Caroline Cares for You Ltd

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• 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

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.

This service scored 50 (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 and honesty. Staff listened to concerns about safety and investigated safety events internally. Lessons were learnt to continually identify and embed good practice.

The provider had systems in place to monitor and review incidents and accidents. Their response to incidents and accidents was prompt and focused on learning.

Throughout the assessment, the provider was receptive to our feedback and quick to learn from concerns we had identified. This included the Registered Manager attending additional training in areas we identified shortfalls in knowledge, promptly, before the assessment had finished.

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

The provider had tools in place to ensure safe and smooth transitions between health and social care services, such as Communication Passports. These contained key information in relation to people, such as how they communicated, what their likes and dislikes were and information about their conditions.

However, the provider had not ensured that tools in place to aid in emergency situations were effective or contained enough detail. For example. Emergency exit plans did not contain clear guidance on how to support people out of their homes should there be an emergency such as a fire.

The provider did not share concerns about safety, quickly and appropriately. Staff and leaders had insufficient knowledge and understanding about their responsibility to report safeguarding concerns.

We found that, overall, people were safe. When incidents or safety events occurred, the provider would investigate and take action internally, however, they were not upholding their duty to report concerns to external organisations. This included raising safeguarding alerts to Local Authorities and submitting statutory notifications to the CQC. This meant that multi-agency working didn’t take place to ensure a holistic approach to actions in response to events or incidents.

There were significant gaps in knowledge amongst staff and managers, and some were not aware that even when a safety event happened outside the hours of care they provide, that they still had a duty to raise a safeguarding alert to relevant agencies.

The provider did not always work well with people to understand and manage risks.

The provider had a policy in place which encouraged positive risk taking, however there was little evidence that this policy had been put into practice.

Risks were not thoroughly assessed which left people at risk of harm. For example, one person who received support with their medication, would take some of their medication themselves. This meant staff would prepare the medication before they left after their evening visit and leave it out for the person to take when they were ready. There was inadequate risk assessment around this practice, and we did not receive assurances that this process was managed safely.

Risk assessments and care plan documentation was vague and lacked evidence that people and their relatives were involved in the formulation and review.

The provider supported people within their homes, so they did not have responsibility over the environment, however some people and relatives told us that staff supported them to complete tasks around the home. There was little information or guidance within people’s plans in relation to these tasks, and staff’s responsibility.

The provider did not have environmental risk assessments in place for people’s homes.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

We found that staff were recruited safely and properly vetted before commencing work. Staff received an induction and a set of mandatory training courses before they begun work. This included face to face moving and handling training and medication training, and these were followed up with a competency assessment to ensure their practice was safe.

However, the provider did not ensure that staff’s training compliance remained safe, and we found that some staff had multiple mandatory training courses that had expired, meaning staff’s knowledge may not be current and up to date, and their skill may have deteriorated. To counter this, the provider completed spot checks on staff to assess whether they were competent to complete necessary tasks.

The provider assessed and managed the risk of infection.

There was adequate Personal Protective Equipment (PPE) in place and accessible to staff to provide care to people safely without risking the spread of infection.

We observed staff using PPE appropriately and correctly.

The provider had a policy in place which covered most aspects of infection prevention and control, with detailed information about correct handwashing procedures for example. However, there were some aspects missing, such as the correct procedures for donning and doffing PPE.

The provider did not make sure that medicines and treatments were safe.

The provider did not support all people with medication, and many were self-medicating. However, plans were not always clear and implied staff had some input in people’s medication even where they or their relatives were the ones responsible for this aspect of their care.

We found that where people had support from the provider with their medication management and administration, risk assessments were not adequate, and there was no system or process in place to monitor the temperature of people’s medication storage environments. Most of the medications we saw during our assessment, required to be kept below 25 degrees Celsius, we were not assured that the provider had oversight of this aspect nor could they provide assurances, that during the recent heatwaves, people’s medications had not become spoiled.

There was a medication policy in place, however it was not adequate and lacked information about key aspects, such as homely remedies and over the counter medications.

People had pro re nata (PRN) medications in place, but there were no PRN protocols or anything of a similar nature that instructed and guided staff on when and how to administer these, additionally, how long someone could take a PRN medication for before they needed to access a health professional for input.