Accolade Support and Care 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 assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

The service had a positive approach to learning from events. Following incidents, staff received information to share and learn from events and had the opportunity to further reflect in a debrief. Staff told us, “We get debriefs and the office will come and address this for example discrimination” and “I would report it to my line manager and things are followed up on very well. I can reach them 24/7 and I feel very supported.”

Incidents and accidents were recorded including the actions that had been taken and put in place to further keep people safe. Staff were informed about any changes and had to read the updated care plans ahead of visiting people.

People and their relatives told us the service responded well to any learning outcomes and adapt care where necessary. One person commented, “There have been a few tweaks we’ve had to make with length of time required for care and Accolade have worked with us and it is working well now.” A family member told us, “We haven’t had any concerns whatsoever. The only time I’ve had to ring them was recently when the times were incorrect on the roster and they apologised and said it was a typing error.”

We saw that the provider encouraged open communication among the staff team recording in their handbook that ‘At Accolade we have a culture of understanding and learning from our mistakes. If you did something that had an adverse effect on a client or their property, you simply must let us know, so that we can put it right.’

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 and their families told us they were given time to explain their needs and wishes to ensure the care they received was suitable and in line with their needs and preferences. One health and social care professional praised the service for enabling smooth transitions for people. They said, “Accolade always support with restarting packages of care where appropriate following hospital discharges and requests for increases to care packages are managed efficiently.”

The service had information available to share if a person needed to transfer into a different setting. This contained information including communication needs, mobility, any allergies the person had and any medicines they were currently prescribed. This enabled people to have continuity of care between the service and other settings.

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.

People and their families told us the support they received from staff made them feel safe and they had no concerns with one relative commenting, “Because we have regular staff that we know, [relative] feels safe with them” and “Yes, they do keep us safe. Staff take note if anything needs doing and action it.”

People were sent a staff profile page alongside the weekly rota for any new staff which informed them in advance with a picture who would be supporting them with their care. The registered manager told us, “This ensures clients are informed in advance and helps them feel more comfortable by knowing who will be visiting them.”

Staff had completed safeguarding training and understood their responsibilities in monitoring and reporting potential safeguarding events. Staff told us, “I feel completely confident that if I raised a safeguarding concern with any of my management team they would act immediately and appropriately” and “Being vigilant and noticing any changes in a client’s behaviour or body language, including not wanting to wash, becoming withdrawn, not eating and drinking and physical signs such as bruising or hand marks.”

Following a recent external quality review, the registered manager had made changes to how safeguarding events were recorded to ensure greater detail was included about the outcomes and ongoing actions. One health and social care professional told us, “No concerns, I hold Accolade in high esteem. We’ve never received a concern.” The deputy manager was the safeguarding lead for the service and told us they were planning a meeting specifically around safeguarding for staff awareness. They explained “We discuss it in induction not just mandatory training. We have an open-door policy and staff know they can come to us.”

The registered manager and staff team demonstrated a good understanding of supporting people who may at times lack capacity to make a decision. One staff member told us “If a person does not have capacity, it does not mean that they should not feel included, and it does not mean they are totally unable to make decisions. We make them feel seen.” The registered manager spoke about a safeguarding that had been raised when one person they supported was making an unwise decision that was detrimental to their health. They explained, this person had capacity to understand the consequences but continued to act in a harmful way. Staff had supported this person to reach an understanding and mitigate the risk whilst respecting the decision they wanted to make.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks had been identified, recorded and as far as possible mitigated for people. We saw risk assessments gave staff information on how to support people safely around their risks in a way that was person-centred and regularly reviewed with the person.

We saw that the ongoing risk to people had been considered. For example, one person had experienced several falls and in addition to their falls risk assessment a falls record had been put in place. This looked at the circumstances around each fall to try and establish patterns or links to better influence the ongoing care provided and keep this person safe.

Staff we spoke with felt confident in supporting people with any risks and knew what action to take in the event of an incident or accident. Staff told us, “I have had training in reporting and recording accidents. The falls forms and incident forms are kept in the clients care planner. I would check for people’s responses including their airway and breathing. I would check to see if they had any injuries or pain, if they do, I would call 999. Then contact our office and they or I would contact the family and stay with them” and “The good thing about the risk assessments is that they are ongoing, so it helps in keeping in line with where the person is at. It keeps the information up to date and identifies what they need in terms of support.”

There was a business continuity plan in place to account for any factors that may impact on the delivery and running of the service. This included identifying people at particular risk if their support visit was compromised and ensuring they would be a priority. We saw the service had a plan for each person about what support to implement during these times.

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 carried out assessments of people’s home environment to identify and reduce any risks which could impact on staff and the people they support. We saw these assessments considered people’s pets, any fire risks and safe access to the property.

The provider had on occasion taken action to refer any concerns to the fire service who undertook a check to the person’s home to ensure they remained safe. The registered manager told us, “We look at all the risks and with clients consent we have helped to move things around and make them safer and help them with clutter. We will be proactive with things like this.”

