Choices Care Ltd (Birmingham)

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.

This service scored 75 (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.

People were supported by staff who were aware of the risks to them and the actions they should take in response to any accidents or incidents. Where these events took place, they were acted on and reported in a timely manner. Following these events, meetings took place with the person affected to ensure the actions taken were appropriate and if there were any further arrangements that needed to be made. For example, following an incident regarding a key safe, lessons were learnt and additional checks and balances were put in place to reduce the risk of re-occurrence.

Staff explained that keeping people safe was a priority, giving examples of how they checked people’s living environment to ensure they were safe in their homes before leaving each call. A member of staff told us, “We always discuss situations at staff meetings every month - everyone can share information.”

People told us that if there were any changes in their care needs, the service was responsive and acted on these immediately and ensured all staff who supported them were aware of the changes.

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.

Information regarding people’s needs was shared through handovers, electronic records and staff meetings. We noted systems were in place to support people to safely transition to new services where appropriate.

People were supported by a consistent group of staff, maintaining continuity of care. Staff advised they were kept up to date when it came to any changes in people’s needs. There was a clear emphasis on team-work and monthly staff meetings took place enabling staff to share information. For example, a member of staff explained that during a staff meeting, a discussion took place regarding a person who had a poor appetite. Staff collectively discussed the person’s particular food preferences and suggestions were made to try alternatives, in-order to encourage the person to eat.

People told us any changes in their care needs were noted and acted upon and relatives commented positively on how proactive staff were noticing the need to work with other healthcare partners.

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.

People told us they felt safe when supported by care staff. People’s relatives told us how reassured they were knowing their loved ones were safe and cared for in their absence. A relative told us, “[Person] is very safe, we never have any concerns when the staff are there.” One person told us, “I feel very safe with them [care staff].”

People were supported by staff who had received training in how to recognise signs of abuse. Staff were aware of the types of abuse people may be exposed to and the actions they should take, if they had concerns. Although no members of care staff spoken with had had to raise a safeguarding concern, they provided many examples of the circumstances in which they would do this. All staff told us if they had any concerns, they would raise them with a member of the management team and were confident they would be listened to.

Where safeguarding concerns had been raised, they had been responded to and acted on appropriately.

Staff had received training in the Mental Capacity Act and had a good understanding of what this meant when supporting people. Staff were mindful that people they supported had the capacity to make their own decisions and gave people the opportunity to make their own choices, as part of their daily living.

The provider ensured systems were in place to support staff to work well with people to understand and manage risks. Information was not consistently and easily accessible to staff to ensure they were provided with a clear and easily-accessible written information and guidance on how to safely meet people’s needs.

Staff demonstrated a good understanding of the risks associated with the people they supported and how to manage these effectively. However, information relating to risk management was not always consistently recorded and care records reviewed were difficult to navigate, making it challenging to locate key information needed to support people safely. Despite this, staff spoken with were knowledgeable about the risks to people, including catheter care risks and how to manage them. Relatives also reported that the catheter care their loved ones received was good and raised no concerns.

Following our discussion, the registered manager initiated a review of the existing documentation to improve its clarity and ensure information was more accessible for staff.

People’s care records were reviewed at least every 3 months, or sooner where their needs changed, to ensure their care remained responsive and up to date. People confirmed they were involved in these reviews and 1 person added, “Staff are always encouraging me.” They went on to describe how with the assistance of staff and their encouragement, they had been able to manage the risks to them and reduce their package of care. They told us, “They [care staff] always say at the end of the call if you deteriorate or need more help we will come and reassess you.”

The registered manager commented on their approach to the management of risk and the ensuring people were supported by a consistent group of staff who they trusted and who they felt comfortable with. They said, “When there is a consistent group of staff, they know if something is wrong or out of character.”

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 reported they felt safe in their own homes when supported by staff. Staff were mindful of the need to ensure people’s living environment was safe and clutter free, respecting people’s choices but being mindful of the need to ensure they left them in a safe living environment when they finished their call. One person told us, “They always check my phone is near me before they leave and that I can reach it.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People told us they considered staff to be well-trained and they had no concerns regarding staff’s abilities to support them and/or their loved ones safely and effectively. People reported they never had missed calls and staff were always on time and stayed for the correct length of the call. On the rare occasion that staff may be running late for a call, people told us they received a phone call to advise them of this. One relative told us, “When it was snowing one day in January and there was a snowstorm, the office rang to ask if staff cold leave the call a little earlier so that they could get home safely. Of course, we were fine with that and agreed.”

A live call monitoring system enabled management to maintain oversight of calls and take prompt action where concerns were identified, such as delays in call delivery.

People were supported by a consistent group of staff who knew them well. People commented on the fact they had been supported by the same group of staff for a number of years. A relative told us, “It’s the same staff all the time, very rare someone new, always the same girls and they know [person] really well.” All people spoken with raised the point that if a new member of staff did come out to support them, they were introduced and supported by a senior, experienced member of staff at the same time.

One relative told us, “I feel the staff are well trained, and [person] is safe with them. They always ask for feedback when I speak to the manager, and they email us as well. You can always ring up and get hold of someone.”

Safe and effective recruitment processes were in place. Staff received regular supervision and the regular spot checks of staff practice took place to assure the provider that staff were supporting people in line with their training and their care needs. The registered manager told us, “After training, we call new staff back into the office and tell them about the person they will support, show them the care plan and explain everything. We always send them with a senior carer who knows the client.” A member of care staff also confirmed this adding, “We also discuss everything monthly about clients and we talk with family members as well.”

Staff told us they felt well trained and were given the opportunity to develop their learning further, being supported to access National Vocational Qualifications.

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.

People reported staff wore personal protective equipment (PPE) when they supported them and changed it, as appropriate, throughout the call. One person told us, “Staff always wear gloves, aprons, masks and always wear their uniform.”

Staff confirmed they had access to a plentiful supply of PPE and had received training in infection control.

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.

Those people who were supported with their medication reported they had no concerns. A relative said, “[Person] is given their medication and support with personal care; staff know them really well and have cared for [person] for a long time.”

Staff had received training in how to administer medication and were provided with clear information regarding people’s medication. Medication audits were in place to identify any potential errors and staff competency checks took place on a regular basis.

The provider had invested in an electronic medication recording system which provided them with accurate information in real time. This meant any potential concerns regarding medication could be picked up quickly and dealt with immediately, reducing the risk to people. The registered manager told us, “Previously the MAR charts [medication administration records] would be picked up on a weekly basis [for auditing]. Now everything is listed [electronically] and we can see if medication has been given or refused in real time.”