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. 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

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 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.

Staff told us they were confident to report incidents to their line manager or on the provider’s digital care management system and incidents are later discussed with them. One staff member said, “When something happens there is always a debrief and trigger which is completed by the senior management and if it has to be reported to the social workers or local authority, we would follow the necessary steps.”

Accidents and incidents were reviewed by the registered manager and actions were taken. A system was in place to log and analyse all incidents for themes or trends. The registered manager provided some examples of where action had been taken and implemented after incidents such as the implementation of fire safety measures. However, there was limited recorded evidence if all the actions identified as part of the analysis had been implemented and had been effective in reducing further incidents. The registered manager explained the systems used to share any outcomes or learnings from incidents. However, some staff told us they weren’t always aware of learning from incidents especially when they were not directly involved. This meant there was an inconsistent culture of learnings across the service.

Concerns and incidents were raised with people’s funding authorities; however, we found there was not always a consistent approach in notifying CQC of incidents relating to people who receive personal care.

The provider was working with the provider of their digital care management system to establish a report functionality which would enhance the registered managers' understanding of incident themes and trends with the aim to drive improvement across the service.

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 registered manager worked with people and key professionals to ensure the service could meet their needs. We were told the service was working with commissioners to improve their joint systems to share information about people to ensure the service could meet people’s needs.

Where possible, people had been invited to spend time in the service prior to their transition; however, their care records did not reflect this process and demonstrate that people were fully involved and given a choice about their new home and care provider.

Most staff said they could access people’s care plans before they started to support people who had moved into the service. One staff member said, “The service users come with history and a support plan is drawn up based on their history. We make the service as homely as possible to ensure their routine is personalised and they settle in.” Some staff felt some people had not always been appropriately placed, and on occasions staff weren’t able to safely meet their needs which had impacted the overall safety and quality of the service. However, we saw evidence of the provider escalating staff concerns with people’s funding authority to facilitate increased support, alternative accommodation and improved care provision.

The provider did not continually work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always 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 had safeguarding protocols and policies in place and had a designated safeguarding lead to oversee safeguarding incidents or allegations. Plans were in place to ensure the provider’s safeguarding policies addressed all current forms of abuse and included the contact details of relevant local authorities. Most staff had current safeguarding training in place and were aware of their role to report any concerns to their line manager. Staff were aware of their role to record and report any safeguarding concerns. One staff member said, “Safeguarding incidents will be raised with the registered manager or deputy manager.” The provider prioritised protecting people from abuse and regularly addressed the subject of safeguarding in staff meetings and supervision.

Safeguarding concerns were reported to the funding authorities and mainly reported to CQC. The registered manager maintained a safeguarding log of all concerns, but the investigation outcomes were not explicitly recorded to identify if any improved practices and strategies were needed to support people. Whilst the provider supported people with complex emotional and care needs and took action to support people in a crisis; there was limited recorded evidence of reflective practice and the strategies and measures which had been taken after safeguarding incidents to protect people and improve the quality of people’s lives and experiences.

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

People’s support requirements and associated risks had been assessed. People’s care plans provided staff with information about how to manage people’s risks; however tailored and personalised strategies had not always been recorded to guide staff on the practicable steps to reduce these risks.

Staff’s daily records of the care they provided did not consistently show how people had been supported in line with their assessed needs. It was not always evident people’s care records had been reviewed and updated following any incidents or as a result of any concerns noted in staff daily records. However, one person’s relative said, “The staff review the risk assessments regularly and are very aware of risks for [name of person] …….they are on top of the risk assessments and involve me in discussions when needed."

Staff had worked with other health care professionals to help people progress in their wellbeing and improve their confidence at their own pace. However clear strategies of staff approach in people’s individual goals and the progress made by people were not clearly recorded.

Staff said they knew people well. People’s care plans relating to their behaviour and emotions were in place and how staff should address potential triggers which affected their behaviour and emotional well- being. Most staff had received training in understanding, preventing and responding to aggression. Staff were aware of people's risks and were positive about the information available in the care documentation. One staff member said, “I have good knowledge of the clients I support, I know what their triggers are. We distract them by singing and talking to them especially when they display aggressive behaviour. We know what works for them.”

An on-call system was in place to assist staff and people with any out of hours queries or support.

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 were supported to clean their home and to report any maintenance issues. One relative said, “It is very clean and maintained.”

The provider had a designated maintenance person to address any issues relating to people’s home environment. Regular cleaning and fire safety checks were completed to ensure people lived in a safe environment.

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.

Safe recruitment and the training of some staff had not always been maintained. Recruitment records reviewed during the inspection included Disclosure and Barring Service (DBS) checks and evidence of employment references. However, we found a small number of gaps in staff employment which had not always been fully explored in line with the provider’s policy.

The registered manager had ensured staff had completed the provider’s mandatory training and we saw some evidence some specific training to meet people's individual needs had been completed by staff. However, the provider training matrix did not clearly indicate the training levels achieved by staff in relation to their roles and responsibilities.

Many staff had completed training in the general awareness and need to provide care and support to autistic people or people with a learning disability. Staff said they felt well trained, supported and there were enough staff to meet people’s needs. We received comments such as, “We work with managers so get constant support. We can raise concerns and good communication with all managers”; “We have bank staff as well if we need to go to them” and “We have a lot of staff in the company. We work well together, sometimes there will be 3 or 4 people in the shift so we are all here to support each other and work as a team.”

Whilst staff were satisfied with their induction, training and supervision they received; the records of their supervisions, probation meetings and competency assessments were not always recorded in detail. However, we are told a new structure and systems to monitor staff development was being implemented.

Staff rotas were planned in advance to ensure people received the right level of staff support depending on their activities and needs. We expressed our concerns to the registered manager regarding the number of staff employed to support people as it was unclear whether people were consistently supported by a familiar core team. The registered manager explained people’s support needs and preferences were considered during staff scheduling, and the senior management routinely reviewed staff rotas to ensure staff were compatible and skilled to support the person.

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 encouraged to take part in cleaning and household tasks such as laundry as part of their independent living skills. Staff were aware of how people wished to be supported and encouraged their levels of independence. We were unable to assess the cleanliness of people’s homes. However, family members raised no concerns about people’s homes and told us people’s homes were kept clean and tidy.

Training records confirmed staff had received Infection Prevention and Control training. Staff told us they had access to good supplies of Personal Protective Equipment (PPE) and wore it when supporting people with personal hygiene or handling toxic waste.

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. People’s care records referenced their medicine support throughout their care plan. However, staff would benefit from a clear medicines care plan to guide them in people’s personalised medicines support requirements including a list of the prescribed medicines, dose and the rationale for the medicines. Care plans did not always contain personalised information about how people liked to take their medicines. Protocols were not always in place for medicines to be administered as required or for prescribed creams. People’s lawful consent to the management of their medicines was not always clear in their care records.

It was not clear from people’s care records, if staff people had received annual medicines reviews or had been supported to reduce their medicines. We found some discrepancies and gaps on people’s medicines records and administration charts. Medicines audits had been completed but had not been effective in identifying the shortfalls of the management of people’s medicines. This placed people at risk of not receiving their medicines as prescribed.