BGS Healthcare Ltd

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• 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

We reviewed 8 quality statements for this key question. There were systems to keep people safe from abuse and harm. Risks had been assessed and guidance was available to staff to enhance safety. There were enough staff to provide people’s support and staff were recruited safely. Since our last inspection improvements had been made to the management of medicines, and safe systems had been established. There were systems to manage infection prevention and control.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were confident any concern raised would be properly investigated with improvements made. This included one person who said they would call the office if they thought a particular staff member needed additional training to use their hoist more safely.

Leaders told us they had significantly improved the service and its safety. They said our previous inspections had provided a steep learning curve, but everyone had worked hard, and the service was now operating well. Leaders told us improvement would be ongoing as there were always things that could be developed. They said they encouraged people to raise any concerns, as this enabled improved practice to be implemented.

There were systems to ensure a learning culture. Staff training was given priority, and some staff were trained to facilitate face to face training sessions. Equipment to help staff learn how to move a person safely and manage a stoma or catheter were available. Accidents and incidents were investigated, with action taken to minimise a reoccurrence. Leaders had oversight to identify any patterns or trends in accidents, incidents, and complaints. People were informed how to raise a concern and were encouraged to do so if needed. Records showed concerns had been investigated and appropriately resolved.

People told us staff worked well with other health and social care providers to ensure seamless support. This had enabled timely assessments, reviews of people’s support and effective hospital discharges. One person told us they had a folder which contained their care plan to be used if they needed an ambulance or hospital admission. This ensured medical staff were aware of their needs.

A health and social care professional told us the service was good at reporting any shortfalls or concerns, and therefore were open and transparent in their approach.

Leaders told us they worked well with other health and social care professionals to ensure people received the support they required. This included calling the pharmacy to follow up a prescription or contacting the occupational therapy team if a person required more equipment. Staff told us they worked with families to ensure continuity of care and with professionals such as the community nurse. This enabled shared knowledge to meet the person’s needs more effectively.

There were clear processes to ensure a collaborative, joined-up approach to people’s support. For example, each person was asked if staff could contact their GP as part of their comprehensive, initial assessment. This enabled information to be gained about medical history, medicines, and allergies. Records showed other professionals were involved in providing advice, specific support or attending care reviews.

People told us they felt safe with staff supporting them. They said staff were caring, trustworthy and good relationships had been established. People said staff wearing identification badges and respecting their wishes of only being supported by staff of the same gender, enhanced their safety. They said they would inform the office if they had any concerns and were confident appropriate action would be taken.

Staff told us they would immediately report any safeguarding concerns to the management team or other agencies. Leaders were confident staff would do this. They said staff received training in safeguarding and regular discussions were held to ensure understanding. Leaders confirmed any concern would be taken seriously, appropriately addressed, and reported. Staff told us they understood personalised care and the principles of the Mental Capacity Act. They knew how to apply their knowledge in practice and said the service enabled them to do this.

Leaders used an electronic system to assign staff to people’s visits. This enabled people to determine who they wanted to support them, and their preferences were allocated accordingly. The system prevented a staff member to be allocated to the person, if they did not want them. There was an up-to-date safeguarding policy and safeguarding formed part of the provider’s mandatory staff training programme.

People told us any risks they faced were discussed with them and measures were agreed to enhance safety. They said this information was then detailed in their support plan and regularly reviewed. People said staff were very good at identifying any risks and informing those who needed to know. This included sore areas of skin or any changes in health care needs, which impacted on mobility. A relative, speaking on behalf of a person, told us staff managed any anxiety and aggression their family member experienced well.

There was an electronic care system which alerted leaders, in real time, to any late visits or care interventions which had not been completed. This enabled immediate action to be taken to minimise the risk of any harm. There were systems to ensure people were involved in managing any risks they faced. This included discussing risk as part of the person’s initial assessment and regularly thereafter. Staff were able to access detailed, person-centred information to help them manage any risks people faced. Office staff had been given the responsibility for ensuring all information was up to date. Any incidents were thoroughly investigated and reported, with action taken to minimise a reoccurrence.

Leaders told us positive risk taking was important and managed with individuals in a person-centred way. This included enabling people to administer their medicines if safe to do so. Leaders told us some people found accepting support difficult, but staff worked with them to enhance safety. Staff told us they always notified the office of any risks they identified, so discussions could be held with the person. This included difficulties with assisting a person to move safely, so an occupational therapy assessment was requested, and new equipment was provided.

