Care 4 All 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 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 provider was in breach of legal regulations in relation to staffing.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. No improvements were identified during this assessment, and the provider remained in breach of this regulation.

This service scored 44 (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.

The registered manager told us there had been no incidents or accidents since the last assessment, and therefore, there were no lessons learned to review during this assessment.

The staff members we spoke with described the actions they would need to take in the event of an incident. However, while gathering assessment feedback from a member of staff, we became aware of an incident in which a person fell while staff were supporting them in transferring from a chair to a bed. All the relevant actions were taken by the staff member, including organising support from healthcare professionals. However, when this incident was discussed with the registered manager, they said they were unaware of the incident, despite the staff member confirming that they had reported it, and the registered manager stated that the person had not mentioned it either. This meant the systems in place to identify and respond to risks were not effective.

Staff also confirmed that the management encourages discussion about improving care and practices. One staff member said, “The managers are very good at communicating what they’ve learned from feedback, and what changes they’re making as a result.”

Following our last assessment, the provider recruited a social care consultancy service to provide expert guidance and support for improvement. An action plan was implemented with the support of this consultancy firm, which included all areas requiring improvement, as well as some additional areas identified by the consultant. However, action had not been fully taken to make those improvements to the service by staff. This plan failed to fully address all issues identified at the previous assessment, nor did it identify the concerns found during this assessment.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety.

Initial assessments were being completed by the service prior to care commencing, with the support of relatives, but the information gathered was minimal (See the ‘involving people to manage risks’ and ‘assessing needs’ sections for more details).

The registered manager confirmed that the GP was the main point of contact for 1 person whose medical care was overseen by several healthcare professionals, including physiotherapists, occupational therapists, and neurologists. However, despite the care plan indicating families and carers maintain regular communication with medical professionals to receive updates, there was no evidence of these updates within this individual's care records, indicating the level of care required or whether the care plan was, in fact, up to date and relevant. There was a risk that this person might not receive continuity of care when transitioning between different services.

A service user guide was provided to each person using the service, which contained information relating to the service, including the type of care service they provided, their values, and details of the types of care they could offer. However, the guide did not provide information on the kind of support Care 4 All Limited could offer when transitioning between services.

The registered manager had recorded people’s health and care needs, so they told their history only once. Records showed 2 people had a hospital passport in place. This is a tool used to document key and vital information about individuals, to share with healthcare professionals in emergencies, such as paramedics, or for hospital staff should the person be admitted to the hospital.

The registered manager confirmed that with the consent of relatives, they would refer people to relevant professionals, if required.

The registered manager told us if 1 of the people currently using their service decided to move to another care provider, they would confidentially share relevant information they held about that person.

The provider did not have effective safeguarding systems to help protect people from abuse.

The registered manager told us there had been no safeguarding concerns or referrals since their last assessment; therefore, a safeguarding log was not currently in use.

During this assessment, we raised a safeguarding alert with the local authority following information received from a member of staff. We asked a staff member to describe in detail how they transferred a person from their bed to their commode. The staff member told us they completed the transfer alone, and said, “[Person] would hold onto my neck, and sometimes my chest.” However, the description of the transfer sounded unsafe for both the person receiving care and the staff member. The risk assessment in place did not provide the staff member with enough information to complete a safe transfer. This incident had not been reported to the CQC as required.

Following our feedback, the registered manager visited the person’s home to assess their needs and found that no changes were required.

Safeguarding concerns were not always identified or reported to the appropriate organisations. This meant that some incidents, which required a safeguarding notification, such as alleged neglect, had not always been investigated or steps taken to mitigate future risk.

Although a safeguarding policy was in place, it had not been fully formatted, and there were several blank pages throughout the policy that was shared with us. The policy did not include the name of the policy lead or their contact details, nor the contact details for the local authority’s safeguarding team. Therefore, staff and people did not have the relevant information about whom to contact in the event of a safeguarding concern.

Relatives we spoke with felt the service was safe. A relative said, “My relative is safe with the carer.” No other relatives expressed any concerns during our telephone calls when gathering feedback.

The provider did not work well with people to understand and manage risks. People were at risk of receiving unsafe care from staff who did not fully understand their needs.

Although an initial assessment was conducted to determine people’s care needs, the information gathered was limited. Therefore, the care records did not provide the staff with the information required to deliver safe and effective care.

Consequently, we found that risk assessments were missing for people in key areas, including personal care, nutrition and hydration, mobility, continence, skin care, respiratory support, emotional/psychological support, communication, pain management, and medication administration.

For example, there were gaps in people’s assessments in areas such as ‘outdoor outings, mobility and choking’. There was not enough detailed information in either the risk assessments or care plans to guide staff on what signs or triggers to observe and what actions to take should people become distressed during outings. Furthermore, information to guide staff on how to support people safely during transfers and mobilisation around their homes, and how best to assist them in the event of a choking incident, also required improvement. This meant people were at risk of poor outcomes due to a lack of suitable risk assessment and formal consideration of risk-reducing measures.

