Joy2care

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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

The provider carried out their own investigations when things went wrong to establish the cause and identify any actions required or learning points.

Staff told us incidents and mistakes were shared with them via email. Not all staff felt this was an effective way to share learning.

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, which included when people moved between different services.

The provider had implemented an on-call system to ensure staff always had someone they could escalate any safety concerns too. Staff were also provided with district nurse out of hours numbers. The registered manager had contacted the local NHS trust to try and improve the discharge process for people back into the community to ensure a safe continuity of care for people.

A healthcare professional told us, “Relevant information has typically been shared appropriately, allowing for informed decision-making.”

The provider did not always share concerns quickly and appropriately and did not always meet their obligations under the Mental Capacity Act (2005).

The provider had not always notified CQC when potential safeguarding concerns were identified as stated in their own policy, however they had escalated concerns to the local safeguarding team.

Staff did understand how to recognise and report potential signs of neglect or abuse.

People’s mental capacity was only briefly considered across the range of care plans and assessments we looked at. When discussed with the registered manager they stated they would look into how to document best interest decisions that they held. They advised all decisions made on behalf of people were discussed with relevant healthcare professionals, family and, if applicable, those that held lasting power of attorney.

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.

Risks associated with people’s health and wellbeing were identified and assessed. Clear guidance was in place for staff to follow and the provider worked with other agencies for risk management, for example people had the Herbert Protocol in place. (This is a a national scheme in the UK designed to help locate people living with dementia quickly and safely if they go missing).

However, we did find that some people’s risk assessments had not been reviewed or updated. Consequently, they contained conflicting information and were not consistent with people’s care plans which had been updated. This placed people at risk of not being supported safely.

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

The provider checked staff were alert to any trip hazards during unannounced spot checks to ensure staff were continually aware of any risks a person’s environment might pose.

People had environmental risk assessments of their homes in place. This was for both risks to people and staff. Concerns identified had been escalated appropriately, for example to the fire service where the risk of hoarding had been identified.

The provider did not always ensure there were sufficient numbers of suitably qualified, skilled and experienced staff deployed to meet people’s needs. Systems to support staff through supervision, training and development were not consistently effective.

Feedback from staff about their induction and management support was mixed. Some staff described their induction and support as positive, while others felt there was room for improvement. However, staff consistently spoke positively about the support they received from their colleagues.

We found not all staff had completed up-to-date training in key areas relevant to their role, such as moving and handling. The provider had recognised this shortfall and had implemented an action plan to address it promptly. Risk was mitigated as all staff had completed an induction and had regular competency assessment to ensure staff were able to deliver care safely.

People and their relatives were generally satisfied with the timing of visits. They told us they received information about scheduled calls via email and were informed of any changes. Some described the service as flexible. However, a small number of people reported occasional late visits, which they attributed to factors such as traffic.

Staff feedback regarding travel time between visits was mixed. Some staff felt insufficient travel time was allocated, which caused stress and had the potential to impact on care delivery. Based on our feedback, the provider started to monitor call times and review travel arrangements, to make adjustments where required to support the timeliness of visits.

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.

The provider conducted random checks on staff to ensure they wore appropriate personal protective equipment (PPE) in accordance with their infection, prevention and control (IPC) policy.

People told us staff wore PPE when staff supported them. A person said. “Our home is left clean and tidy…The whole process is perfect.”

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 trained in medicine administration and the provider conducted random spot checks to ensure staff administered medicines safely.

The electronic medicine administration records (eMAR) prompted staff to administer medicines and flagged to the management team any discrepancies.

People told us they felt their medicines were managed and administered safely. One person said, “They are really on it with medication.”

However, we did note there was little guidance for staff on the administration of pain patches, for example what to do if a patch fell off, or the need to ensure it was not administered on the same site within a certain time frame. We raised this with the provider and they took prompt action to ensure documentation was updated.