Care Staff Services Ltd

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 inadequate. At this assessment the rating has remained inadequate. This meant people were not safe and were at risk of avoidable harm.

At our last assessment the provider was in breach of the legal regulations in relation to people’s safe care and treatment, staffing, and fit and proper persons employed. Improvements were not found at this assessment, and the provider remained in breach of these regulations.

The provider was no longer in breach of regulation relating to safeguarding identified at our last assessment. However, on-going improvement was required to ensure safeguarding processes were consistently followed and embedded into practice.

This service scored 34 (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.

Improvements had been made in relation to how accidents and incidents were reported and acted upon. An accident and incident log had been established which detailed the concern identified and action taken. However, we found this had not been updated to highlight actions and learning from the most recent events. This showed the system was not fully embedded into practice. In addition, there was no periodic review of accidents and incidents completed to ensure potential themes and trends were identified to further reduce risks to people’s safe care.

The manager told us they were taking steps to promote an open and transparent approach with staff. They described there being a ‘blame culture’ in the service which they were trying to breakdown, as this deterred staff from reporting concerns. They told us, “I want it to be open and have told staff they must report to us, and we can learn from it. It’s not about disciplining staff, but about learning.”

The provider did not work well with people and system partners to establish and maintain safe systems of care. They did not manage or monitor people’s safety well.

The provider had not established robust contingency plans to ensure people received the support they required in the event of an emergency or unforeseen events, such as a breakdown in the management of the service, bad weather, extreme staff shortages or road closures. There was no document to highlight who would continue to require support or at what level, who could be supported by family members and how contact would be made. This risk to people’s safety was significantly increased as the new management team had very limited knowledge of people’s needs or those of their families. There was no interim risk management plan in place to ensure people received their care safely whilst the manager and Nominated Individual learnt about people’s needs.

Whilst there was reference to emergency protocols within some people’s records, these lacked detail and guidance for staff. Examples included care plans which stated, ‘Contingency plan in the event of inclement weather or staff shortages: ‘The staff has to manage and visit service user’. As contingency information had not been collated into an overarching document, this meant staff would need to go into over 100 people’s care plans whilst dealing with an emergency. This put people at risk of not receiving the care they required in the event of an emergency or unforeseen circumstance.

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, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People and their relatives told us they felt the service kept people safe from harm. One person told us they trusted the staff supporting them. They added, “Although they know me very well, they never take advantage.” On the whole relatives told us they were satisfied their family members were safe from the risk of abuse when being supported by staff.

The provider had developed systems to record safeguarding concerns and ensured these were reported to the relevant authorities. However, whilst more recent safeguarding concerns had been acted upon, they were not recorded within this system. This meant there was a risk that concerns would not be fully reviewed and information may not be available to complete trends analysis and learning.

Staff confirmed they had received safeguarding training and were able to describe the different categories of abuse to be aware of and reporting procedures.

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.

Guidance in relation to people’s healthcare needs was not always available to staff. This included information relating to diabetes, epilepsy and asthma. Whilst basic information was provided there was a lack of guidance regarding how to identify potential concerns and the immediate action to take. This put people at risk of harm. In addition, risks in relation to people’s skin integrity and mobility were not always recognised and mitigated against. For example, skin integrity care plans for people at high risk of skin breakdown were not always implemented along with guidance for staff as to what signs of concern to look out for.

Risks to people’s wellbeing were not always monitored. Where care plans stated people’s fluid intake should be monitored due to risks associated with them drinking too much, this was not completed. For other people care plans highlighted people’s needs in relation to monitoring their catheter care. However, records of how this was monitored were inconsistent which meant there was a risk any concerns would not be identified.

Changes to people’s needs were not recorded in a way which gave staff clear information regarding the most significant risks. One person’s health care needs had changed significantly and meant staff needed to be aware of new emergency protocols. This information was written at the end of the person’s care plan as an update rather than being clearly visible and easily accessible to staff. This meant there was a risk staff would not be aware of this essential information.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

The provider did not have systems in place to support people in assessing the safety of their home. As highlighted during our last assessment, there were no risk management plans completed in relation to the external environment of the person’s home, fire management, and risks associated with utilities and the potential need to isolate these in the event of an emergency. This was of particular concern for people living alone and who were cared for in bed.

Information regarding the equipment people required to support them with their care was not always clearly identified within their care plans and there was no information for staff regarding safety checks they should undertake prior to using equipment such as hoists and stair lifts. The manager told us they were not confident that staff competency assessments in using equipment safely had been completed correctly.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

The provider had not ensured robust recruitment processes were in place. Following our last assessment, the provider had forwarded recruitment audits to demonstrate systems to ensure staff were safely recruited was in place. However, we found this was not the case. Concerns were identified for staff who had been recruited both shortly before and since our last assessments, such as gaps in employment histories, contradictory information regarding previous employment, internal references being provided on a regular basis and insufficient assurances from previous employers being sought. This put people at continued risk of receiving care and support from unsuitable staff.

We received mixed comments regarding staff skills and knowledge from people and their relatives. One relative told us, “Personally, I question how much relevant training they’ve had, or if they can remember it. They don’t even know how to turn [family member] safely. I don’t think they’re on top of the game.” A second relative said, “My [family member] trusts them now, they know what they’re doing.”

Records showed that staff had completed training relative to their role. However, there was no evidence available to show staff had been assessed as competent in areas such as medicines, moving and handling, and infection prevention and control. The provider told us they were looking to complete competency assessments with all staff although no date had been set for this work.

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 their relatives had mixed views regarding infection prevention and control. One relative told us their loved one developing an infection was their biggest fear due to staff standards of cleanliness. One person told us they felt staff were careful and always wore gloves when providing personal care.

Staff told us they had access to personal protective equipment such as gloves and aprons. They told us they had received training in infection prevention and control which they felt had been useful in their role.

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

Medicines were not always managed safely and guidance regarding indications of concern were not always clear. One person was prescribed time sensitive medicines which needed to be given within a 30-minute window each day. There was no written guidance to inform staff of this, and records showed the person’s medicines were not always administered in line with this guidance. The window for administration on the person’s medicines administration record (MAR) was between 6am and 9am. This put the person at risk of experiencing increased symptoms and discomfort from not having their medicines administered as required.

Where people were prescribed medicines to be used on a PRN (as required) basis, guidance was not always available to staff on when to administer. For example, one person required medicines to be administered to treat a serious health condition. There was no guidance for staff regarding what circumstances the medicine should be administered or what subsequent action they should take to keep the person safe.

Where people were prescribed anti-coagulant medicines, risk assessments and guidance for staff were not personalised and lacked detail. They did not refer to any specific needs and did not highlight the action staff should take should a person have a fall or bang their head.

The previous management team had informed CQC that staff had undergone medicines competency assessments to ensure they had the knowledge and skill to support people safely. However, the new manager told us they were unable to locate the assessments and did not feel staff had been adequately trained. Whilst they intended to arrange competency assessments for all staff, they had not implemented any interim systems to ensure more frequent observations or medicines audits to ensure this risk was closely monitored.

The lack of robust and detailed medicines systems put people at significant risk of harm, of experiencing pain and of a deterioration in their health and well-being.