Desire Care - Burton

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 remained 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.

This service scored 59 (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 learning culture, and improvements were needed to ensure effective systems were in place to support a culture of learning and continuous improvement.

Whilst the provider demonstrated an awareness of individual incidents and actions had been taken, the provider did not demonstrate analysis of themes and trends and actions taken to reduce the risks of these incidents happening again. The lack of a structured approach to auditing meant that opportunities for improvement and learning were not always identified or consistently shared and embedded in practice.

People and relatives we spoke with told us they felt able to raise concerns and they would be listened to. One person told us, “If I needed to say anything, I’d feel comfortable doing so.” While another person told us, “They listen to me and respond to concerns."

The provider worked well with people and healthcare partners to deliver care; however, systems to support this were not always effective. This meant people’s safety was not always managed or monitored effectively.

The provider’s systems were not always effective in supporting the provider to keep people’s care documentation up to date in a timely manner. This meant staff did not always have up-to-date information to refer to around people’s care needs and any changes to them.

People we spoke to told us they were happy with the care and how staff supported them with their needs. A relative told us, “The care plan has been changed as [person’s name] health has changed. The manager called a couple of time to see if the care was okay for us.”

Staff told us they knew people’s needs and were updated when there was a change, although there was also mixed feedback from staff on how these changes were communicated and the clarity. One staff member told us, “I’m kept up to date with the help of support and care plans, messages from the office, team meetings, shift handovers, asking questions if anything is unclearand also reading daily notes before starting work.” Another staff member told us, “Communication can sometimes be improved, particularly around scheduling and updates.”

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 with staff. One person told us, “They look after me, they make sure I am safe” while a relative told us, “[Person] is definitely safe; I have watched the carers with [person]. [They are] very gentle and patient, [person] looks forward to seeing them.”

The provider raised concerns appropriately to the safeguarding team at the local authority, records were maintained as well as notifying CQC, in line with requirements, of any events that could affect people’s safety.

Staff understood what safeguarding meant, had appropriate training and raised any concerns to management. Staff told us they felt confident in management taking appropriate actions. A staff member told us, “I have completed safeguarding training as part of my role, which covers how to recognise signs of abuse or neglect, how to report concerns, and the importance of keeping people safe.”

The provider worked with people to understand and manage risks; however, recording systems were not always effective in ensuring that accurate and up-to-date information was available to staff. This meant there was a risk of care not always being consistently delivered in a way that was safe, responsive to individual needs, and supported people to achieve outcomes that mattered to them.

The provider had not always identified risks associated with people’s health conditions; therefore, this was not always care-planned effectively to reduce risks and ensure staff had relevant and up-to-date information to be able to support people. For example, we found a lack of information in 1 person’s care folder to support staff around their health conditions. This meant the person could have been at risk if staff were not able to identify signs and symptoms associated with conditions to swiftly escalate this to appropriate health professionals. Additionally, further health conditions had not been identified and care planned for and this meant there was a lack of information for care staff to refer to and to guide them when they provided care. However, during the inspection we did not identify anyone who had come to harm.

Despite this, people felt staff responded appropriately and contacted appropriate health professionals when there were concerns, such as during an emergency situation.

Staff told us how they would follow people’s care and support plans to reduce the risks to people and maintain their safety.

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 ensured staff completed their moving and handling training and their training matrix reflected staff had received this training. The provider considered equipment people had in their properties as well as an awareness of people’s security in their own homes.

People and relatives told us they felt safe with staff using equipment to support them. One person told us, “I feel safe with these carers, they are well trained know how to hoist me, I feel comfortable with them.” A relative commented, “They use the hoist confidently and know what they’re doing.

The provider’s systems were not robust enough to demonstrate staff training compliance or ensure consistency in safe staff recruitment processes.

Although the provider had made improvements in relation to their staff training systems and supervisions, systems were not always effective to support the provider to easily monitor staff compliance.

One staff member requested a specific training to support with the care of 1 of the people in the service, although this had been completed, there was a significant amount of time between the request for the training and the completion of this, and their completion of the training had not been clearly documented in the staff member’s file. However, we did not identify any harm having come to the person or staff member because of this delay.

People told us they felt safe with staff. They said staff appeared appropriately trained and there were enough staff to meet their needs, with staff usually arriving at the expected times. One person told us, “They [staff] seem very competent and confident, so yes, I believe they are well trained.”

Staff confirmed they felt confident in supporting people with their training.

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 promoted infection control practices through training and provision of Personal Protective Equipment (PPE) while in people’s homes.

People’s care documentation contained information about care staff wearing PPE and one person commented, “[Staff] always wear their PPE and dispose it before they leave so they are not spreading infection."

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

The provider’s systems have not always been effective in ensuring people’s safety was promoted around their medicines. For example, some people who were prescribed emollient creams did not have a risk assessment to ensure staff were aware of the fire safety risks associated with the use of the creams. The provider was responsive and completed the risk assessments as necessary following our feedback.

We also noted some inconsistencies in updating people’s care plans in relation to guidance for applying creams and in their Medication Administration Records. For example, 1 person’s topical cream had not been added to all their relevant care documentation. This meant the person was at risk of not having the cream applied at the right frequencies. The provider was responsive and this was amended following our feedback.

People told us they felt well supported with their medicines. One person told us, “They [Staff] do my medication every day and there’s no problem with that.”

Records demonstrated and staff confirmed they received their medicines training as well as regular competency checks.