Applewood Support 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 inspection we rated this key question requires improvement. At this inspection 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. Potential risks of harm were not always identified, assessed or mitigated. This meant staff did not always have important information to refer to when needed. There were sufficient staff to undertake care calls to people. Generally, staff were recruited safely and received an induction and training. Staff followed infection prevention and control measures and supported people with their prescribed 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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and, overall, investigated and reported safety events. Where staff had not followed the provider’s reporting processes, this was addressed with them. Some improvements were needed in learning lessons to continually identify and embed good practice. At our last inspection we had identified to the provider that risk management was either not in place or not robust, and on this inspection, we found lessons had not consistently been learned from this. For example, we still found no information for staff to refer to about which hoist loops to attach to a hoist when transferring a person.

Processes were in place to record accidents and incidents, and these had been reviewed by the provider. ‘Flash meetings’ took place on a Monday morning in the provider’s office, and these gave staff the opportunity to share any concerns and actions that were needed to be taken.

The provider worked with the local integrated care board and had recently been engaged in a pilot project with a GP surgery jointly creating an assessment tool around risks of hospital re-admission.

The provider worked well with people, relatives and health system partners to establish and maintain safe systems of care; related to new packages of care. When people were discharged home from hospital, the provider ensured care calls re-started. However, there were no effective processes in place for staff to follow to ensure a person’s care plan and risk management continued to meet their needs. For example, 1 person’s needs had changed following their discharge from hospital. We found the person’s care needs had not been reviewed and no new or updated risk management plans had been implemented to inform and guide staff. The provider and business development and operations manager told us they had a good relationship with the local authority commissioning team.

The provider told us they offered short packages of care for people discharged from local hospitals with ‘care at home’ in place, this was often at short notice and could present some challenges. However, the provider aimed to create a smooth transition of care working with people and their relatives.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns raised to them by staff or others quickly and appropriately. Safeguarding concerns were recorded and acted on by the provider. Overall, 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.

Staff had received training on safeguarding and protecting people from abuse and, staff spoken with told us they would raise any concerns to office staff and the management team. However, on the day of our inspection we reviewed 1 person’s care records and identified an entry in ‘task notes’ that staff should have reported to office staff and managers without delay: in line with the provider’s policy. Staff had therefore not followed their safeguarding training which meant the incident may have beenmissed as a potential safeguarding concern and not acted on by the provider because staff had not raised it with them. The provider took immediate action to investigate following us sharing the information we reviewed in the care notes with them.

The provider did not always work well with people to understand and manage risks. Staff did not always have the information available to them to consistently ensure people’s care was delivered safely and in line with best practice.

Following our last inspection, we had identified to the provider that improvements were needed in the quality of people’s individual risk management. At this inspection we found the quality of people’s individual risk management had deteriorated. Some potential risks to people’s health and welfare had been identified but no risk reduction measures had been agreed and shared with staff. For example, 1 person was at risk of urinary infections, but they had no risk management related to this or their catheter care.
Other potential risks had not been recorded. For example, 2 staff members told us about people they supported who were at risk of choking, but there was no risk assessment of this in their care plan. Other people had restricted mobility and were either cared for in bed or restricted to their chair. No assessments had been completed to reduce the potential risks of skin damage. Some people had damaged skin and had no care plan or risk management plan to guide staff on caring for their damaged skin or how to reduce risks of further damage.

Where people required the use of specialist equipment such as a hoist to transfer safely, moving and handling assessments did not inform staff how to safely position a hoist sling on the person and which ‘hoops’ to attach to the hoist; to reduce risks of falls from the hoist.

Other people were living with health conditions, such as diabetes, but had no risk management plan in place for staff about how the person would present when they were unwell and what actions to take. This put people at risk of potential unsafe care and harm.
Whilst we found no evidence people had suffered harm as a result of not having risk management plans in place, the potential of harm was present because staff did not always have the information, they needed to keep people safe.

Following our feedback, the provider and business development and operations manager assured us immediate actions would be taken to address these shortfalls. The week following our inspection, the provider shared with us examples of risk management they had implemented for people. They assured us these would be shared with staff, and they would continue to improve their risk assessment processes and risk management plans for people supported by the service.

The provider detected potential risks in people’s home environment.

The provider had completed a ‘generic risk assessment’ on people’s own homes, for example looking at gas and electrical safety. The assessment identified potential risks and control measures to reduce risks were recorded. The provider had considered the risks of lone working for staff on care calls and also any potential risks to staff posed by people using the service.
 

The provider made sure there were enough staff to undertake care calls to people and had provided online and face to face training. Overall, staff received support, supervision and development. However, some improvements were needed to ensure staff worked together well to provide consistently safe care that met people’s individual needs.

Generally, staff were recruited in a safe way. Of the 3 staff files we reviewed, all had pre-employment checks. However, 1 file had no previous employment reference. We discussed this with the provider who took immediate action to address this.

The provider told us they were fully staffed and wherever possible ensured the same group of care staff undertook care calls to people, which enabled staff to get to know people they supported. The business development and operations manager explained their role in new staff inductions. New staff completed an induction and shadow shifts with experienced staff members. Staff told us they felt the induction and training met their needs.

People and their relatives were generally positive about staffing levels and overall felt staff had the skills they needed to complete care tasks. However, we found some staff had gaps in their skills and knowledge. Where tasks, such as care plan and risk management writing, had been delegated to field care supervisors, the provider had not always checked staff were sufficiently skilled and experienced to complete these effectively. We discussed this with the provider who told us they would arrange further training. There had been no missed care calls. A few people and relatives told us they felt staff were late for their care calls, however, the provider assured us they monitored these and if staff were running late, they were asked to advise office staff and people waiting for their care call.
 

The provider assessed and managed the risk of infection.

Staff had received training on infection control and prevention and told us they had personal protective equipment (PPE) made available to them. People and relatives told us staff used PPE. One person said, “Staff put on gloves and aprons after they have come into the house.” Where people had specific health concerns, staff wore face masks if the person wished this. Staff understood the importance of handwashing and changing PPE. However, we found people’s care plans did not contain specific information and guidance for staff to reduce the risk of infection when people had ‘in-dwelling’ medical devices such as a catheter. The provider told us this would be addressed.
 

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. Where people’s medicines needed safe and secure storage in their homes, staff were aware of this. Electronic medicine administration records (EMAR) had been completed by staff and indicated people had received their medicines as prescribed.

People raised no concerns in relation to the management of their medicines. Some people had topical items, such as creams, prescribed to them. People’s EMARs recorded creams had been applied as required, however, not everyone had body maps in place to inform staff where to apply the cream. We identified this to the provider who took immediate action to put missing body map information into place.