We carried out a review of the data available to us about Safe Care on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Safe Care, you can give feedback on this service.
Safe Care provides personal care to people who live in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. At the time of the inspection 26 people were receiving personal care support.
People’s experience of using this service and what we found
People were happy with the care they received from Safe Care and said they felt safe. Staff knew what to do to keep people safe and were confident any concerns would be taken seriously.
Risks to people’s well-being and safety were assessed, recorded and kept up to date. Staff supported people to manage these risks effectively. People received support to take their medicines safely.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.
People were supported to develop care plans that were specific to them. These plans were regularly reviewed with people, to ensure they were up to date. The plans contained clear information about people's communication needs.
Staff respected people’s privacy and dignity.
People were supported to prepare food and drinks where needed, ensuring this met people’s needs and minimised identified risks. Staff worked with health teams to ensure people were able to access the services they needed. Staff had clear information about when to contact health professionals to safely manage people’s health conditions.
The management team provided good support for staff to be able to do their job effectively. The provider’s quality assurance processes were effective and resulted in improvements to the service.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Rating at last inspection and update
The last rating for this service was requires improvement (published 22 December 2018) and there were breaches of regulations. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
This inspection took place on 23 October 2018. This was an announced inspection which meant the provider had prior knowledge that we would be visiting the service. This was because the location provides a domiciliary care service, and we wanted to make sure the provider would be available to support our inspection, or someone who could act on their behalf.
This service was rated ‘Requires Improvement’ in February 2018 and the provider was found to be in breach of three regulations. The service was rated as 'Requires improvement' for a third consecutive time. The provider had a positive condition imposed on their registration. This meant they were not able to take on any new packages of care without the prior written agreement of The Care Quality Commission. The provider had to further submit monthly reports of written records of staff training, risk assessments and all quality monitoring conducted within the service.
A Notice of Decision was served to cancel the provider's registration. The provider submitted representations to tribunal. This inspection on 23 October 2018 took place to check if the provider had made sufficient improvements, in order for The Care Quality Commission to withdraw from going to Tribunal. Although there are still areas of improvement, enough progress had been made to withdraw our Notice of Decision. The provider accepted to have a further condition imposed on their registration around risk management.
The provider will continue to provide monthly reports to The Care Quality Commission for ongoing monitoring. The provider will now be able to start accepting new packages of care into the service.
The service is registered as an individual provider and does not require a registered manager to be in place as the provider was in day to day control. The individual provider is responsible for the day to day running of the location, and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
Risk assessments did not always provide adequate measures to reduce the risks. For example, one person who was at risk of serious harm, did not have a risk assessment in place and there was no guidance available for staff to follow in an emergency. After this inspection the provider sent a copy of the updated risk assessment which contained detailed information.
There was not always documented evidence of internal investigations into incident and accidents that occurred.
At this inspection we noted some areas of improvement were needed around safe medicine management. We found that there were no protocols in place for medicine to be taken ‘as required’ (PRN). This meant staff did not have written guidelines available of what to be aware of, in offering and administering PRN medicine.
We saw that care reviews had not always been managed appropriately. For example, one person had an incident where they became dehydrated. There was no evidence that the care plan had been reviewed in response to this incident.
Although not all the concerns from this inspection had been identified prior to this visit, the provider had worked to address most of the previous concerns from our last inspection.
The improvements to staff training had continued. Staff were up to date with their necessary training and receiving refresher training when needed.
People received care and support from staff who had got to know them well. The service maintained consistency for people by providing regular core staff, that allowed mutually trusting relationships to develop.
Staff spoke positively about the support they received from the management. People using the service also felt confident about the management structure in place to deliver their care.
This inspection took place on 6 February 2018. This was an announced inspection which meant the provider had prior knowledge that we would be visiting the service. This was because the location provides a domiciliary care service, and we wanted to make sure the provider would be available to support our inspection, or someone who could act on their behalf.
The service is registered as an individual provider and does not require a registered manager to be in place as the provider was in day to day control. The individual provider is responsible for the day to day running of the location, and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.
This service was rated Requires Improvement in May 2016 and the provider was found to be in breach of three regulations. The service was re-inspected in July 2017 and was found to have remained in breach of the three breaches and a further three breaches of the Regulations were found. We took enforcement action against the provider for the overall rating of repeated ‘Requires Improvement’. We imposed a positive condition on their registration, issued a fixed penalty notice and serve a Warning notice. The provider is not able to take on any new packages of care without the prior written agreement of The Care Quality Commission and submits monthly reports including written records of staff training, audits of care plans, risk assessments and all quality monitoring conducted within the service.
