We Do Care (London) 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

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.

We identified a breach of regulation in relation to safe care and treatment in that the provider had not ensured risks to people were assessed ad managed safely and that medicines were also managed safely. We also identified a breach of regulation relating to staffing as the provider has not always ensured staff received all the necessary and refresher training in a timely manner to ensure they could care for people safely.

We did not assess all the quality statements within this key question. We did not identify concerns relating to these areas which we judged as being met at our last inspection.

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.

There were systems to learn when things went wrong, although these were not always followed. During our assessment, we were informed of a safety incident that staff had not recorded in the accident and incident log. The service manager explained that the omission was due to staff error and assured us they would investigate the matter to prevent a future occurrence.

We found that most incidents, accidents, and actions were discussed in staff meetings to promote learning from safety events. The provider investigated incidents and accidents, taking appropriate action to support learning and prevent recurrence. For example, after a concern was raised in a staff meeting, the provider promptly addressed it by providing additional training and supervision to a staff member, ensuring they understood the correct procedures for safe care delivery.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were procedures designed to protect people from abuse. People and their relatives told us they felt safe with staff. A relative commented, ‘‘[Person] is safe with them. I have been there when the carers turn up and they take care of [them] very well.’’

People who used the service and their relatives said they had felt comfortable raising concerns, and the provider had taken appropriate actions to resolve their issues.

Staff told us they had undertaken safeguarding training to recognise signs of abuse and keep people safe. The provider had worked closely with the safeguarding authority to investigate potential abuse and to help put protection plans in place to prevent abuse in the future.

A review of staff training records showed that while most staff had undertaken safeguarding training, 1 staff member required refresher training, and 1 staff member had no record they had undertaken safeguarding training.

Risks were not always safely managed. This meant that assessments did not always consider risks related to individuals' health, mobility, or medicines. Where risk management plans were in place, these were not detailed enough to ensure staff had all the necessary information to deliver safe care and treatment to people. For example, the provider had not carried out an environmental risk assessment to identify the risks associated with the area where care was being delivered to help ensure the safety of people and that of the care workers. Additionally, the provider had not completed appropriate risk assessments where people were at risk of falls and skin breakdown, were prescribed flammable emollient creams, or required essential equipment such as wheelchairs, hoists, and slings.

One person using the service required support to manage their catheter, but their care plan and risk assessment lacked guidance on how to perform this task safely. They were therefore not protected from the risks associated with having a urinary catheter such a urinary tract infection.

Another person using the service required staff support to visit the park in his wheelchair. There was no guidance about this, or assessments of potential risks. Two people’s care records showed they had diabetes but there were no risk assessments in place to inform staff about how to mitigate the risks associated with diabetes.

Staff supported people using the service with food and drink preparation. However, the provider had not conducted a risk assessment or provided information about one person’s dairy allergy. As a result, staff were not fully informed or aware of the associated risks and how to mitigate such risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were not always provided with the training they needed to provide safe and good quality care or the refresher training they needed to ensure they continue to provide care safety to people. Staff supported people with diabetes, those at risk of falls, and those requiring catheterisation without prior training in these areas. This meant that staff might not have had the necessary skills or knowledge to care for those people safely.

However, staff felt supported in their role. They told us they had completed an induction programme. These included training, supervision, annual appraisal and spot checks to assess their knowledge and skills.

There were enough suitable staff employed to meet people’s needs. A person told us ‘’I have regular carers. 14 visits and at least 10 are the same carers.’’

There were safe recruitment practices to make sure that all staff are suitably experienced, competent and able to carry out their role. The provider had carried out a Disclosure and Barring Service checks. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The check helps employers make safe recruitment decisions.

There were systems to help prevent and control infections. Staff had received training on Infection prevention and control.

Staff told us they had understood IPC and wore personal protective equipment (PPE)to prevent and control the spread of infection to people.

People confirmed that staff wore gloves and aprons during visits.

Medicines were not managed safely. Out of the medicine administration records (MARs) we looked at, we noted that 2 people were prescribed 'when required' (PRN) medicines. However, the provider did not have PRN protocols in place to guide staff on when to administer these medicines and how to properly record their administration.

Staff had completed the MARs when administering prescribed medicines. However, we noted some gaps in signing the MARs. The service manager explained that these gaps occurred when medicines were given by relatives, or an external carer hired by the family. Not signing the MARs consistently can lead to medicines errors. The service manager told us that they would remind staff to clearly document on the MARs when medicines had been administered by relatives or other professionals involved in the person’s care.

At the time of our assessment, we found that people’s care plans did not include a list of their medicines and information about them. This meant that staff may not always be aware of the signs of harmful side effects or adverse reactions associated with the medicines so they could recognise these if they happened and take action.

However, staff undertook training on medicines administration and the provider carried out spot checks on medicines administration to ensure that staff followed the medicines procedures.