Lone working assessments were completed to ensure staff’s safety. Staff were equipped with torches and personal alarms and alerts were received if staff failed to check in for a visit on time, so this could be checked. The registered manager had created a list for staff on how to stay safe which included useful items to keep in the car for emergencies. During extreme weather staff were informed of alternative routes and extra guidance on safe driving was provided specifically for staff who were recruited from overseas.

Security and access to people’s homes was taken seriously and staff were continually reminded about the importance of maintaining safety for people. The registered manager told us that courtesy calls were completed with people to ask if they felt safe and discuss options including sensor lights and cameras that may support their safety.

The provider did not always make sure that appropriate recruitment checks had been undertaken.

We saw that recruitment checks for the five staff records we checked, had not included a history of employment since education and that there was not a reason for any gaps recorded. The registered manager said this had been an oversight and they would ensure this was addressed and additional checks added to the recruitment process. All other parts of the recruitment process had been undertaken safely to ensure staff were of suitable character to carry out their role.

The provider had a sponsorship licence in place to recruit staff from overseas. This was undertaken with the appropriate checks and permits in place. A large number of the workforce had been recruited under this sponsorship, and the registered manager was keen to balance this more with local recruitment to ensure as a contingency the service remained operational.

We reviewed the electronic call data that monitored visit times and duration and saw the majority of calls were delivered within the agreed timeframes. People and their relatives told us there were enough staff and staff stayed the appropriate length of time to support them. Comments included, “Staff stay the required amount of time and timekeeping is pretty good. If staff are going to be very late the office will ring and let me know that they are coming. No concerns about reliability, staff are trained and I have confidence in their ability” and “I have access to the app which show that staff usually turn up at the right time and stay for the correct length of time.”

Although staff were very positive in the feedback they shared, we did identify a theme that was raised around the structure of their visits being closer in proximity to eliminate travel time and reducing how often these changed to keep consistency. The registered manager stated they were aware of these themes from discussions with staff and whilst appreciated this was not ideal there were times due to operational safety had to be changed to provide cover.

We saw there were some gaps in the training matrix where staff needed to complete some refresher training. However, all staff we spoke with demonstrated the appropriate skills, knowledge and confidence to undertake their role safely. Staff were able to describe in detail how they supported people and told us the training they had completed equipped them well. Staff told us, “There is a lot of training sometimes it feels like we are constantly training. I am very confident. They [Managers] are supportive of our learning” and “I have done a lot of training. I have come from another care company, so I had certificates from that company, but Accolade train us again to ensure we are aligned to their policies and procedures.”

New starters into the service received a robust induction process lasting 3 months which included training, having competencies assessed and support from an assigned buddy and line manager throughout. The recruitment and training manager told us, “We set some goals for the future with them. Shadowing is in place and more here than anywhere as we will not send anyone to a client that hasn’t been introduced. It doesn’t matter how much they have worked they will have this shadowing.”

Staff spoke positively about their induction saying, “The induction was good, I feel well supported” and “I feel I was very well prepared by management for my job role during induction.”

Staff said they felt supported and attended regular supervisions with a line member of staff. Staff told us, “When I first started, I had supervisions every week during my probation. They are very on top of things upon joining and supervise us a lot in the beginning. It is a strict process, and they want to check we know what we are doing with the clients” and “We have supervisions and spot checks, and they have certain questions they ask to check our knowledge, and we go through my personal development plan and identify what assistance I need from them. I feel these are very supportive and they make it easier for you to be more open and work better.”

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 were effective infection, prevention and control measures to reduce the risk of infection for people being supported and for staff. Staff were given guidelines which supported their training in how to apply and take off personal protective equipment (PPE) correctly and what PPE they should wear for which care roles. Staff had access to good supplies of PPE which were stored at the office or delivered to them if needed. Staff were given a bag with hand gel, visors and other essential items to maintain good infection prevention when supporting people in their homes.

People and their families told us staff supported them well in maintaining their personal hygiene needs. We received comments such as “They help with personal hygiene for [family member] and they do it well” and “[relative’s] hygiene has improved a lot since Accolade have started supporting them.”

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.

People told us they received their medicines as prescribed and were confident that staff managed these safely. Comments included, “Staff support with medication and they are very on the ball with medication and very efficient. Staff sort everything and keep good records” and “No problems with medication.”

Staff received training in the safe management of medicines, and their competency was observed to ensure their practice remained safe. Staff told us, “Someone comes out to do competency checks and peer observations and then gives feedback and support” and “Accolade always give me good positive feedback to both test my knowledge and help build my confidence.”

Service users had medicines care plans which provided staff with the information they needed to safely manage and administer people’s medicines. One person received their medicines in food which had previously been agreed with the GP, but we were unable to see evidence of this at the time of our assessment. The registered manager assured us there was a copy of agreement and would ensure it was put back in the person’s care plan.

Staff understood the procedure for managing any refused medicine and how to record and dispose of this safely. Staff told us, “If they refuse the most important thing to understand is that the client has the right to refuse and so we have to explain why they need the medication and why it will help them. If they still refuse, we have to raise an alert on the app as well as any reason provided” and “If they refuse, we try again at another time and if they continue to refuse, we log this and a reason. We have a little plastic disposable jar with time and date and initials, and these get sent back to the pharmacy. If it consistently gets refused the office will notify the GP which will trigger a medication review and a visit.”