We followed up on the lack of relevant risk assessment records with the registered manager during our second visit to the location, and they agreed to review the risks associated with people they were caring for and implement new records, where relevant. However, we did not receive any new or updated records.

During our assessment, we received conflicting information regarding the use of bed rails. The registered manager told us no person was using bed rails; however, the staff we contacted confirmed that people did have bed rails and safety bumpers/covers. The service had not completed a bed rail assessment for those people using hospital beds with rails and safety bumpers/covers, as per the provider's policy. This meant there was a risk to people’s safety. A bed rail assessment is crucial, ensuring they are fitted correctly, eliminating entrapment gaps, for example.

However, staff told us, “I feel that the information available is sufficient to manage risk, as it is clear, regularly updated, and specific to each person. For example, supporting someone who is at risk of falls, or ensuring proper handling for those with limited mobility.”

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

Whilst people we spoke with expressed that they were happy with their care and did not raise any concerns about the safety of their environments, our assessment found that some people had been placed at risk of harm. This was due to a failure to ensure all equipment was safe to use.

Safety checks at people’s homes were completed prior to care commencing. Checks reviewed several environmental factors, including whether any mobility equipment or bed rails were in use. We reviewed 3 records which stated bed rails were in use, despite the registered manager advising that no person used bed rails. And a question relating to the condition of a ‘walking stick’ – whether it is in good condition and at the correct height was answered ‘no’, was present on each record, with no follow-up. However, only 1 person's care plan stated they require a mobility aid.

The registered manager was unable to provide a comprehensive list of equipment that people used as part of their daily living and did not have an established system in place to check and record whether all the equipment people were using was serviced and maintained. This had placed people at risk of accidents or injuries.

Staff confirmed they checked on people’s equipment within people’s homes to ensure it was operational. However, there was no record of these equipment checks in accordance with the provider's health and safety policy.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

The registered manager had not always ensured safe recruitment practices were followed, and gaps in staff work history had not always been explored. A risk assessment form, located within a recruitment file, stated the registered manager had undertaken a risk assessment regarding an applicant’s suitability for their proposed position, considering a matter disclosed on their Disclosure and Barring Service (DBS) certificate. However, when we requested to view the risk assessment, the registered manager was unable to produce the document. This placed people at risk of being supported by unsuitable staff.

The registered manager had no oversight of staff training, and not all staff members had completed the essential training required to provide safe and effective care. Although a training and development policy was in place, there was no mention of the staff’s requirement to complete learning disability training, including the Oliver McGowan mandatory training on learning disability and autism, which is the government recommended training for all health and social care staff in England, despite this being a care specialism offered by the service. Checks to assess staff competency in areas such as moving and handling were not taking place. The failure to assess staff's competency levels could lead to people sustaining significant injuries.

However, there were sufficient staff on duty to meet people’s needs. The registered manager conducted ‘spot checks’ during care calls, which provided an opportunity to assess staff conduct and identify any concerns with their work.

Staff confirmed they received a comprehensive induction when joining the service, which included shadowing an experienced carer for 2 weeks and completing mandatory training modules. A member of staff said, “I found the induction very helpful and reassuring, as it gave me the knowledge, skills and confidence to provide safe, high-quality care from the beginning.”

The provider did not always assess or manage the risk of infection.

The provider's infection prevention and control (IPC) policy did not specify who the policy lead was, which meant there was no clear direction on who would develop, review and update IPC policies and procedures based on national guidelines, for example, and lead the response to infection outbreaks, champion infection prevention and control, and promote best practices.

However, we found that staff respected people’s homes. Staff confirmed that there was always an adequate provision of personal protective equipment (PPE), which was easily accessible, including gloves, aprons, and face masks. Staff were able to provide scenarios in which PPE was required and explain how it would be disposed of safely within people’s homes. They were also able to confirm what they would do in the event of an outbreak of infection.

The registered manager told us they would check whether staff were following IPC guidelines when visiting people in their homes during unannounced ‘spot checks.’

The provider did not ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning.

The registered manager told us that staff were trained to administer medicines, but they were currently not providing any medicine support to any of the people receiving care, despite 1 person’s care plan describing staff applying topical creams.

Furthermore, while gathering feedback from relatives on the quality of care received, the CQC was informed by 3 families that the care staff would, on occasion, support with medication administration for their loved ones. This was queried with the registered manager, who stated there had been a misunderstanding and that care staff do not administer people’s medicines.

Daily notes referring to the 3 people mentioned above documented that staff applied topical creams and provided support with other oral medicines. During a visit to the location, the inspector saw that prescribed creams were present. The inspector requested a medicines administration record from the registered manager, but this was never received.

We later received correspondence from relatives stating there had been a misunderstanding, and that staff had not administered their loved one’s medicines. Following this, daily notes were amended and resubmitted to us, recording that families had administered the medicines. However, the original records we reviewed had been altered without a clear explanation for the discrepancies between the initial entries, the relative's comments, and the amended notes. This raised concerns about the accuracy and reliability of the records provided to us after our enquiries.

As a result, we could not be assured that the registered manager had sufficient oversight or understanding of the medicines support being provided, particularly as similar concerns about medicines administration were identified at the last assessment.