents and accidents are reported to the office and then they provide information to who it needs to go to, they will be recorded and investigated. The policy is on our app.” One professional told us, “I have never had any issues with contacting Ability Care with concerns. I feel they are approachable and always keen for feedback regardless of the nature. I do feel they take any concerns on board and actively advocate a learning culture within their team.”

The provider did not always work well with people to establish and maintain safe systems of care. They did not always manage or monitor people’s safety, including when people moved between different services. Staff were not always provided with full information about people’s care and treatment. Information relating to people’s health conditions and associated risks had not always been assessed and detailed within people’s care plans. This meant there was a risk people’s care and treatment was not always delivered in line with their assessed needs, and staff did not always have the relevant guidance to ensure people were safely transitioned into the service.

The provider did work well with healthcare partners to make sure there was continuity of care. One professional told us, “They have kept on several of my patients on their caseload when there has been a change in funding to support continuity.”

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 service shared concerns with appropriate bodies. Relatives told us their loved ones were safe with the staff that supported them. Comments included, “I have no doubt at all that [relative] is safe with the carers”, “We feel that [relative] is safe, and they know what they're doing” and “I do feel [relative] is safe and they [carers] are all very conscientious.”

Staff received safeguarding training and understood the process they should follow should they have any concerns. Comments included, “Should there be a safeguarding issue reported and unresolved by the organisation I would then escalate the concern and report to the CQC team” and “If I had a safeguarding concern, I would make sure the person is okay. I would call the [registered manager] or [nominated individual] straight away or anyone else who needed to be involved i.e. police. I would document everything straight away, so I never forgot anything. I would only share information with people who need to know and always follow company policy.”

The provider did not work well with people to understand and manage risks. Risks had not always been assessed and there was a lack of clear guidance in place for staff to follow. People had some risk assessments in place, such as for choking, falls and pressures sores. However, these were generic and did not always contain person centred information. For example, people’s tissue viability risk assessments stated staff must check each pressure relieving mattress was set at the correct weight for each person. However, there was no detail within each person’s care records on what the correct setting should be. This placed people at increased risk of skin damage.

For 1 person, who had an eating and drinking plan written by a health professional, the choking risk assessment stated, ‘staff to be aware of any dietary requirements/or dysphagia and dietary levels in place’. It did not give details of the person’s eating and drinking plan and there was no reference to this within the person’s care plan. This placed people at increased risk of choking.

Where people had specific health conditions, there was a lack of risk assessments and information in care plans to guide staff on how to keep people safe. For example, for 1 person with a specific health condition there were no details regarding the actions staff should take should they become suddenly unwell. For another person supported with a specific medical device, there was no guidance or risk assessment in place to support its safe use. This lack of clear guidance meant staff providing care and treatment would not have access to important information and associated risks. The concerns we identified were discussed with the registered manager who started to address them during the assessment process. A new framework was included on the electronic care planning system which included a specific management plan for each clinical care need.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.Risks associated with the environment were assessed before the service started supporting people within their homes. This covered fire safety, electrical risks, flooring, water leaks, pets, lighting, access and alarms.

The provider did not make sure there were enough qualified and skilled staff. This placed people at risk of harm. Staff told us their ‘care runs’ were busy, and there wasn’t always time for them to have a break. They told us there were enough staff now, although there hadn’t been in the past. Staff, and the registered manager told us people had not always received support from 2 staff when necessary to provide safe care, although the service was commissioned to provide this level of staffing. The registered manager told us they were not aware of this at the time it was happening, and provided assurances that measures had now been put in place to ensure this didn’t happen again.

Staff received an induction when they first started working for the service and completed key training such as moving and handling and basic life support. Specialist training was also completed, including key topic areas such as dysphagia, dementia and motor neurone disease. However, 2 peoples care records detailed clinical tasks that had been delegated by a health professional. This included the use of a medical device to deliver medication, nutrition and fluids, non-invasive ventilation, cough assist and the use of rescue medicine. Not all staff had received the appropriate training and had their competency assessed by a health care professional. This meant people were at risk of unsafe care by untrained staff. During the assessment, the service stopped supporting the people who required support with these clinical tasks.

There were systems in place to ensure staff were recruited safely. During the assessment we received a concern that staff had started working for the provider prior to their Disclosure and Barring Service (DBS) safety check being received. Although rotas viewed did not detail this, the registered manager provided assurances that if this happened the staff member was not lone working and/or risk assessments were in place to protect people.

Some relatives reported variable visit times. They found the timings of the visits were too varied with little advance warning of changing times and some reported being given a 3-5 hour window for their visits which then would affect the spacing of the visits. Some people’s relatives told us this did impact them and their loved ones. The registered manager told us they were not aware of these concerns and where possible tried to accommodate people’s preferences. One relative told us, “I've requested a 7am call and they do come on the dot and have kept that time so that it means [relative] doesn't go for more than 12 hours’ from 7pm to 7am without being repositioned.”

Relatives described staff as knowledgeable, gentle and patient. They told us they were supported by a regular team of carers. One relative told us, “We have the same carers four times a day… it makes such a difference”.

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. One person was being supported with a clinical task that could produce small particles which stay suspended in the air and pose an increased risk of spreading infections. A risk assessment was not in place to prevent the risk of spreading infections to care staff or others.

Risks associated with the environment were assessed before the service started supporting people within their homes. This included infection control considerations.

Staff told us they had access to the personal protective equipment (PPE) they required, and people confirmed staff wore these when required. One relative told us, “They have all the PPE with gloves and aprons and the uniform and they throw the dirty gloves away here.” Staff received infection control training.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Some families administered medicines themselves. However, where staff were involved, there was not always clear guidance in place for staff to follow.

There were no protocols in place for the safe administration of medicines taken ‘as and when needed’ such as pain relief.

Where people were prescribed laxatives, there were no plans in place to guide staff on when this should be administered or when to seek medical advice.

Medicines risk assessments were not always in place. For example, people prescribed anticoagulant medicines did not have a risk assessment identifying what action staff should take if the person fell or hit their head, despite the increased risk of internal bleeding.

Where people were supported with the application of creams, body charts were not always in place and documentation did not detail where this should be applied.

This lack of clear guidance meant we could not be assured people’s medicines were administered as prescribed. The concerns we identified were discussed with the registered manager who started to address them during the assessment. Staff received training and competency checks.