Jewel Home Care

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 newly registered service. This key question has been rated inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to people’s safe care and treatment, and the ways people’s medicines were managed safely.

This service scored 34 (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. Staff did not listen to concerns about safety and did not always investigate and report safety events. Lessons were not learnt to continually identify and embed good practice.

People did not receive care from a service which consistently learnt lessons and improved outcomes. A relative said, “I can speak to the manager but nothing get’s done.”

We reviewed 3 complaints records during the assessment and identified that 1 did not have any outcome of the actions taken to improve the safety and quality of care, and 1 which only described the actions the provider should take, as opposed to the actions which had been taken and the improvements this promoted.

During the inspection, we identified a range of significant concerns relating to people’s safety and the quality of care being delivered. We raised these concerns with the provider, to give them the opportunity to immediately take steps to improve the areas of concerns, however the provider’s response failed to assure us the concerns had been adequately and robustly addressed in a timely manner.

Staff understood how to record incidents and accidents which had occurred within people’s homes, and advised their log created an alert which went to the registered manager.

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

The provider had a contract with the local authority, and significant concerns had been raised around the quality and safety of care which was being delivered to people. The provider acknowledged there had been shortfalls in their referral and assessment processes. People’s needs had not been fully understood, care plans had not been reviewed, and risks had not been escalated as required.

Records held by the provider failed to demonstrate there was adequate information for robust continuity of care, including when people moved between different services. This included when people were admitted to hospital due to their health conditions having deteriorated. The provider failed to maintain comprehensive records of the care and support provided by staff and the provider’s processes had not regularly monitored information to make sure risks to people were correctly recorded and managed to keep people safe.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not 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 share concerns quickly and appropriately.

People did not receive care which protected them from the risk of harm or injury. One person explained, “A recent incident was that I got cut underneath my stomach. This happened because the carer had long artificial nails. I told the agency about this and they asked [Staff] to bring [Staff] nails down. But [Staff] was still rough and after I told the agency, I never saw [Staff] again.”

Relatives also raised concerns about the safety of the service. A relative stated, “[Family member] lives with us, and I wouldn’t trust [staff] to look after them if they lived on their own.”

Another relative told us, “[Staff] don’t always do what they are supposed to, and you have to tell them what to do. If I don’t keep an eye on them, they will be doing something else.”

We also identified a staff member, who we were advised had been dismissed due to safeguarding concerns prior to this inspection, to still be attending care visits at people’s houses. We raised this with the registered manager, who advised the rotas were created in error. This showed a significant lack of safeguarding processes within the service, and placed people at increased risk of harm and abuse.

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

People did not receive safe care which met their needs and protected them from the risk of injury or accident.

During the inspection, we identified staff were undertaking manual assistance with continence care for a person without the required level of training, and their competency had not been adequately assessed. This placed the person at a significantly increased risk of infection and injury. This was raised immediately with the provider and stakeholders, who moved the person to an alternative care agency.

Risks associated with mobility were not always adequately managed. One relative told us, “[Staff] don’t leave [family member’s] walking frame within reach.” This placed the person at increased likelihood of falls. Other people who were at risk of falls and took blood thinning medication did not always have risk assessments and guidance in place for staff to follow in the event the person had a fall.

Risks associated with catheter and stoma care had not been adequately assessed, recorded and care planned to ensure staff had guidance to support them to deliver this care safely. We did find 1 stoma care plan which had more detail; however, it failed to identify key information such as who was ultimately responsible for the management of the person’s stoma.

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

People who received support from Jewel Home Care, lived in their own houses and flats, and were responsible for the upkeep and maintenance of their own accommodation.

The provider completed assessments of people’s environments upon commencing the package of care to ensure the environment was safe for staff to work in. Staff understood how to raise a concern, should there be a change in the suitability of the person’s home environment.

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.

Feedback from people was poor regarding staff training, with 1 person explaining, “Some of [the staff] are not so well trained – sometimes they don’t know what they are doing.”

Staff training was identified as a significant concern. The staff training matrix showed some staff had completed large amounts of training on the same day. For example, 13 different training sessions had been completed in one day for some staff. On the same day, staff had also read and understood 18 detailed policies issued by the provider. Another staff member had been signed off as having completed the Care Certificate, which is a complement of 16 nationally recognised standards and behaviours all care staff should complete to demonstrate they have the required skills and knowledge to work in the care sector. Upon review of the training content of the staff member’s record, this showed the training which had been recorded as the Care Certificate, was an online day course, the contents of which did not align with the 16 standards. This meant the provider could not demonstrate all staff had been trained to a sufficient standard to be able to deliver safe and competent care, which increased the risk of potential harm to people using the service.

We also identified a number of staff had not been recruited safely by the provider, particularly around background checks and training. One staff member had references on their staff file which did not relate to their employment history which meant we could not be assured as the validity of the references. Another staff member had worked for another care provider in the UK, however, the provider had not contacted them to seek a reference and to ensure there had been no safeguarding concerns raised during their employment. We received information of concern to advise a member of staff had been dismissed from their previous role, and upon checking the staff members file, identified the provider had not sought a reference from their previous employer and was unaware they had been dismissed. We also identified the provider was using references staff had brought with them when they commenced employment, as opposed to applying for their own references to ensure the accuracy of the information. This meant the provider could not demonstrate they had recruited staff safely and this placed people at risk of receiving care and support from staff who may be unsuitable.

Following the inspection, the provider sent us an action plan describing the actions they would take to ensure staff were safely recruited and trained moving forward.

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.

Feedback was mixed regarding staff understanding and actions to prevent and control the spread of infection. One relative explained, “[Staff] very rarely change the bed when it’s been soiled. I’ve complained and even taken photographs of the bed.” This placed the person and those who they lived with, at an increased risk of infection and contamination.

Staff understood the purpose of Personal Protective Equipment (PPE), and people told us staff usually wore gloves and aprons. Staff told us what steps they would take in the event on an outbreak of an infection.

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

People did not always receive their medicines as prescribed, particularly creams. We identified examples of prescribed creams being recorded as applied by staff within the person’s daily notes, however, these were not recorded on a Medicine Administration Record (MAR) chart, or on a Topical Medicine Administration Record (TMAR). One person was having a cream applied by staff which was not on their MAR charts, and the cream which was recorded as being required to be applied by staff, was not.

We identified a person’s medicine care plan stated staff should ‘leave [person’s] tablet out for lunch’. The person had a diagnosis of dementia, which meant they could not reliably remember to take the tablet at lunch time without staff promoting. This increased the risk of the person missing doses of their prescribed medicine. This had not been identified as a risk by the provider, and no actions had been put in place to escalate this or reduce the likelihood of them missing doses of prescribed medicine.

Where people took high risk medicines, such as anticoagulant medicine, risk assessments had not been completed by the provider. This placed people at increased risk of harm, particularly internal bleeding following a fall, as staff did not have clear guidance to follow to reduce the risks whilst taking this type of medicine.

The provider’s systems and processes for medicines lacked oversight. The registered manager told inspectors they were responsible for all medicines oversight and regularly completed audits, however the issues we found had not been identified by the registered manager in their audits.

One person had also received a full audit completed on medicines and creams, despite nothing being recorded on the provider’s system as being prescribed to them.