Choices 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 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.

People and relatives said they felt safe and had no concerns about the care provided. One relative described a recent safety concern; following this, the registered manager told us the actions taken to ensure learning was shared and improvements were embedded.

Staff explained what they would do in an accident or fall, including calling emergency services, informing families and keeping the person comfortable. One staff member said, “I would call the emergency number, wait for an ambulance, inform family, make my client comfortable and communicate with them.”

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 relatives told us pre‑assessments were completed before care began and were used to ensure the right support was in place from the outset. One relative explained how the provider kept in close contact with them when their family member was admitted to hospital, and how care was restarted and adjusted in line with any changes to the person’s needs. The registered manager confirmed this and said, “If someone goes to hospital, we keep the package of care open so people can come back to us for continuity.”

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 relatives were positive about the way their safety was considered. One person told us, “Being on my own all day is lonely and I get worried. When the carers arrive, I feel protected and safe because they know me and help with my worries.” One relative said, “They send regular carers, [Person] is organised and needs a routine, they keep to this routine and that’s why [Person] is safe.” One staff member explained the different types of abuse and shared their responsibilities to report any concerns to their manager. They said, “If I don’t protect my client then I’m not a good carer. My clients are very important to me.”

Safeguarding policies and procedures were in place and staff had undertaken safeguarding training. At the time of our inspection, no person had been granted or an application made to the Court of Protection for a Community Deprivation of Liberty Safeguard (DoLS). This occurs when a person lacks capacity to consent to their care and treatment. It protects people who can’t protect themselves.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found improvements were needed around the documentation relating to managing risks to people. Some people were supported with their percutaneous endoscopic gastrostomy (PEG) tube (a system to deliver nutrition, fluids and medication directly into the stomach via a tube). One person was supported by staff and their family member. Care records did not always specify which healthcare tasks were carried out by staff and which were undertaken by family members. We were assured people were safely supported during this period.

Another person managed their own diabetes, but their records did not include information about the signs and symptoms staff should be aware of. Following the inspection, the registered manager updated the diabetes care plan and said people’s care records would be updated to reflect what they were responsible for and family members. People and their relatives we spoke with raised no issues around the management of people’s health needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Environmental risks within people’s homes were identified during the person’s initial assessment process. This included potential trip hazards such as rugs or trailing cables and any pets. Information was included in people’s care records about any actions staff should take to keep themselves and people safe. The provider had a lone working policy and an out of office procedure which staff could use to contact for support or advice.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Some people were supported with their health care tasks this included using specialist equipment. Staff were supporting a person with their equipment, but they had not received all the training they required with this or had their competency assessed by an appropriate professional to confirm they could carry out the task safely. Following the inspection the provider told us they had taken appropriate action to find training and assess staff competency. We were assured people were safely supported during this period.

People received their care calls as assessed and planned. One person shared they required support from staff and described staff as “Exceptional”. Another relative said, “Staff follow [family member’s] routine, they have a good bond, most of the carers are really good.” The provider operated safe recruitment processes. Safe recruitment checks included undertaking checks such as references and Disclosure and Barring Service (DBS) checks and right to work documentation. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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.

People and their relatives told us staff wore Personal Protective Equipment (PPE). Staff had completed IPC training and demonstrated an understanding of how to reduce the risks of infection. One staff member said, “We always collect PPE from the office, we wear it for all of the care tasks. It’s important to follow infection control, for example, we change our PPE after personal care.” Observed practice was completed to ensure staff had and used appropriate PPE when required.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People’s medicines were recorded in their care plans, but these records were not always accurate. Where responsibility for managing medicines was shared between the provider and family members, records did not clearly show which elements were managed by staff and which were undertaken by the family. This increased the risk of inconsistent medicine management and unclear accountability. However, people we spoke to raised no concerns around their medicines. One person said, “The carers give me my medicine and always check it has been taken safely.” The registered manager said medication records would be updated to clearly reflect the aspects of medicine management for which the service was responsible.