Care Matters (Wiltshire) 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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

The registered manager told us they promoted ongoing development and a learning culture. This was evidenced when improvements had been promptly made following our inspection feedback.

The registered manager said they always talked to the person about any accident sustained, including any steps needed to minimise a reoccurrence. These steps were then discussed with the staff team. Staff confirmed this and said they were informed of any changes to a person’s support in a timely manner.

Staff told us a meeting was arranged to discuss the outcome of staff surveys. They said resolutions for improvement were agreed within the team. This ensured ongoing development within the service.

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.

A copy of the person’s care plan was sent with them if they were admitted to another service. A health care passport, which contained basic details of the person’s medical history, their medicines and communication needs was also sent. This provided the new service with information about the person and their needs.

Staff told us someone would be nominated to accompany the person, if they were anxious or had communication difficulties. This ensured the person had an advocate to help them express their needs effectively and understand what was being said to them.

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 and their relatives knew how to raise a concern but said they had not needed to. They were confident they would be listened to, and any issues would be satisfactorily resolved.

Staff had received training in safeguarding and were aware of their responsibilities to keep people safe. They said they would report any concerns immediately. Management told us they were always open and transparent and promoted this ethos within the staff team. They said they gained advice and discussed concerns with the local safeguarding team. There was a safeguarding policy for staff reference as needed.

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.

Care planning identified some risks people faced, but there was a lack of detail. The information did not demonstrate an assessment of the risk, or what action was needed to enhance safety. This included areas such as pressure area and catheter care, choking and the risk of falling. The risks associated with specific health conditions such as diabetes and epilepsy had also not been assessed. This lack of assessment did not always ensure sufficient action was being taken to enhance safety. However, staff knew people’s needs well and people had a consistency of care which reduced risks to people’s safety.

We discussed risk management with the management team and the registered manager immediately researched different risk assessment formats. After our site visit, the registered manager sent us assessments as examples of the work they were undertaking and progress being made. This provided assurance risks people faced were being reviewed and mitigated.

People and their relatives told us staff were flexible and helped manage any risks. Specific comments included, “They’re always nearby just in case” and “Balance and cognition are the biggest cause of risk. Sometimes she thinks she can do more than she really can, so they’re especially vigilant.”

The service used an electronic monitoring system, which identified if staff were running late or had not arrived at a person’s property. This minimised the risk of any support being missed and ensured a reliable service. One person told us, “They're totally reliable and have never let me down.” The electronic monitoring system highlighted to management if people had not received their medicines. This enabled action to be taken to minimise the risk of error.

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

Staff told us they were vigilant and checked the safety of the person’s environment whilst supporting them. This included identifying broken equipment, trailing leads or out of date food. They said they would discuss any concerns with the person or their family to enable action to be taken. One member of staff told us they were concerned about the safety of a person’s environment so contacted their placing authority. This had enabled a joint plan of action to be implemented.

Records showed risks associated with a person’s environment were assessed during their initial assessment. This included adequate lighting and ensuring windows and doors were secure. Records showed smoke alarms were in situ and fire escape routes were kept clear. The registered manager told us they would add details about any evacuation procedures.

The provider did not always make sure there were enough qualified, skilled and experienced staff. This was because recruitment procedures were not always in line with best practice. The provider made sure staff received effective support, supervision and development.

Recruitment records did not always show an attention to detail. For example, there were no records of the applicant’s interview, and feedback from the applicant’s present employer was not always sought. One record showed gaps in the applicant’s employment history without explanation. The registered manager told us most new staff were known or recommended to themselves or other staff. They said they were assured of the applicant’s qualities but would ensure improved recording.

People were very complimentary about the staff. They said they were supported by a small staff team who knew them well. One person told us the staff were “Absolutely charming.” People told us staff were on time and stayed the full allocation of their visit. They said on the rare occasion a staff member was running late, they would be informed.

The registered manager told us many of the staff team had worked at the service for many years. They said staff were experienced and supported people well. A member of the management team confirmed people were always supported by staff they knew. Any new staff were introduced and worked alongside a familiar staff member. This ensured confidence and consistency.

All new staff completed a detailed induction. This included a range of training and working alongside more experienced members of staff. One person told us they had met new staff, but they were always supervised. Records showed staff received regular support and supervision, and ongoing training to keep their knowledge and skills up to date.

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 told us staff demonstrated good infection prevention practice. They said staff regularly washed their hands and changed their personal protective clothing when required. One person told us staff were meticulous with their personal care as they were at particular risk of infection. They told us “Infection control is second nature to them.”

There were effective systems to prevent and minimise infection. This included staff training and regular audits of staff practice. Staff confirmed this and said their training included hand washing and how to safely put on and remove personal protective equipment. Staff said they could help themselves to personal protective equipment and always wore a mask if they had been unwell, or if a person wanted them to.

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.

The medicine administration records showed clear instructions, and staff had signed to demonstrate they had given the person their medicines. However, there was no written guidance regarding medicines to be taken ‘as required’. Staff told us people were able to ask for these medicines, but without guidance, there was a risk they would not be administered as prescribed or with maximum effectiveness.

Some people were prescribed high risk medicines such as anticoagulants. Whilst ‘high risk’ was identified on the medicine administration record, there was no further detail such as the risk of internal bleeding following a fall. Management told us medical assistance was always gained following an injury, but they would amend the records to ensure urgent assistance was sought.

People told us they were happy with the support they received with their medicines. They said staff prompted them to take their medicines and watched to ensure they had taken them.

There were systems to ensure the safe administration of people’s medicines. This included staff training and assessments of staff’s competence. The electronic care planning system highlighted if medicines had not been given, and there were regular audits throughout the day. This identified any errors so prompt action could be taken to minimise any harm.