Better Care & Support 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 service under this registration. 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 regulation in relation to people’s safe care and treatment and good governance at the service.

This service scored 53 (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. Lessons were not always learnt to continually identify and embed good practice.

Incidents, accidents and complaints were not always documented which meant the provider could not be assured they had identified patterns, learnt where things went wrong and taken appropriate action to mitigate risk to people. This meant people were at risk of reoccurrence of harm or poor quality of care.

All staff were clear about how to report concerns. Staff had confidence the provider would address any concerns and make improvements. One staff member told us, “I am able to share my views and feel they are listened to and valued.” However, records evidenced that concerns had not been thoroughly investigated and shared with the correct stakeholders such as the local authority safeguarding team. When an investigation did take place following an allegation, formal processes were not in place to ensure staff learned from their mistakes to reduce the risk to people’s ongoing safety. This meant the provider did not always have an effective learning culture.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

The provider did not always document assessments following people’s discharge from hospital. The provider shared information via an electronic staff messaging system when there were changes to people’s care needs. However, people’s care plans and risk assessments were not always updated to reflect these changes. This meant staff were not provided with clear written guidance to follow regarding peoples care and support needs. This meant, people were at increased risk of harm. We raised this with the provider, and they assured us they would review all care plans to ensure they were accurate.

The provider did not always ensure they requested relevant information from healthcare partners to enable them to provide people with the appropriate care. For example, one person’s care plan stated that they required repositioning every 2 hours; however, there was no evidence of this being directed by an appropriate health care professional. This meant the person was at risk of developing further skin damage and risk of harm.

Processes in place did not always ensure risks to people were monitored and managed safely. This involved not sharing information or requesting support from relevant external agencies to ensure best practice was followed. For example, we found one person with skin damage, however there was no care plan in place, and the provider or care staff were unable to explain what type of skin damage and where on the body this was and if care and support was required by staff. There was no evidence or documentation from relevant health care professionals with details on how the skin damage should be managed. The lack of risk assessments meant staff had no guidance to ensure they could support people safely. This placed people at risk of harm.

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 registered manager and staff were able to demonstrate an understanding of abuse and safeguarding concerns; however, the provider did not always share safeguarding incidents with relevant others such as health professionals to minimise further risks of harm or abuse.

Documenting and recording safeguarding concerns was not thorough and effective. The registered manager did not take appropriate actions to contact the local authority safeguarding team. This meant people were left vulnerable and were at risk of ongoing harm. For example, we found a person to have significant skin damage, however we found no evidence of this within any of the provider records. Due to the lack of recorded information, we were not assured that this had been reviewed and analysed or reported to the local safeguarding team,

People were supported by staff who were committed to keeping them safe and were aware of how to escalate concerns.

Staff were able to demonstrate an understanding on the Mental Capacity Act 2005 (MCA); however, there was limited documentation in place to show the MCA had been considered when care plans and risk assessments were formed. This presented a risk of unlawful care and support being provided that did not reflect people’s wishes and best interests.

The provider did not always work well with people to understand and manage risks. Lessons were not always learnt to continually identify and embed good practice.

Care plans and risk assessments did not always reflect the risks to people’s health and safety. This meant staff did not always have sufficient guidance to provide safe and effective care. For example, we found people did not always have care plans and risk assessment in place relating to skin integrity, diabetes and mobility. This meant people were at risk of harm of not receiving safe care to manage their known risks. People were not provided with opportunities to be involved in discussions about how they wanted their care to reduce and manage the risks to their safety.

Daily logs of the care tasks completed by staff showed elements of care were being provided; however, due to the lack of detailed records, we were not assured staff provided all care and support that people needed. This meant people were at risk of receiving incorrect care, placing them at risk of harm.

The provider did not always detect and control potential risks in the care environment.

There was a lone working policy in place as well as an Environmental Risk Assessment Policy and procedure which stated risk assessment of people’s homes should be completed before care started. Records showed these had not been completed placing both staff and people at risk of harm.

Staff understood their responsibility to support people to maintain a safe environment. However, the provider failed to carry out regular environmental risk assessments of people’s homes and the equipment in use. For example, moving and handling equipment had not been regularly checked to ensure the home environment and the equipment used during the delivery of personal care was safe and fit for purpose. This meant people were at risk of harm due to the possible use of faulty equipment.

The provider had not always ensured there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked well together to provide safe care and support that met people’s individual needs.

Staff had not alwaysbeen recruited safely. We found the provider had not followed their recruitment procedures. The recruitment policy stated that 2 references should be sourced; however, staff files reviewed showed only 1 reference was being requested. This meant the policy had not been followed and robust recruitment process had not been carried out. Evidence of people's right to work in the UK were not in staff files. This placed people at increased risk of receiving care from inappropriate staff. This was raised with the provider and rectified immediately.

Records provided showed that staff had not received training on diabetes and Parkinson’s disease. This was raised with the provider who told us that they would arrange training, to improve staff understanding. This would reduce the risk to people health and safety.

Evidence of Disclosure and Barring Service (DBS) checks were in place. DBS checks provided information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People told us there were sufficient staff to meet their needs and people did not feel rushed when staff were supporting them with care. People told us staff were knowledgeable and provided them with good quality care that met their needs.

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.

There was an Infection Control policy in place. Staff had also received training regarding infection control. This meant staff had guidance in place on how to manage infection risk and reduce the spread of infectious diseases.

However, one person we spoke with told us that staff did not wear masks when they were asked to by family. This meant there was a risk of spreading infection at this time.

Other people and staff told us that Personal Protective Equipment (PPE) was available, used and disposed of appropriately.

The provider did not always make sure that medicines and treatments were documented, detailing people’s needs, capacities and preferences. We saw evidence that staff had completed medicines training.

We reviewed electronic medicine administration records which showed the time that medicines were administered. We found some instances, where two staff members had signed to say they had administered the same medicines. This could imply that too much medicine had been given. Additionally, we found on some care calls where two care staff were present, both care staff had recorded administering different medicines. This meant people were at risk of missing or over administering medicines due to multiple care staff administering medicines at the same time.

Care plans did not contain information regarding medicines, including what the medicine was for, when it should be taken or possible side effects. This meant care staff did not have details on what to look for when administering medicines.

Protocols were in place for the administration of PRN (as and when) medicines. These had review dates, dose and frequency of the medicine, as well as minimum time between doses. They detailed special instructions and possible side effects.

People we spoke with told us that they had confidence in care staff who supported them with medicines; however, there was an increased risk to those who did not have capacity to make such decisions and observations.