Oswestry Also known as Approved Care and Support

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 requires improvement. At this assessment the rating has remained 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 regulation 12 relating to people’s safe care and treatment. Not all service users had health-specific care plans and necessary risk assessments in place, and there were concerns regarding the safe management of medicines.

This service scored 56 (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.

During this inspection, we identified repeated concerns regarding care planning and risk assessments. As noted in the previous inspection in 2020, the service did not consistently maintain health-specific care plans and risk assessments for all people using the service. Similar themes were observed during this assessment, indicating learning from past findings had not always been embedded into practice. However, we found evidence of strong processes in other areas.

The service had a clear and structured process in place for managing complaints. During the review, we noted three complaints had been submitted, all of which were handled in accordance with the service’s policy. Each complaint was investigated, and feedback was provided to the individuals who raised the concerns, demonstrating transparency and responsiveness. In addition, measures were implemented to reduce the risk of recurrence, and these actions were discussed at the subsequent focus group meeting to ensure the wider team was informed and engaged in learning.

There was oversight of accidents and incidents, supported by a reporting process facilitating timely escalation and resolution. Evidence showed learning outcomes were shared both with the individuals directly involved and with the wider team, reinforcing a culture of learning. Furthermore, care records confirmed staff took immediate and appropriate action to support people when incidents occurred, ensuring their safety and well-being.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

We found systems were not effective in ensuring health specific care plans, such as those for diabetes or epilepsy were in place. We also found risk assessments had not always been completed. For example, a moving handling risk assessment was missing for one person. This meant staff did not always have guidance to support people safely. This increased the risk of people receiving unsafe care and support. These issues were identified during the previous inspection in 2020,indicating continued ineffective systems.

Risk assessments were embedded within the care plan documents, which led to inconsistencies regarding individual risk. For example, one person was initially assessed as low risk for falls but later in the same document was noted as high risk. We also found where local authority assessments were in place, key information was not fully transferred into the care plans. For instance, a local authority document recorded one person had a diagnosis of autism, but this was not reflected in their care plan. This omission placed the person at risk, as appropriate support could not be provided.

Staff told us information was shared with them via email, and they had access to care plans through phone systems. They also advised they communicated any changes in need to the office and care plans were often updated to reflect these changes.

The provider was responsive to the concerns we raised and acted to ensure people were protected from the risk of harm.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidableharmand neglect. The provider did not always share concerns quickly and appropriately.

We found the provider did notalways recognise incidents as safeguarding concerns. For example,a medicine error was not reported to the persons GP, the local authority orCQC.We also found another 2 safeguarding concerns which had not been reported or documented correctly. Failure to ensure safeguarding concernswerereported to relevantprofessionals increases the risk of recurrence, which placed people at an increased risk of harm.

Staffcompletedsafeguardingtraining and were able to explain how to recognise signs of abuse. They told us they would report any concerns to the office forescalationas necessary. We saw evidence confirmingstaff reportedconcerns to the office asidentified. People and their relatives told us they felt safely cared for.Comments included,“Staff treat us exceptionally well they are lovely people. Wehaven’thad any problems; we feel safe.We would raise any issues with managementwe’vemet them a few times, or the supervisor. It seems very well run.”

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 that was safe, supportive and enabled people to do the things that mattered to them.

We found there had not been sufficient improvements following our previous inspection in 2020. Risk assessments were not consistently undertaken for specific health care needs, including diabetes and catheter care. Staff did not always have guidance to ensure they could support people safely. For example, where people were supported to transfer using moving handling equipment, manual handling risk assessments were not always in place. Failure to ensure risk assessment were completed and staff had access to accurate guidance increased the risk of people receiving unsafe care and support.

We received mixed feedback about how all staff managed individual risks. For example, one person told us staff were good, well trained, and competent. They said they felt confident and safe with these staff; however, they did not feel confident with some staff, particularly regarding manual handling. Another person also expressed a lack of confidence in some staff in relation to manual handling. They explained they were not always comfortable in the way they were supported, and they had shared this the management team. We found the feedback the person shared did not align with the risk assessment in place. Failure to ensure staff followed guidance placed people at an increased risk of harm.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We saw environmental risk assessments were in place and care plans included recommendations to help keep people safe within their own homes. This included guidance for ensuring areas were left clean and tidy following support calls. We also noted a fire risk assessment for one person who smoked in their home, which had been completed with support from the fire service. The service worked closely with the fire service to deliver fire safety training to staff, the fire service confirmed the provider sends relevant referrals to help keep people safe from fire within their 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.

We found there was a robust induction and annual refresher training process in place. However, we identified a medicine error where the staff member involved had not been competency assessed following initial training or after refresher training. This meant the provider could not be assured the staff member was applying their training correctly. The provider told us and provided evidence they had sourced further training in this area to ensure people received their medicines safely.

We found some health-specific training was delivered, such as dementia awareness and catheter care. However, other health-specific training, such as autism awareness, was not provided to all staff; although those working directly with people with these needs had completed the required training. The provider advised that autism awareness training had been sourced and rolled out to all staff following our visit and this would form part of their mandatory training. We also found all staff had either completed or were in the process of completing an NVQ or Care Certificate. One relative told us, “Staff seem to work together to understand and meet (people’s) needs, they seem well trained and do a good job.”

Some people who use the service told us staff did not always stay for the full duration of their care calls. Others shared staff remained until all tasks were completed, sometimes staying beyond the scheduled call time to fully support them. We found no evidence of any missed care calls. During focus group meetings, we saw the issue of staying for the full care call duration had been addressed with care staff.

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.

We found good processes in place regarding infection prevention and control, supported by a robust policy and procedure. We observed a staff member visiting the office to collect personal protective equipment (PPE) and saw a delivery of PPE to the office. We were informed PPE supplies are maintained within people’s homes and managed collaboratively by office staff and care staff. Infection prevention and appropriate PPE use had been discussed during focus group meetings, and staff demonstrated awareness of infection prevention processes and procedures. However, one person raised a concern telling us, staff sometimes used the same gloves for personal care and food preparation. No other concerns were shared with us regarding infection prevention.

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.

We found evidence of a medicine error involving a controlled drug. The incident was reported by staff; however, the investigation took three weeks to complete. During this time, there were no assurances that immediate action had been taken to address the concern. It was also unclear whether any further medicine errors had occurred. The investigation report stated the staff member advised the incorrect dose had been administered since their start date, indicating a potential three-month period of errors. The provider did not follow up with the person’s GP, this meant there had been no assessment of whether the person had to come to harm as result of the error. We also found there were no PRN (as and when required) medicine protocols for this person, despite them being prescribed medicine on a PRN basis. PRN protocols are essential to ensure safe administration, provide clear guidance for staff, and support appropriate monitoring of effectiveness.

We found there were systems in place to audit and monitor medicine administration. Where medicines had not been signed for as administered on the electronic system, the office followed up to confirm whether it had been given as prescribed. The registered manager informed us there are occasional issues with signal connectivity, which can impact staff’s ability to record medicine administration in real time. However, the registered manager stated these instances are always followed up and checked. Concerns regarding the signal had been reported to the system administrator.