Karrek Community

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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 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 provider ensured all accidents or incidents that occurred were fully investigated and any areas of learning or improvement identified. Where issues were identified in relation to individual staff actions, additional support and refresher training was provided. Where staff performance failed to improve, disciplinary procedures were used appropriately.

Planned care visits were infrequently missed. Each missed visit was fully investigated to prevent recurrence and written apologies given to people detailing the circumstances of each missed visit.

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.

Summary information about people’s specific needs and preferences was available to be shared with health service colleagues in the event a hospital admission became necessary. When care was transferred to other providers, the service shared information openly to ensure people’s specific needs were recognised and understood.

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 consistently reported and demonstrated through their actions that they felt safe with their support staff. We observed people were comfortable requesting support and reassurance from staff. People told us, “I feel really safe with them”, “I feel safe with carers”, “Their duty of care is really good. I feel safe with them” and “I have one consistent carer, and I know all the ones who come. I feel very secure with the care and how it is arranged”.

Involved heath care professionals were confident the service provided safe care. They told us, “The provider shows a proactive approach in adapting care to changing circumstances, ensuring that people feel safe, respected, and valued”.

Staff had a good understanding of local safeguarding procedures and were confident any safety issues they raised would be investigated and resolved. Staff said, “If I raised a safeguarding, it would be acted upon, 100%.”

Where people lacked the mental capacity to make specific decisions and their care plans were potentially restrictive, these issues had been reported to the local authority for authorisation via the Court of Protection. Where orders were made, any related conditions were understood and had been complied with.

There were processes to ensure people were protected from financial abuse,where the service provided support with shopping tasks, records and receipts were maintained for all purchases made.

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.

Staff were confident people were safe, risks had been identified and during home visits we observed risks were mitigated effectively.

People reported their visits were not missed. Their comments included, “They have never missed a visit”, “No missed visits that I can remember” and “You can guarantee the carer will be on time”. Where staff arrived early for a visit, they waited nearby until within 15 minutes of the planned visit time. This prevented early staff arrivals from impacting on people’s normal routines.

Where staff were unable to gain access to a property or contact a person at the time of a planned visit this was reported to managers and further investigations completed to ensure the person’s safety.

Specific risks associated with people’s support needs had been identified and mitigated. We observed staff acted on guidance provided to ensure people’s safety. People told us they felt comfortable and safe while being supported to mobilise.

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 supported people to manage risks in their home environments and ensure all equipment necessary to meet people care needs was regularly serviced.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, some staff had been permitted to work excessive hours with insufficient rest.

People reported their staff normally arrived on time and records confirmed this. When staff were running late managers contacted people to advise them of the expected delay. People’s comments included, “The staff are very good, they do what I need them to do”, “The carers come on time” and “The staff are very skilled and competent”.

The service rotas were well organised and included appropriate travel time between planned care visits. Staff told us “We get the rota a week in advance”.

People told us they were supported by small staff teams who visited regularly and that they valued this continuity of care. Their comments included, “I have 2-3 different carers and have got to know them. They come on time and are reliable”, “The consistency of staff is good” and “We see the same staff, that’s a good thing that”.

However, we found some staff were working excessive hours with insufficient rest. For example, one staff member had worked every day for the 4 weeks prior to the inspection and had worked on average over 80 hours during each of these weeks. Three other staff worked an average of over 70 hours per week in the same period. These working practices meant people may have been receiving support from staff who were tired. This put them at risk of receiving poor quality care. Prior to the inspection the provider had identified a small number of staff were working excessive hours. These staff had been offered additional support and managers had confirmed staff had requested these working hours.

Following feedback, the provider developed a new policy to limit the maximum number of hours staff routinely worked to 60. In addition, an approval process for staff working up to 70 hours in response to an emergency was introduced.

Staff were recruited safely and necessary pre-employment checks had been completed. Staff described how people they now supported had been involved in their recruitment processes.

Staff new to the care sector were supported to complete the care certificate as part of their training and induction shifts were completed before staff provided support independently. Staff told us they received regular training updates and were confident they had the skills necessary to meet people needs.

Supervision was provided regularly and team meetings held to provide opportunities for information sharing and reflection and learning. Staff comments included, “I am up to date with my training”, “We do training regularly, occasionally online, sometimes in person. I had First Aid training this month. There is some training to do most months” and “We had a staff meeting 3 weeks ago”.

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.

Staff had access to good stocks of Personal Protective Equipment (PPE) and received training in the management of infection control risks. During our home visits staff managed infection control risk effectively and PPE was used correctly.

People recognised staff took action to help them manage infection control risks and we noted during home visits that rooms were clean, and people well dressed. People’s comments included, “They are very particular about using PPE, I like it that they change gloves between doing different tasks”, “I’m very happy with how they maintain hygiene, they use gloves and aprons and clean up after themselves” and “They uphold high standards of cleanliness.”

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 were confident staff understood how to safely support people to manage their medications. We observed during most visits staff were responsible for prompting and reminding people to take medications. People told us, “The carers ask if I have taken my tablets, and on the days I don’t have support, they ask when they phone me” and “I see to my own medicines, but they check that I’ve taken them”

Medicine Administration Record charts were accurately completed and demonstrated people had received their medicines as prescribed. Where errors occurred, these were reported promptly to the office, guidance sought from health professionals where necessary and staff actions investigated to identify any areas of improvement or learning.