Gemcare South West Plymouth

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 service at its new office location. 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.

The service was in breach of legal regulations in relation to people’s safe care and treatment, medicines, staffing, governance at the service and notifications.Complaints and concerns were not always listened to or action taken to drive improvements. The service had safeguarding policies and procedures available for staff and leaders but these were not always followed when a safeguarding incident occurred. People did not always have risk assessments to guide safe practice. The provider did not make sure there were enough suitable, skilled and experienced staff. Staff did not always manage medicines safely.

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 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.

Some people told us they had raised safety concerns with the service but these had not been listened to or addressed. Comments included, “Things are ok for a couple of days and then back to normal” and “Some staff stay as long as they should and some don’t, I have told the office but it doesn’t seem to go anywhere.” Other people told us they had no complaints and felt able to speak with the office.

Some staff felt able to raise safety concerns, but others did not. “I try not to have too much to do with the office if I can help it but I do feel when I have raised concerns, action has not always been taken” and “We just do not get the travel factored in and we do raise it in team meetings.”

We did not receive any feedback from other professionals.

The service sent us conflicting information around complaints. This meant we were not assured concerns about safety were reported, investigated, and lessons learned

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

The provider had a good relationship with the local authority team and discussed referrals. Staff visited people before their care started so they could carry out an assessment and ensure they could meet the person’s needs.

One person told us, “I’ve got an alarm and once when I rang the carer stayed with me until the paramedics arrived.”

We did not receive any feedback from professionals about the service.

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.

Most people told us they felt safe with the care they received. One person told us, “I feel very safe with my carers.” Another person commented, “Most of the time but not all of the time. I felt nervous, I didn’t feel as comfortable with them.” One person told us there were 2 particular staff members who made them feel uncomfortable.

Staff had the skills and knowledge to raise concerns about abuse or neglect. All staff we spoke with demonstrated an understanding of safeguarding adults. One member of staff told us, “I would report it instantly if I witnessed abuse or had any safety concerns and we have safeguarding training and information.” However, we were not assured staff’s safety concerns would be listened to.

The provider had safeguarding policies and procedures available for staff and leaders, but these were not always followed when a safeguarding incident occurred. We were told there had been 1 safeguarding incident in the past 12 months. The service had not informed the CQC of the incident as they are legally required to do and a statutory notification had not been sent, without delay, as required

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.

Staff were not always given enough information so they could provide safe and appropriate care to people as risk assessments were not robust. For example, 1 person’s care plan stated they had a catheter. The care plan did not give staff information on how to manage this or what potential issues to look for.

Another person’s care plan stated there was an overall significant risk due to insulin-controlled diabetes. There was no further information so staff would know the risks this presented, for example low blood sugars and what to do if this should occur.

This placed people at risk as staff did not have information on how to safely manage catheter care and diabetes.

However, some staff felt they had the information they needed. When people had regular staff who knew them they felt staff could manage risks. One person said, “They are well trained and if I have a seizure they know what to do for me.” However, when new staff, who may not be able to recognise and respond to risk, visited people there was a potential risk to people’s safety.

The provider detected and controlled potential risks in the people’s home environment where care was delivered.

The service carried out environmental risk assessments for each person they supported. These identified potential risks in people’s home and how to manage them. The regional operations manager told us they had a good relationship with the local fire service who would visit people’s homes to assess risks and improve safety.

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.

During our inspection, the provider did not have enough staff and sent 1 staff member to visits where 2 staff were needed to help ensure safe care. This placed people and the staff member at risk of potential harm.

Visit rotas showed staff had not always been provided travel time in between calls. This was impacting on the length of time staff stayed at the call. Some visit times overlapped, meaning staff had been allocated 2 visits at the same time. People told us staff were frequently not staying for the full length of the call which they told us impacted them as staff were rushing their care. People commented, “They rush me and don’t do what needs to be done”, “Sometimes there’s not enough time to dress me. I’m sat there in my nightie” and “I’ve missed my activities because it’s been too late for me to have a shower.” Staff told us there were not enough staff and not enough travel time between visits.

The service told us new staff were required to complete all online training before shadowing experienced staff in the community. We found instances where care staff were undertaking care tasks when they were not trained or assessed as competent. For example, in relation to moving and handling (using a hoist), catheter care, dementia, and supporting people who were non-verbal. This placed people at risk of unsafe care.One staff member described how new starters had been out with them on their first visit run to deliver care to people who needed 2 staff. They said, “It’s incredibly difficult for myself to be doing everything while either explaining what I'm doing to watching them do it,but the new starter themselves is thrown right in the deep end.”

Some staff told us they were happy with the training. One commented, “We do training regularly (face to face and online) and the topics covered are up to date and very practical and useful.” Others felt more training was needed. One staff member said, “Think that a bit more on the job training could be beneficial.” The in-house trainer was delivering face to face training during our visit to the office. The service told us staff had completed the Oliver McGowan level 2 training on Learning Disability and Autism.

The service did not have any professional references as part of their recruitment process, for 1 staff member. The regional operations manager told us they would be out with someone really experienced. However, we found this staff member was out with a staff member who was on their second day of employment. The service had not followed processes for new staff and this placed people at risk of potential harm of receiving care from staff who were not suitable for working in the care sector

The provider assessed and managed the risk of infection.

Staff followed guidelines for infection control to keep people safe and healthy. People told us staff wore personal protective equipment (PPE) appropriately during their care visits.

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

We found staff had been administering medicines to 1 person but this had not been added to their care plan which stated they were still self-administering their medicines. The provider had completed a person specific audit but had not identified this. We found a new staff member had visited people and administered their medicines before they had been assessed as competent. This placed people at risk.

However, other staff told us they had completed medicines training and felt the information on the electronic app was accurate.

People told us they were happy with the way their medicines were managed.