Wisteria Care

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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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last inspection this key question was rated good. At this assessment the key question 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 regulations in relation to safe care and treatment.

This service scored 53 (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 ensure there was a positive and proactive learning culture.

There were processes in place for reporting incidents, however when incidents occurred, associated risk assessments were not always put in place. The registered manager demonstrated there had been a reduction in incidents for 1 person. Staff had identified a trigger to the persons anxiety, however, the information regarding this was not in their care plan. There was not a formal process for staff debrief or record of learning on incident forms which meant opportunities for learning could be missed. We received mixed feedback from staff relating to learning from incidents. Comments from staff included, “Managers send out regular emails with lessons learnt to staff”, “The manager calls meetings for us to discuss what happened and how to avoid it. They do send out emails if anything happens, so we know what to do if we find ourselves in the same situation” and “Yes we have to raise a concern, we don’t get any feedback, we get emails at the end to say if they’ve been to hospital but there’s no learning.”

The service did not always effectively work with people and healthcare partners to establish and maintain safe systems of care. Systems to support people safely through pathways and transitions were not always effective. The service worked with health and social care professionals, including discharge teams, however some people’s documentation was incomplete. We received mixed feedback from professionals regarding communication and the quality of daily notes. One professional told us, “We have struggled to get timely records from the service.” Another professional told us the service was good at “Providing information promptly when required.”

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 told us they felt safe with staff. One person told us, “I feel very safe, all staff are trustworthy and helpful.” Another person commented, “I get on well with them all, I feel very safe, they are all trustworthy and helpful.” Comments from relatives included, “[Name of relative] does feel safe since the transition from hospital to home, no abuse, far from it” and “We do feel safe as we know them all [staff].”

Safeguarding systems were in place. Safeguarding concerns were raised appropriately and referrals made when required, and managers demonstrated openness with external agencies.

Some staffs understanding of safeguarding and whistleblowing procedures varied, most knew about reporting concerns to external agencies. Prior to our assessment the registered manager circulated information to all staff about safeguarding and whistle blowing procedures and checked staff understanding during staff supervision.

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

We found shortfalls in risk assessments relating to supporting people with diabetes, moving and handling, pressure care, catheter care and safe eating and drinking plans. For example, we found conflicting information in 1 person’s care plan relating to their speech and language therapist eating and drinking plan. Staff told us another person had a pressure sore; there was no information or guidance available for staff in this person’s care plan. This placed people at risk of harm. One person had diabetes, there was no guidance or risk assessment in place to inform staff of the signs if the person was becoming unwell. Not all staff were confident to recognise the signs of a person with diabetes becoming unwell. This placed the person at risk of not receiving appropriate support if they became unwell.

The provider had a system to detect potential risks in people’s homes. Environmental risk assessments were completed. Where risks were identified, such as mobility hazards or unsafe home conditions, the registered manager gave examples of how they worked with other agencies to reduce harm. People and their relatives told us staff used equipment safely. One person told us, “The staff are all trustworthy and helpful, I have a slide board, sheet and commode, they are all used safely to get me in my wheelchair.”

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.

We received mixed feedback from staff regarding staffing. Some staff told us they felt rushed and travel time was not always factored into their runs. One staff member commented, “Travel time is my main problem, sometimes there is [travel time] but it’s not enough. If it’s an out-of-town visit 15 minutes away, you only get 5 minutes travel time.” Another staff member told us, “There’s not always enough time to travel.” We reviewed the providers scheduling system and identified some of the runs did not have realistic travel times factored in. We discussed this with the registered manager who told us they had been working on the schedules to cluster calls together and reduce travelling time. The registered manager had also arranged for drop-in sessions for staff to attend and raise any concerns with managers regarding their rotas and the runs.

We received some mixed feedback from people and their relatives regarding staffing. Some people commented that staff rushed and did not always stay for their allocated time. Comments from people included, “Carers don’t always stay the correct time, it can vary. The office does respond and things have got better” and “I’m fairly satisfied with the continuity, but their time is limited. They are rushing in and rushing out all the time.” We reviewed people’s daily notes and could see where staff had not stayed for the full time of the visit, staff had asked people if further support was required and people had confirmed staff could leave. Although most people were happy with timings of visits, we received some comments where they were not. One person told us, “The rota can keep changing sadly which can be erratic”, and another said, “Visit times can be hit and miss.”

People told us staffing was mainly consistent. One person told us, “I usually see the same carers, familiar faces, on time, no complaints, no missed visits.” Other comments from people included, “I do see different carers, they stay their time, haven’t been late and no missed calls.” A relative commented, “We have 3 carers that alternate. We are happy with the continuity and familiarisation of the staff.”

The provider had a training programme to ensure staff received training relevant to their role. We received mixed feedback from staff relating to the training they received. Not all staff felt confident in supporting people’s specific needs such as diabetes and catheter care. Staff also told us they would benefit from more face-to-face training. We discussed this with the registered manager who told us they had already contacted a team in the local authority to arrange further training for staff. Staff had received training relating to supporting people with a learning disability and autistic people. They were looking at sourcing further training to ensure staff received appropriate training.

Most of the comments we received from people and their relatives regarding staff skills and training were positive. One person told us, “There are no training issues with any of the carers.” One relative told us how they felt some staff were not confident supporting their family member during moving and handling transfers. We discussed this with the registered manager who gave us assurances regarding the training staff received. They also told us they received regular feedback from people and would address any concerns raised regarding training.

There was a system in place to ensure the safe recruitment of staff. We identified 1 staff file where the most recent care employer had not been contacted for a reference. The registered manager told us they would address this.

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 relatives told us staff used personal protective equipment (PPE) appropriately and maintained good hygiene. Staff had access to appropriate PPE.

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

There were gaps in some medicines administration records. For 2 people these gaps involved anticoagulant medicines that should not be omitted unless in consultation with a clinician. Staff could not tell us why these medicines had not been given or what action had been taken. We were not assured that staff were aware of the risks associated with missing anticoagulant medicines and this placed people at risk of harm.

Care plans did not contain information on how people liked to take their medicines. Care plans lacked detail to support the safe use of some medicines. For example, for people prescribed high risk medicines associated with a risk of bleeding and bruising there was no risk assessment in place to support staff to manage this scenario.

Care plans contained no information to support staff with the use of “when required medicines” such as painkillers and medicines to relieve chest pain in an angina attack. Staff did not always assess people’s capacity and in some cases, staff could not tell us when these medicines should be used or what they were prescribed for. This meant people may not always receive their medicines as prescribed or when needed. Staff were not always aware of what action to take if “when required medicines” did not have the desired effect.