COOCI Associates LLP

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 good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Systems were in place to promote learning from accidents, incidents, complaints and safeguarding concerns. Accident/incident forms were reviewed and signed off by the registered manager. These showed follow up and actions to incidents such as missed signatures on medicine administration records (MARs). The provider had an accident/incident tracker with accidents/incidents discussed at team meetings and at the providers monthly meetings which enabled further opportunities to identify trends and put measures in place to prevent a reoccurrence. Any learning outcomes were communicated to staff via email to team leaders, and/ or staff at team meetings.

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.

People had up-to-date hospital passports in place which was accessible to staff in the event of an emergency. Where people were admitted to or discharged from hospital, or transferred to or from another case management company, transitions were well planned and coordinated.

The case managers worked closely with relevant professionals to ensure people’s on-going needs were understood and communicated effectively, supporting continuity of care and safe seamless transitions between services. This meant people received consistent well- coordinated care, reducing the risk of delays or gaps in support and promoted better health outcomes for people.

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.

Systems and processes were in place to safeguard people from the risk of abuse. Staff understood their safeguarding responsibilities and had access to training, policies and procedures needed to support them in recognising, responding to and reporting concerns. Staff recruited to support children had received safeguarding children training and had access to safeguarding children’s policies and procedures. The required notifications had been submitted to CQC, and safeguarding concerns had been referred to the local authority in line with local authority procedures.

Staff told us they felt confident in recognising and reporting safeguarding concerns, and they felt confident any concerns raised would be acted upon. Staff commented, “My understanding of safeguarding is protecting people from abuse, neglect, discrimination, and harm. If I witnessed a person being treated badly, I would report it immediately following safeguarding procedures and company policy,” and “If I had any safeguarding concerns, I would feel assured, I could contact my managers with my concern or be able to 'whistle blow' if needed.”

Relatives told us they felt assured their family member received safe care and support. Relatives commented, “We feel assured [person] receives safe care. Regarding the services input they are involved in regular monitoring of the work of the support team, requiring diligent record keeping, holding regular training sessions for the support team to ensure the highest level of care is maintained, liaising with the therapy team, consultant team, organising all necessary meetings, and chasing where it is necessary to ensure the highest standard of care for [person],” and “[Person] has a really lovely team. They support each other. [Person] is comfortable and safe.”

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, the recording of person-specific risk assessments required improvement to consistently promote safe care.

Systems for recording and maintaining person- specific risk assessments were not consistently robust. While the provider had a range of generic risk assessments in place, person -specific risk assessments within the care records reviewed did not always provide sufficient detail to clearly demonstrate the identified risks, and the measures required to reduce or manage them.

In 1 care plan reviewed, person-specific risk assessments were not included in the initial care plan provided to us. Following discussion after the inspection the provider submitted a revised version of the care plan which included those additional person-specific risk assessments.

In a second care plan, risks including the use of bed rails, use of a lap belt, choking and Percutaneous Endoscopic Gastrostomy (PEG) management were identified. However, although these risks were referenced within the care records, the associated risk assessments did not consistently contain sufficient detail to demonstrate the nature of the risk or the specific measures in place to manage the risk. This was discussed with the registered manager, who agreed to review and update the person-specific risk assessments to ensure they clearly documented identified risks and the measures in place to manage them.

People were supported by a consistent staff team who demonstrated a good understanding of their individual needs, risks and the actions required to support people safely. Care plans contained detailed guidance for staff about how to provide care and respond to people’s needs. However, limited detail in person-specific risk assessments reduced assurance that risks were effectively assessed and reviewed.

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 had effective systems in place to promote environmental safety. Environmental and health and safety risk assessments were completed to identify and manage potential hazards within people’s homes. These included fire safety, gas and electrical safety, the Control of Substances Hazardous to Health (COSHH) risk assessments and checks to be assured smoke and carbon monoxide alarms, were in working order. Lone working risk assessments were completed to help protect staff delivering care and support in people’s homes.

People had Personal Emergency Evacuation Plans (PEEPs) in place. The provider maintained oversight of equipment used to support people, ensuring servicing and maintenance were completed in line with recommended timescales. These arrangements helped to reduce risk and promote the safety of people and staff.

The provider made sure there were enough qualified staff who were supported in their roles. However, they did not always ensure staff were suitably recruited to provide safe care that met people’s individual needs.

People’s relatives were actively involved in the recruitment and selection of staff to help ensure they were well matched to the individual’s needs and preferences. Appropriate pre-employment checks, including enhanced Disclosure and Barring Service (DBS) checks were completed before staff commenced employment. However, recruitment processes were not consistently robust. References from applicants’ most recent employers had not always been obtained and independent character references were not consistently sought. In addition, gaps in employment had not always been explored. This meant the provider could not consistently demonstrate robust recruitment processes were followed in line with their own recruitment policy. In response to our feedback the provider took immediate actions to strengthen their recruitment procedures.

Staff received an induction and mandatory training appropriate to their role. Specialist, person-specific training and staff competency assessments were arranged to meet people’s individual needs. Staff told us they received appropriate training and competency assessment to support them in their role. Relatives and professionals consistently described staff as knowledgeable, skilled and well supported to meet people’s complex needs. A relative commented, "[Case manager’s name]’s management and oversight of[person]’scare has been nothing short of five-star excellent. They have extensive experience of all aspects of care necessary for the nature of [person]’sinjury and will always go the extra mile on their behalf."

Staff received regular supervision, peer support and annual appraisals to support them in their role and development. Supervision records included discussions about training, individual learning needs and how staff had applied their learning in practice. Staff told us they felt well supported by their managers and could seek advice and guidance at any time, rather than having to wait for a scheduled supervision session.

Staffing arrangements were planned around people’s individual needs and reflected the level of support required. Person – specific rotas demonstrated appropriate staffing levels to meet people’s assessed needs. Where vacancies occurred, the provider had arrangements to maintain safe care, including the use of suitably trained agency staff. Care plans clearly identified the agreed involvement of family members where this formed part of the person’s agreed care package.

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.

Systems were in place to support effective infection prevention and control practices. Staff had received infection control training and had access to relevant policies and guidance to support safe practice. Infection control risks relating to the people supported were identified and managed. Staff were provided with appropriate equipment such as gloves and aprons to safely deliver care and support. These arrangements helped to reduce the risk of infection and protect people’s health and wellbeing.

The provider did not always make sure medicine management documentation was maintained in line with their own medicine management policy.

Staff had access to guidance within care plans to support the administration of prescribed medicines. However, documentation was not consistently maintained in line with the provider’s medicine management policy. Protocols for ‘when required’ (PRN) medicines were not consistently available, and risks associated with the use of flammable emollient creams had not been formally assessed. The registered manager agreed to review and update the documentation and communicate the changes to staff to ensure practice was consistent with the provider’s medicine management policy.

Staff involved in medicines administration had received appropriate training and had their competencies assessed to ensure they were able to administer medicines safely. Where medicine errors occurred, such as missed signatures, these were monitored, and action taken to address concerns and provide further training where required.

A sample of medicine administration records (MARs) was reviewed and showed medicines had been administered as prescribed, with records completed appropriately. Where people were prescribed medicines via transdermal patch, records showed these were rotated in line with the prescribed instructions. Body maps were in use to guide staff where prescribed creams were required to be applied, supporting consistent and safe administration.

Relatives told us they were happy with the way medicines were managed. They commented, “The support team organises and administers [person]’s medication and we have no concerns.”