Capital Staffing Services Ltd

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 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.

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.

Despite mainly positive feedback, we were not assured that the provider’s systems and processes consistently supported a learning culture that ensured people’s safety. Audits of care and medicines records were limited in scope and covered only a small number of people each month. These audits had not identified the issues we found during our inspection, which meant there was a risk that unsafe practices or gaps in care could go unnoticed, reducing confidence that people were consistently receiving safe care.

Notwithstanding our concerns with systems and processes we received positive feedback from people and staff. Staff told us they regularly discussed incidents and learning in meetings, describing how they could, “raise issues or challenge areas that might need to be changed”, which showed they felt able to speak up.

People and relatives reported that managers responded quickly when concerns were raised. One relative told us the provider had removed staff immediately when concerns about suitability were raised, demonstrating a willingness to learn and act quickly to resolve issues.

Accidents and incidents were recorded and staff told us they discussed previous incidents during staff meetings. The provider demonstrated willingness to improve the culture of learning, but processes for capturing and embedding learning needed further strengthening.

Systems designed to support safe and effective care were not always implemented consistently. Discharge summaries were obtained when people were discharged from hospital, however, care plans and risk assessments were not routinely reviewed or updated after hospital admissions, meaning staff sometimes relied on outdated guidance.

We found examples where, key information of people’s care needs appeared in multiple documents, with inconsistent instructions around areas such as repositioning or medicines frequencies. This made it harder for staff to follow a single, reliable plan of care. Guidelines were not always accurate or in line with current practice. One person’s care plan stated they were to be catheterised every 3 hours. However, care notes showed staff were carrying out a different task which was not in line with the care plan.

Staff worked well with families and external partners, but gaps in documentation and audits limited assurance that people always received safe care.

The provider worked with people and healthcare partners to understand what being safe meant. There were systems to protect people from the risk of abuse. There were safeguarding and whistleblowing policies in place which were discussed with staff regularly.

Staff had completed safeguarding adults and children training and could demonstrate an understanding of their responsibilities and acted appropriately to protect people from harm. Families felt confident concerns were taken seriously. Staff could explain signs of abuse and knew when to escalate concerns and described safeguarding as “everyone’s responsibility”.

Records showed the registered manager attended child protection and safeguarding meetings and updated plans in response to professional advice. People and relatives told us they knew who to contact if they were worried about safety and said managers responded promptly.

People and their representatives were involved in identifying and managing risks and felt listened to. However, written plans did not always fully reflect this collaboration or describe shared responsibilities clearly. Staff did not always record actions taken to mitigate risks.

Due to inconsistent records we could not be assured staff were always following guidelines to mitigate risks. Some people receiving care were assessed at being at high risk of skin breakdown and required regular repositioning by staff to reduce the risk of developing pressure ulcers. We found repositioning records to be inconsistent so we could not be assured people were always being repositioned regularly in line with their care plans.

Staff recognised the vital role of families and described working “in partnership” with them when managing risks to people’s health and wellbeing. However, risk assessments did not always clearly document who was responsible for specific tasks, and in one case, the absence of electronic records meant they were unable to evidence how risks were being monitored.

The provider detected and controlled potential risks in the care environment. There were processes in place to ensure people’s homes and equipment supported the delivery of safe care.

Families told us staff ensured hazards were removed, equipment was used safely and homes were left clean and tidy. Staff also described supporting families to understand risks, such as the dangers of hot water bottles.

Environmental checks were carried out and covered issues such as fire risks and checks of equipment. However, maintenance dates for equipment being used were not recorded so the provider could not be completely assured all equipment was safe to use.

Despite these documentation issues, we saw no evidence of unsafe environments. Staff awareness and communication helped keep people safe.

People benefited from skilled and compassionate staff, but weaknesses in recruitment checks, training and competency records and oversight of timekeeping meant staffing arrangements were not consistently safe.

Recruitment processes were not robust. Employment histories were incomplete for some staff. We discussed this with the registered manager who began rectifying this during the assessment.

Training and competency checks were inconsistent, and it was unclear how staff knowledge and understanding was assessed when they covered multiple training subjects in one day. Staff also reported that manual handling competency had not been assessed in people’s homes to ensure they were competent to carry out the specific moving and handling tasks relevant to their role. There was also no record of paediatric resuscitation training which is key training needed for staff working with young people with complex health conditions.

Concerns about timekeeping highlighted that the provider lacked a reliable process to monitor staff attendance. Most people were positive about staff timekeeping and the skills of staff. However, 1 person raised concerns about staff performance and timekeeping, and the lack of a robust process meant the provider could not be assured all staff were attending on time and staying for the correct duration. We raised this with the provider, and they have started making improvements during the assessment, directing staff to use the electronic care monitoring (ECM) system to record start and finish times.

Most people receiving care and/or their relatives praised the staff team and said staff had strong clinical skills and understood people’s needs well. Despite the gaps in records most staff told us they were given opportunities for skills development through shadow shifts, specialist training and competency checks, which supported their confidence in delivering complex care.

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. There was an up-to-date infection prevention and control policy in place. People and relatives reported that staff followed safe hygiene processes, used personal protective equipment (PPE) appropriately and left their homes clean and hygienic. One relative said staff wore gloves and aprons “as necessary” and were diligent with hygiene.

Staff had received infection control training and had access to PPE when needed. Infection control audits were completed to ensure safe infection control practices were followed.

People’s medicines were not always managed safely. Although families valued staff’s medicines knowledge, significant documentation issues meant the provider could not demonstrate safe and consistent medicines management.

We identified a range of issues with medicine care plans and recording. Allergy status was not consistently documented, and medicines care plans contained out of date information. In some cases, medicines that had been stopped remained listed, or the frequency differed between care plans and administration records. This created a risk that staff could make decisions based on outdated or inaccurate information.

For people receiving medicines via enteral feeding tubes (a method of delivering liquid nutrition directly into the stomach), some plans included appropriate instructions to support safe preparation and administration. However, staff did not always have access to clear instructions for medicines given in ways that differed from manufacturer guidance, such as administration through enteral tubes. This increased the risk of incorrect preparation, tube blockages or reduced medicine effectiveness.

The provider acknowledged and respected the role of parents in medicines administration, and staff adapted care in line with parental preferences. There were risk assessments in place for parents or carers to administer medication which stipulated staff should check what medicines had been given by relatives and record this. This was not routinely happening which resulted in unexplained gaps in people’s medicine administration records (MAR).

Despite the issues with records people and relatives told us staff managed medicines well in practice, notified them when supplies were needed and updated records when changes were made.