The Business Centre

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 safe care and treatment. People’s medicines were not always managed safely or given as prescribed.

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. Lessons were not always learnt to continually identify and embed good practice. Accidents and incidents had been reported, and investigations had been completed. However, some incident records did not provide an outcome, therefore it was difficult to understand if effective action had been taken. For example, 1 incident involved a person making accusations about staff, there was no evidence the provider had taken steps to protect both the person and staff following the accusation. People and relatives had raised concerns in relation to the timings of their calls. The provider had not completed an effective action plan or acted on the concerns to make improvements.

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. Staff understood how to protect people from harm and had received the relevant training. They told us they knew where access information to report any concerns. Safeguarding concerns were recorded and reported to the relevant bodies, but it was not always clear on how the concerns had been concluded, we shared this with the provider to ensure all documentation offer's a clear outcome..

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. Staff understood how to protect people from harm and had received the relevant training. They told us they knew where access information to report any concerns. Safeguarding concerns were recorded and reported to the relevant bodies, but it was not always clear on how the concerns had been concluded, we shared this with the provider to ensure all documentation offer's a clear outcome..

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs which was safe. The provider did not always identify, or risk assess people’s specific support needs. For example, some people’s care plans lacked information and guidance on bowel management support, which posed a risk staff as may not recognise or take action when people’s symptoms changed. People told us they felt safer with staff supporting them, 1 person told us, “I do feel safer with them coming I wouldn't have a shower without them”. Another person said, “We feel very safe with them; they seem to be confident in what they do”. The service operated a 24-hour on call system to support staff. The provider had a business continuity strategy which planned for emergency situations such as extreme weather, vehicle breakdowns, staff shortages and illnesses.

The provider detected and controlled potential risks in the care environment. People did not raise any concerns in relation their home environment not being safe. The provider carried out environmental risk assessments to guide staff in the event of an emergency such as gas, electric, heating and identifying emergency exits.

The provider did not always make sure staff had received the relevant skills and training to complete their roles. For example, staff had not received additional training to support a person’s neurological needs. We were not assured staff were always safely recruited into the service. We reviewed staff personal files, where 2 staff members had gaps in their previous employment history. One staff member did not have their previous employer's reference from their position in Health and Social Care, despite it being cited on their reference request form.This is a repeated concern for the provider. This meant we could not be assured the provider had followed safe recruitment processes in order to ensure staff employed were suitable. We received mixed feedback regarding people’s call times and duration. Some people said they would prefer times to be more consistent whilst others seemed happy with their call times and said, “They come in when they should, keep to times as much as possible”. The Electronic Call monitoring data suggested not all people received their fully allocated care times and staff did not always arrive at the scheduled time. This meant we could not be assured people received their care and support as planned.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading. Staff told us the provider ensured there was enough appropriate personal protective equipment (PPE) available. Staff were also able to access this on weekends when the location office was closed. People told us staff wore the appropriate PPE when delivering care and support.

The provider failed to make sure medicines and treatments were safe to meet people’s needs, capacities and preferences. Medicines processes were not always effective in ensuring people received their medicines safely. Time specific medication was not administered as prescribed for a person which put them at risk of harm. Records showed us there had been inconsistent call times for people with time specific medicines. We identified 2 people who were prescribed bowel medication who did not have the appropriate documentation or guidance for staff to follow. Topical creams were not being recorded at each application; therefore, we could not be assured people had their creams applied as prescribed. The provider’s medication policy did not incorporate topical creams advice or administration. We shared this with the provider to start taking action. Staff told us they felt they had received the relevant training to complete their roles which included the safe administrations of medicines.