Support Care Services

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 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.

We found the provider to be in breach of 1 legal regulation in relation to recruitment.

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 culture of safety and to identify and embed good practice. Systems were in place to respond and monitor accidents and incidents if and when they occurred. The registered manager told us there had been no accidents and incidents; however, they were aware that any lessons learnt would be used to improve the quality of service and relayed to staff in staff meetings to embed good practice. The registered manager told us she would always respond to any concerns and ensure issues were always resolved. This was reflected in the feedback we received from relatives. A relative told us “[Registered manager] did contact me once with a concern they had about something and discussed the options with me. She recommended a course of action and then monitored it herself until she was satisfied that the problem had resolved. We were very impressed.”

Care records included prompts in relation to maintaining people’s safety and reporting and recording of accidents and incidents. Staff were aware of actions to take in such instances. A staff member told us, “Any accidents, we call the manager, record the incident, let the family know and if it’s an emergency, I will call the ambulance.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care. Systems were in place to ensure continuity of care. Care and support was planned and organised with people, relatives and relevant healthcare professionals in ways that ensured continuity and managed to keep people safe during their care journey. A relative told us, “They [Support Care Services] appear to have a very comprehensive approach and will contact other healthcare professionals if necessary for us.”

The provider worked with people and healthcare partners to understand what being safe meant. People and relatives told us they felt safe using the service. A person told us, “They come to help me have a shower and I feel so much safer with the carer here.” A relative told us, “[Person] had resisted care for so long, so initially was understandably anxious and nervous about having someone in the house. The carers have been so delightful, calm and patient that [person] has accepted them well and feels safe with them around.” Another relative told us, “I am very happy that [person] is being kept safe as the staff will do anything to help.”

There were systems to protect people from the risk of abuse. There were safeguarding and whistleblowing policies in place to report potential abuse. The registered manager told us there had been no safeguarding concerns. Staff had completed safeguarding training and were aware of the different types of abuse and reporting procedures to follow if they had any concerns.

The provider did not always work well with people to manage risks. Risk assessments were in place which covered areas such as continence, falls, washing and bathing, fire, health, medications, mobility, moving and handling and skin integrity and provided some information to minimise risks and measures for staff on how to support people safely. This helped ensure people were supported to take responsible risks as part of their daily lifestyle. However, there were some instances where risk assessments were incomplete.

For example, the risk assessment for one person who was cared for in bed stated they were at risk of falling and this was managed with a crash mattress on the floor. However, records had not been fully completed to detail how this was being managed.

The risk assessment for another person who required some support in the community contradicted information in their care plan. The risk assessment stated the person had no mobility problems. However, the care plan in relation to their mobility stated due to the person’s dementia, this may affect their awareness of risk and safety which could increase the risk of falls and accidents. This mobility risk had not been assessed.

We raised this with the registered manager who acknowledged this issue and told us they would ensure the risk assessments were fully completed.

Despite this, we found risks to people were being managed which enabled their needs to be met in a way that was safe and supportive. A relative told us, “I don’t have any concerns about [persons] safety.”

People and relatives told us staff were aware of their needs and provided them with the support they needed to keep them safe from harm. For example, some people were cared for and supported in bed and the service ensured people’s skin integrity was maintained and the risk of pressure sores was reduced. A relative told us “I really like the fact that they have a body plan to monitor people’s skin. They will observe and record all areas of [person’s] skin and keep a very close record.” Another relative told us” [Person] is fully bed bound but because they are so good at keeping [person] clean and turning them regularly, [person] has not developed any pressure sores.”

When speaking to staff, they understood the potential risks to people and actions to take to maintain people’s safety particularly in relation to skin integrity. Staff were aware of the appropriate moving and handling techniques for safe transfers and always ensured there were two staff members when undertaking this task.

The provider detected potential risks in the care environment to support delivery of safe care. Processes were in place to ensure risks within the environment were assessed and monitored. Assessments of people’s home environment were carried out covering areas such as home security, gas and electrical appliances and ensure people were supported in a safe, clean and clutter free environment. A relative told us, “They [staff] are very respectful and look after [person’s] property, always making sure things are left clean and tidy. They really are a fabulous bunch, and we are very lucky to have them.”

The provider did not always make sure there were fit and proper persons employed. Recruitment processes were not always operated effectively and consistently to ensure staff were of good character.

We reviewed 7 staff files and found recruitment checks were not robust. For example, interview forms detailed the questions used and answers provided by applicants and contained a scoring matrix to assess their answers for suitability. However, the scoring matrix had not been completed for all the staff files we reviewed, therefore we could not be assured how staff had been assessed and confirmed as being suitable and competent for the roles applied for and on what basis a staff member was offered a job within the service.

Job offers were made before ensuring staff were of good character and authenticity of any previous organisations worked for. For 5 staff members, we found full education and employment histories had not always been listed and no satisfactory written explanation of gaps in employment and education.

For 5 staff members, character references such as friends were obtained even though they had prior work employment. There were no reasons recorded as to why a character reference was applicable.

For another staff member, 2 references were obtained from companies that were not listed in their application form as part of their employment history.

For 1 staff member the disclosure and baring services (DBS) check acquired at the time of recruitment were undertaken by a previous employer. There were no reasons recorded as to why a full DBS check could not be obtained by the provider at the time of recruitment.

For another staff member, although their DBS check had been completed by the provider at the time of recruitment, we found a DBS check completed by another company which was not listed in their application form as part of their employment history.

We raised these issues with the registered manager who was receptive to the feedback. They told us they would ensure recruitment checks were robustly completed for future recruitment. We will follow this up at the next assessment.

Records showed staff had completed mandatory training in areas such as safeguarding, infection control, moving and handling and health and safety. Staff received supervision and appraisal to monitor and review staff performance. The competency of staff was also assessed through spot checks. This involved staff being observed by management staff and assessing how staff carried out their duties. Any areas of improvement were identified and addressed by the provider.

The provider assessed and managed infection prevention to ensure people were protected from the risk of infection. The service had an infection control policy in place. Staff had received infection control training. Infection control audits had been undertaken to ensure safe infection control practices were implemented and staff had access to personal protective equipment [PPE] when needed.

People and relatives told us staff always wore PPE when supporting them with personal care. A relative told us, “I am happy that they [staff] are wearing all the correct gloves and aprons and the standard of hygiene is satisfactory.” Another relative told us “They [staff] are very hot on hygiene. They wear gloves, masks and aprons and regularly wash their hands.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines administration records (MARs) showed people received their medicines as prescribed. A relatives told us, “There have never been any issues with this [medicines].”

There was guidance in place for the administration of medicines that were prescribed to be given 'as required' (PRN) and a medicines policy in place. Medicines risk assessments were in place to ensure risks to people were identified and managed safely. For example, where people had difficulties swallowing, the service ensured medicines were available in liquid or dissolvable forms. A relative told us, “[Person] does have some medication which is difficult for them to take because of their swallowing issues, but the staff are very patient and make sure [person] has it. The medication is being reviewed by the GP because the carers have suggested there may be the same thing in liquid form.”

Medicines management audits were carried out to ensure any shortfalls were identified and followed up. Records showed staff had completed medicines training and medicine competency assessments were undertaken to ensure staff were competent and administered medicines safely.