Farecare Gloucestershire 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. At our last assessment we rated this key question Inadequate. 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.

This service scored 56 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The manager was in the process of developing a new system to follow when an accident or incident occurred. This was due to inconsistencies of recording and monitoring incidents and accidents. The manager was working to address these; however further time was needed to embed these new practices.

At the time of the assessment, we could not find any person had come to harm because of missed communication following an incident, however improvements were needed to how incidents were documented in care records.

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.

We saw evidence the manager had assessed people’s needs before they started with the service. Pre-assessments were comprehensive and completed to a good standard. We saw evidence the manager and senior staff had close communication with external health professionals and involved them when people’s needs changed.

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. They did not always 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 always share concerns quickly and appropriately.

At the time of the assessment the manager had recently begun to monitor accidents and incidents. Further time was needed to embed these processes, however the information collected was allowing the manager to identify themes and trends which could be used to highlight areas for improvement. The manager was also working on implementing new systems and processes to ensure people received extra support to prevent further accidents. However, we found the manager was not completing mental capacity assessments. This meant people did not have their capacity assessed appropriately which increased the risk of unsafe decision making.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

While improvements had been made since the last inspection, notably when supporting people with risks relating to oxygen therapy and diabetes, we found care records were not person-centred. The manager had considerable information in the care records about peoples identified risks, however the information was generic, not tailored to the person and written in a way which was not appropriate. For example, people’s records did not always correspond with their actual needs. One person was receiving support from 2 staff members, but their care records did not state this. Another person had a medical condition affecting their shoulder, but the care records did not specify which shoulder was affected.

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

We found environmental risk assessments were inconsistent. One person had a very detailed plan in place which clearly indicated the risks to their home. Another person’s fire risk assessment stated they could in the event of a fire evacuate from either their front or back door but failed to identify they were immobile.

The provider did not always 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 always work together well to provide safe care that met people’s individual needs.

We found there was enough staff working at the service to ensure care was delivered in a timely way. Since our last inspection improvements had been made to staff training, and staff now had face to face moving and handling training before beginning their shadow shifts. The manager had implemented a training matrix which allowed them to have sufficient oversight of training. We found spot checks were being done and recorded on the training matrix. However, we found some inconsistencies with how staff recruitment files were being stored. We reviewed 2 people’s recruitment files and found missing application forms; missing references and the provider had not seen original copies of staff Disclosure and Barring Service (DBS) checks. A DBS check is a legal requirement for employers to check if a person has a criminal record which enables providers to make safe recruitment decisions. We found the provider was not receiving 2 references in line with their own recruitment policy, this was a continuation of the breach identified at their previous inspection. After our on-site assessment, the provider shared with us an updated policy on references.

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.

There were sufficient supplies of PPE, staff were aware of their responsibilities around infection control, and we received positive feedback from people and relatives. However, some staff we spoke to were not aware of certain infection control policies and procedures which had been implemented by the provider. For example, staff were seen wearing long false nails. Artificial nails are more likely to harbour germs and pathogens and can interfere with thorough handwashing and the effective application of alcohol-based hand rubs.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Staff were able to explain the process of medicines management in the service, and we saw evidence of a policy underpinning good practice for staff involved in medicines administration. There were separate policies and protocols for specialist management of prescribed medicines such as oxygen. People were given their medicines as prescribed in most cases, and there were PRN protocols in place for relevant medicines. When medicines were not given reasons were recorded and advice sought. Medication care plans were completed well and personalised for people. Staff training was completed for carers to support people with medicines and for managers to support carers. Body maps for topical medicines were in place. Whilst there were mention of instructions to keep flammable creams away from fire or flames, there were formal risk assessments missing; however, the manager assured us these would be completed. We saw evidence this had been actioned.