Supreme Care Services Limited

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 legal regulation in relation to safe care and treatment.
 

This service scored 62 (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. We found that incidents and accidents forms were appropriately recorded and completed in full. The provider communicated safety events and the actions taken at staff meetings to support shared learning and continuous improvement. Staff confirmed that safety events and the actions taken were shared appropriately to support learning.

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. The service completed an initial needs assessment before people started using the service. Staff involved people and their relatives to develop the care plan. A relative told us, ‘‘Care plan was discussed initially and [family member] needs were considered.’’ Information about people’s needs was documented within their care plans and was shared with staff to guide the delivery of care and support.

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 told us they felt safe with staff and were aware of who to contact if they had any concerns regarding abuse or neglect. People using the service told us, ‘‘I feel quite safe and happy”, ‘I do feel safe as I see 2 lovely carers every day’’ and ‘‘[Family member] feels very safe.’’
Following a safeguarding concern, we found that staff completed safeguarding report forms. They completed these in full, and protection plans were put in place to keep people safe. Staff confirmed that they knew how to raise concerns and had received training in adult and child safeguarding, enabling them to recognise the signs of abuse or neglect.
 

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. 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 completed appropriate risk assessments for mobility equipment, including wheelchair, and specialist mattress. Additionally, appropriate risk assessments had not been completed for risks associated with asthma, fire, catheter care, and wound care. Additionally, appropriate risk assessments had not been completed for risks associated with asthma, fire, catheter care and wound care. This meant staff did not always have the necessary information to provide safe care and support or guidance on how to manage these risks safely.
We spoke with the registered manager, who informed us that they would update risk assessments where required to ensure people’s safety.
 

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff had received appropriate health and safety training, including fire safety, to ensure they understood how to respond in an emergency. The provider also had robust risk assessments in place, covering environmental risks and the steps needed to reduce them.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff had received training that was appropriate and relevant to their roles, including autism care, catheter care, epilepsy awareness and conflict resolution. They were also supported through regular supervision, annual appraisals and spot checks to assess their knowledge and skills.
The provider had completed Disclosure and Barring Service (DBS) checks or Right to Work checks appropriately prior to staff starting their roles. A DBS check is a record of a person’s criminal convictions and cautions. These checks help employers make safe recruitment decisions.
There were enough staff employed to meet people’s needs to ensure people get the care they need when they want it. People experienced continuity of care. They told us they were supported by a regular staff team, with care delivered through an agreed routine. The provider used an on-call monitoring system to maintain oversight of service delivery. This included monitoring staff attendance and punctuality through electronic call monitoring and scheduling systems, which recorded arrival and departure times. People using the service confirmed that staff arrived at the planned call times and stayed for the agreed visit length.
 

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 told us they understood Infection prevention and control (IPC) policies and wore personal protective equipment (PPE), such as disposable gloves and aprons, to help prevent and control the spread of infection to people. People using the service confirmed that staff wore gloves and aprons when delivering personal care. A relative told us, ‘‘Good hygiene is maintained and correct PPE are worn always.’’ In addition, staff had received food hygiene training to ensure that they understood how to handle, prepare, and store food properly to prevent illnesses.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. There was insufficient oversight of medicines management in line with current legislation and guidance. Staff had completed medicines administration records (MAR) when administering prescribed medicines. However, we noted some gaps in signing the MARs. The provider had not put measures in place to address these gaps, which were required to ensure safe medicines practices. For 1 person, we found that staff had not administered 1 medicine on several occasions due to reported side effects, including diarrhoea, vomiting, and nausea, without seeking input from a healthcare professional.

Individual ‘as required’ PRN protocols were not consistently in place. For example, we found for 1 person PRN protocols were not in place where required to guide staff on when to administer this medicine and how to accurately record its administration.

The provider did not always record information about medicines in people’s care plans. This meant that staff may not always have been aware of the signs of harmful side effects or adverse reactions, reducing their ability to recognise and respond appropriately if these occurred.
We spoke with the registered manager, who told us they would update the MAR charts and put PRN protocols in place for individuals who required them.