Bosun Care Limited

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 of the provider’s previous registered location, we rated this key question good. At this assessment the rating has changed to requires improvement for the assessment of the provider’s homecare service. 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 the management of people’s medicines and the recruitment of staff.

This service scored 56 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Although staff reported a positive learning culture in the homecare care service and felt updated on changes to people’s needs and support requirements after incidents, these updates were not always recorded.

There was limited evidence of these debrief conversation or sharing learnings from incidents across the service. Incidents had not been effectively recorded or monitored by the registered manager prior to the implementation of the provider’s digital care management system. Therefore, it was difficult to assess if there had been any themes or trends which may inform improvements to the service such as staff training. However, the provider had identified reflective practices were needed to foster a wider culture of learning within the homecare care service.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

People’s holistic support and care requirements were discussed with people and their families prior to being supported by a care staff to ensure the service could meet their needs. People received staff profiles and had video meetings with prospective care staff to ensure compatibility and to start to build a rapport before their homecare care package began.

The provider was working on updating the ‘welcome pack’ to ensure people had access to the information they needed to understand the service’s terms and conditions and key policies such as the provider’s complaints processes and on-call contact details.

Staff confirmed the systems in place to ensure essential information was shared with them to promote continuity of care. They told us they had a good working relationship with people’s families and health and social care professionals and sought advice and support when needed.

The provider worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They concentrated on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. However, the provider had not always shared concerns quickly and appropriately.

People told us they mainly felt safe around staff. One person said, “I can’t fault them.” However, another person reported the approach of a staff member on one occasion had been concerning. Disciplinary action had been taken with a staff member as a result of a safeguarding concern; however, this incident had not been reported to CQC.

People were supported by staff who knew how to raise concerns. Staff had received training in safeguarding adults and children and were aware of the provider’s safeguarding policies. The provider agreed to delegate a safeguarding lead to enable them to have better oversight of safeguarding risks associated with homecare care. Plans were in place to review the provider’s safeguarding policies to ensure all current forms of abuse prevalent to today’s society were included in the policy and the contact details of relevant local authorities.

The provider did not always work well with people to understand and manage risks. However, we found staff worked well to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s care and associated risks had been assessed and information about how staff should support people to reduce their risks had been recorded. However, we found some aspects of people’s risk management plans were generic and lacked personalised detail.

Whilst people confirmed staff had supported them to health care appointments, records of the appointments and the outcome were not always recorded. This meant people with complex needs or cognitive impairments may receive inappropriate care as staff were not able to access tailored and personalised guidance when supporting people. However, the provider had identified further development and oversight of people’s care and risk management plans was required as a priority.

Staff felt supported and could contact the homecare manager if they required support. However, the provider had not ensured the on-call arrangements were effective when offering appropriate support to the homecare care service.

People and their relative told us their care staff understood their needs. One relative said, “[Name of carer] is very hands on and keeps an eye on [name of service user] so they don’t fall. [Name of carer] approaches [name of service user] if they are concerned or see them struggling.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Staff reported they supported people in a safe environment, and their well-being and safety had been regularly checked by the homecare manager. We were told an assessment of any environmental risks to people, and the homecare care staff was completed as part of the people’s initial assessment. However, discussions around environmental risks, lone working and the agreed management of people’s equipment were not consistently documented. This meant the registered manager could not be assured whether sufficient control measures had been put in place to ensure people lived in an environment that met their needs and staff remained safe. However, the provider had identified they needed to further develop and sustain improved lone working and environmental safety practices within the homecare care service.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Improvement was needed in the safe recruitment of staff. The employment histories, reason for leaving and gaps in the previous employment of care staff had not been effectively explored to ensure people were supported by fit and proper staff. The provider’s recruitment policy did not fully align with regulatory requirements.

Staff reported they felt supported and were suitably trained to carry out their role. Staff had completed the provider’s mandatory training in key health and social care subjects. However, not all staff had received the training they required to support people with complex needs or cognitive impairment. The provider had not assured themselves that staff trained by other care providers were qualified and competent to carry out more complex procedures. Not all staff had completed training in the general awareness of the support that autistic people or people with a learning disability may need.

Records of staff supervision, skill assessments, well-being checks, and meetings during the probation period were insufficiently detailed and showed no evidence of follow-up actions taken after addressing any issues.

However, the provider had identified further development was needed to ensure staff had been suitably recruited and were effectively supported and skilled to manage the needs of people.

Most people and their relatives reported no concerns about the skills and training of staff. One person said, “They are spot on. Well trained and very professional.” However, one person felt staff were not competently trained in supporting people with complex 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.

People were protected from the risk of infection. People and their families raised no concerns about staff infection control practices and told us staff wore personal protective equipment (PPE) when supporting them with personal care and other household tasks. Staff had received training and had access to supplies of PPE.

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

Improvement was needed in the safe management of people’s medicines. Medicine management systems were in place and people raised no concerns about the management of their medicines; however, improvements were needed to the records of people’s medicines to ensure these were managed safely and in line with their prescription.

People’s care records referenced the support and management of their medicines throughout the care plan. However, staff would benefit from a clear medicines care plan to guide them in people’s personalised medicines support requirements including the agreed shared management and a list of people’s prescribed medicines, dose and rationale for the prescription. Care plans lacked personalised details about the management of people medicines and their preferred methods of taking them. However, staff were knowledgeable about people’s preferences and how they supported people to have their medicines safely.

Protocols were not always in place for medicines to be administered ‘as required’ or for prescribed creams. Medicine care plans for people who required variable doses of anticoagulants and associated risks were not in place. People’s lawful consent to the management of their medicines was not always clearly recorded.

Staff transcribed people’s prescribed medicines on to medicine administration records (MARs) at the beginning of each month. However, a system of countersigning or checking the accuracy of this process was not in place, in line with best practice guidance.

Staff had received medicines training; however, records of their competency assessments to administer people’s medicines safely did not robustly document the areas of administration that was assessed, or any follow up discussions.

These concerns placed people at risk of not receiving their medicines as prescribed.

The provider had identified further development was needed in the management of people’s medicines in line with their medicine policies and national guidance.

However, people and their relatives confirmed they received their medicines as prescribed. One relative said, “[Name of staff member] medicines are done in the morning and evening. They seem to have everything in order as it was getting too much for me.”