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. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

The service was previously in breach of legal regulation in relation to people’s safe care and treatment. The provider had made sufficient improvements and is no longer in breach of this regulation.

This service scored 72 (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 demonstrated a proactive and positive approach to managing complaints. Staff actively listened to concerns related to safety and followed an internal investigation process. Outcomes and lessons learned from incidents and complaints were documented and used to inform improvements in practice.

When an investigation did take place, processes were in place to ensure staff learned from their mistakes to reduce the risk to people’s ongoing safety. This conclusion was then shared with staff and relevant people to demonstrate changes that had been implemented.

Adopting a positive learning culture meant when things did not go well, they were reviewed by the management team and actions put in place to avoid the issue recurring, this therefore improved people’s safety.

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 kept records to show that care plans and risk assessments were in place and updated when people's needs changed. This was supported by evidence which showed us where individual’s care records had been audited.

We saw evidence of communication between the management and care staff team and other health care professionals to ensure continuity of care.

We reviewed documents that evidenced the provider had worked with people’s GP’s, pharmacists, social workers and other professionals alongside people and their families.

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 provider shared concerns quickly and appropriately.

There was a safeguarding policy in place which staff had access to which detailed types of abuse and provided timescales for care staff to inform the manager, and the responsibilities for reporting safeguarding concerns.

Staff had received safeguarding training and demonstrated an understand of safeguarding and their role within the process.

People told us that they had raised safeguarding concerns with the provider or other professionals. One family member told us, “[They] had a few unexplained bruises. Perhaps by knocking on the rails. Some of the safeguarding concerns were attended to.” The provider had a safeguarding log where concerns were noted, investigated and responded to in an appropriate and timely manner.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

The provider had risk assessments in place to address identified risks to people and plans were developed to inform staff how to address these. We saw evidence where people and/or their relatives were involved in developing risk assessments and care plans.

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 registered manager informed us that risk assessments of people’s homes were conducted prior to the commencement of the care package. This process was undertaken to ensure that the environment was safe for staff members, but also to ensure people were in safe home environments.

We saw that care plans and assessments contained information which evidenced the safety of people’s home environments were considered and measures put in place to support people to live in a safe environment.

Where incidents and accidents had happened in people’s own homes, we saw an analysis, followed by recommendations on how to prevent this happening again, such as recommendations to remove rugs to prevent falls.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

We reviewed staff files, training records, induction documents and supervision information. We found the provider followed safe recruitment processes and staff received ongoing training and support which ensured people received support from suitably skilled and experienced staff. Evidence of Disclosure and Barring Service (DBS) checks were in place. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People told us that they find staff did not always communicate in English which could be confusing to those receiving support. One person told us, “They talk in [a language other than English] and I told them to stop doing it. I reported it to the manager who apologised.”

People told us there were sufficient staff to meet their needs, however, they did raise that there was often inconsistency with staff that supported them. People also told us that call times varied, and people did not often say the full allocated time. We reviewed information from the provider that showed in some situations, staff had not attended in line with the rota and actions had not been put into place to rectify this. People told us staff regularly arrived late for visits by more than 30 minutes and occasionally longer by an hour to two hours.

One person told us “The [staff] are coming later than (expected) visit times. Normally they ring or the office calls to say they’re going to be late. Once no carer came and we weren’t charged.” Another person told us they had to raise a concern that staff were “Coming early at 7.00pm to put [them] to bed and switching off the T.V. Or coming at 11.00am to give [them] dinner. That’s not wanted. It was sorted out through the social worker. That was about six weeks ago.”

It was also raised that staff turnover was high. This, alongside inconsistent members of staff meant that people were unable to build a trusting relationship with care staff.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff members were trained in medicines awareness, with their competencies re-assessed. People had detailed care plans in place. We reviewed care plans where people self-medicated which were also detailed on how the person managed to take and order their medicines.

We reviewed electronic medicine administration records which showed the time that medicines were administered, who by and the method of administration.

Additionally, medicine audits were carried out by management to ensure compliance and address any concerns.

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 times between doses. They detailed special instructions and possible side effects.

Feedback from one relative told us, “[Staff] prompted [them] with the medication… [Staff] got it all down and recorded. No, never missed any. When doses of medicines change then I let the office know and [staff] are informed.”