Leaders told us staff worked with people to enhance safety within their environment. This had included cleaning and sourcing new equipment to make household tasks safer and easier for a person. They told us home environments were regularly assessed for safety. Discussions would be held with the person, their family or the local authority if deemed appropriate. Leaders told us one person had been prescribed a paraffin-based topical cream, but this created a significant fire hazard, as they were a smoker. Leaders told us they liaised with the GP and pharmacy to ensure a safer option was prescribed.

Risks associated with a person’s home environment were identified during the person’s initial assessment. This included areas such as trip hazards, faulty looking equipment, poor external lighting, and household pets. Records showed measures to enhance safety were discussed with the person, but also clearly documented for staff awareness.

People told us they had the equipment they required to meet their needs and ensure safety. This included stair-lifts, hoists and wheelchairs. One person told us they had a hospital bed, and another had a specialised mattress to minimise the risk of pressure sores. People told us staff were well trained and had the knowledge to use their equipment safely.

A high level of informal support for staff was provided, but the frequency of formal supervision was not in line with the provider’s policy. Leaders told us as the current system was working well, they would amend the policy accordingly. A staff member had been designated to organise staff training, which ensured all staff were up to date with their learning. Leaders had a mandatory staff training plan and various training providers were used to deliver face to face training. Some staff had completed training so they could facilitate training sessions. This included moving people safely. Staff had been recruited safely, as all required pre-employment checks had been carried out prior to them starting work.

People told us they were usually supported by a consistent staff team who knew them well. They said staff knew what support they needed, and they were never rushed. However, some people told us it was not always easy to communicate with those staff who had English as their second language. They said there was also a cultural issue, whereby some staff did not know how to prepare basic food such as toast or cheese on toast. Leaders told us they would address this with staff. People told us staff stayed for the whole duration of their visit and would do extra jobs if needed. They said staff were usually on time although traffic sometimes impacted on timeliness. Two people told us this had impacted on them taking their medicines in a timely manner, causing pain and difficulty spacing the next dosage.

Leaders told us there were enough staff to support people effectively and any new care packages were always assessed in line with capacity. The service experienced some staff sickness, but the office staff were fully trained and able to cover any shortfalls. Staff told us there were enough staff and they felt very well supported. They said they received regular on-line and face to face training, which enabled them to do their job effectively. Leaders told us clear focus was given to training as it was essential in creating a knowledgeable and efficient workforce.

Staff told us they received on-line infection prevention and control training. They knew how to recognise signs of infection and would report any concerns to office staff or the manager. Staff said there were ample supplies of personal protective equipment, which they could access as required. Leaders confirmed this and said all staff had been given small cards to carry, which explained the signs of sepsis. They said information about sepsis and infection management was also identified in people's care plans. This reminded staff of the immediate action they needed to take to ensure people's safety.

There was an infection prevention and control policy, and training formed part of the provider’s mandatory staff training plan. Infection prevention and control also formed part of each person’s support plan. This gave staff clear guidance about how to identify and minimise the risk of infection. Records showed spot checks of staff’s performance included infection prevention and control practice. If any shortfalls were identified, the staff member was required to repeat their training and have further discussions with their line manager.

People and their relatives told us they were happy with how staff minimised the risk of infection. This included wearing personal protective equipment, clean uniforms, and regular hand washing. One person told us staff were aware of their high susceptibility to infection so would not visit if they were unwell.

Staff told us before supporting people with their medicines, they needed to follow a very thorough process. This was to minimise any error and included various training courses, observing more experienced members of staff, and having their competency assessed. Leaders confirmed this and said focus had been given to enhance the safety of medicines. They said staff were required to take a photograph for verification and ensure each medicine was correct once dispensed from the pharmacy. Any abnormalities were then reported and addressed accordingly.

People told us their medicines were safely managed. They said staff reminded them to take their medicines or administered them from a monitored dosage system. People told us staff clearly recorded when they had administered the medicines and when they needed to be reordered.

Leaders had created a new job role to ensure oversight of people’s medicines. This meant a member of the office staff had been given overall responsibility and concentrated solely on people’s medicines. This included reviewing the accuracy of the completed medicine administration records and the organisation of staff training and competence checks. There was a detailed, up to date medicines policy and care plans contained information about any medicines people were prescribed. Additional safety steps such as checking the prescription and taking a photograph of any new medicine, had been implemented. This minimised the risk of error and included checking the ingredients of a topical cream to ensure it was not flammable and therefore suitable for a person who smoked.