Coast Community Care

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 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment. This included risk management, staff training and ongoing support.

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.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. There were no processes in place for capturing lessons learned or the sharing of either positive or negative patterns with staff. No analysis took place of repeat incidents for example falls. Accidents and incidents were recorded within care plans and the registered manager had the ability to view and oversee each one. Not all records had been supervised or audited by the registered manager and there was little ongoing instruction for staff following incidents. Issues were sometimes discussed at handover meetings. Staff knew the process to follow if an accident occurred and relatives told us they were always informed and that communication with the service was good.

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. The registered manager told us of positive professional working relationships with the local authority, GP surgeries and other professionals involved in people’s ongoing support. Most health and social care appointments that people needed were arranged by family members but sometimes, when needed, staff would help. Transitions into the service ran smoothly with people receiving support to settle in and adjust to the level of care they required. When people needed to move to and remain in hospital for any period of time, the service supported and a ‘hospital passport,’ document containing key health and personal information about people, was provided by the service. In the event of people’s needs increasing and being no longer able to remain within their own home, the service worked with the local authority to secure the most appropriate residential or nursing service to meet their needs.

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 loved ones told us they felt safe when being supported by staff. Comments included, “Yes, she is very safe. She could not do without them,” “Yes. He is very safe. They follow all the procedures to keep him safe” and “Yes. I am with her all the time.” Staff had received training in safeguarding and knew what signs to look out for and told us they were confident in the actions they would take. One staff member said, “Check person is all right. May need escalating, call office, 999 if needed. Talk to client and make safe.” Another added, “Make me and them safe. Record and tell office.” Managers knew the process of how to alert the local authority and the CQC in the event of a safeguarding issue. Staff were aware of the whistleblowing process and told us they would make a call if they had any concerns about people’s safety.

The provider did not 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. Not all known risks to people had been fully documented and there were risk assessments missing. Some risk assessments lacked instruction or advice to staff as to recommended actions in an emergency. Staff training did not match the risks they were expected to manage. Some people lived with epilepsy. In two cases there was no epilepsy risk assessment in place and in another the assessment provided no helpful instruction to staff in the event of the person experiencing a seizure. Staff had not received training in epilepsy. In another case a person lived with swallowing difficulties but there was no advice relating to the type and texture of food to be provided. It was recorded that cereals had been provided which could potentially cause a choking incident. Some people required equipment to help them with movement and transfers. Some people had Waterlow scores in place with some shown as being at high risk. Waterlow scores indicate a person’s likelihood of developing pressure sores. There was no instruction to staff relating to these scores, or how to move people safely and to minimise the risk of pressure sores developing or what action to take if they discovered a pressure sore area. Some people lived with substance dependency issues for example, alcohol. Although these were largely managed there were no risk assessment in place to advise staff what action to take in the event of a re-lapse. All of these concerns were raised with the registered manager and wider management team and they agreed to take action to resolve these matters. However, it would take time for all of the documentation to be completed and for staff to be fully appraised of all risks and expected actions to take.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. As part of the pre-assessment process the registered manager or other senior member of staff carried out a home visit. These visits included getting to know the person and their preferred environment, how and where they preferred to spend their time and if there were any environmental risks that needed to be assessed and recorded. These risk assessments included details of how staff were to access people’s homes, where water stopcocks and electric mains switches were found and any risks associated with trip hazards for example pets living in peoples home or any obstacles that may present trip or access concerns. Staff told us they had opportunities to read the environmental risk assessments and any updates, before entering people’s homes.

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 staff training was out of date and some key training modules had not been delivered. 12 members of staff were shown in ‘urgent’ need of training in supporting autistic people and in diabetes training. There were several people living with these needs that were being supported. There were similar shortfalls in some areas of medicines training for example, 10 staff overdue training in medicines administration and 9 overdue in medicines awareness. No training had been completed for epilepsy. There were inconsistencies on the regularity of staff supervision meetings. The registered manager told us that face to face staff supervision meetings alternated with on-site spot checks, unannounced visits by supervisors to check on staff practice, every 2 months. However staff feedback varied on the frequency, some telling us it followed a 2 or 3 month cycle but others stating they had only had 2 in the past 12 months. Staff had been recruited safely and staff files contained documentation confirming this. Documents included, references, interview notes and Disclosure and Barring Service (DBS) checks. DBS checks assisted managers in making safer recruitment decisions. People and their loved ones told us there were enough staff and there was a process in place if staff were delayed and running late for a care visit that involved the office calling them to forewarn them.

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 loved ones told us that staff wore personal protective equipment (PPE) appropriately. Comments included, “Yes. One came round today and they had a gown on and bags over their shoes. They all do wear PPE,” “Yes, they do wear shoe covers, aprons and gloves” and “Yes and if and when needed they dispose of it appropriately.” Staff confirmed they had plentiful and accessible supplies of all the PPE they needed. Infection prevention and control policies were in place and reviewed regularly by the registered manager.

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.Relatives told us they struggled to get their loved ones medicines reviewed by GPs or specialists and that the service did not help with this process. Some people told us they had been waiting several months and in one case over a year for a medicines review. One relative told us that their loved one had been prescribed PRN (as and when required) medicines for over a year and they were anxious to get this reviewed. Staff had received medicine training although there were some gaps identified, (see safe and effective staffing). Medicine competency checks were carried out but staff were inconsistent in how frequently these took place. Some staff told us they had only had 2 checks in 3 years. The service policy stated these should be carried out yearly. Staff were able to tell us the steps they would take if medicines were spoilt or if people refused to take them with one telling us, “Try my best to encourage and support them. Call office if not.” Medicine Administration Records (MAR) were held on an application on staff mobile phone and had been completed correctly with a colour and letter code used for each administration.