At this inspection we found the service had made some improvements to meet three of the six breaches of Regulations, but however still remained in breach of three Regulations. This is the third consecutive time the service has been rated as Requires Improvement. Therefore the positive condition will remain on the provider’s registration at this time. The provider will continue to submit monthly reports so we can monitor this service and they are unable to take on any new packages of care until further agreement from The Care Quality Commission. Due to the on-going concerns we will met with this provider to seek assurance on how they will address these concerns without delay. We are now taking further enforcement action and will report on this when any representations have been concluded.
The provider and the assistant manager had spent time since our last inspection creating a risk assessment template that they felt was appropriate. However, at this inspection this was only in the early stages of being put in place and some care plans we reviewed did not have risk assessments in place and the one’s that did were not fully completed. One person’s care plan stated they had a history of falls and their carpet was loose. It recorded that the person’s walking aid would sometimes get stuck in the loose carpet which was a trip hazard. A risk assessment was in place but made no mention of this loose carpet or how staff should support the person safely in light of this risk. The service remained in breach of this Regulation.
Improvements had been made overall to the management of medicines. However when the service did not support someone with medicines this needed to be made clearer in the medicine support plan.
The care plans we reviewed were still not in an organised format. The provider and assistant manager told us they had struggled with the conflicting information received on developing their care plan format. 13 out of 37 care plans had the new template in place, however not all aspects of the person’s care were detailed. This meant a completed working care plan was not available The service remained in breach of this Regulation.
The provider had failed to meet their registration condition to submit monthly reports around risk assessments, care plans and of all quality monitoring conducted within the service. Improvements had not been made in a timely manner to ensure the service was safe, responsive and well-led. The service remained in breach of this Regulation.
The provider had ensured that all staff completed the required training to effectively fulfil their role. We saw that each staff had a training development plan in place which included regular observations, one to one meetings with the provider and an annual appraisal
People continued to praise the care they received and gave positive feedback about the staff who supported them. People told us “It’s very important to me that I only have a few carers who I know well, and that happens. If a new carer is starting, the managers will bring them out, introduce them to me and show them what to do” and “For me, they are my lifeline. I can’t praise them highly enough. Professional, well trained and just willing to take whatever time is necessary to get things right.”
The provider monitored the care people received through regular reviews with people, surveys and observations of staff. People were encouraged to be at the forefront of any care decisions made.
Staff attended team meetings and told us they felt well supported by the management in place and able to raise concerns when they needed.
The service is registered as an individual provider and did not have a condition requiring a registered manager to be in place at this service, as the provider was in day to day control. The individual provider is responsible for the day to day running of the location, and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. People, their relatives and staff referred to the provider as the manager, but throughout this report we have used the term provider.
At our previous inspection the home received a rating of requires improvement and were in breach of three Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that the service remained in breach of all of these three breaches and a further three breaches of the Regulations were found. You can see what action we told the provider to take at the back of the full version of the report. We are taking further action in relation to this provider and full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.
Risks to people’s personal safety had not always been assessed or plans put in place to minimise these risks and to provide guidance to staff.
Staff had not been supported to receive necessary training relevant to their role before they started providing care to people. This meant people were receiving care from staff that were not appropriately trained which potentially put them at risk of unsafe practice.
Care plans were not always person centred and where people had a specific health need there was not always clear information in place and documents were not always completed appropriately. There was no end of life wishes documented in people's care plans.
Since our last inspection the provider had failed to document monitoring that was conducted on the quality of care delivered. We saw that where incidents had occurred there was no documentation or investigation recorded of these other than what staff wrote in the daily record. The provider told us that because she had been working care shifts, she had been unable to progress much in the last year.
Services are required by law to send us statutory notifications about incidents and events that have occurred at the service and which may need further investigation. During our inspection we found that the service had not reported four notifications which included one incidents involving the police, one death of a person using the service, one allegation of abuse and a grade three pressure sore. The provider was not aware of the responsibilities of her registration and was not acting in line with these requirements.
We saw that the provider had not displayed their ratings from the last inspection on their website or at the location from where the service is run. This a requirement and further action is being taken in relation to this.
People spoke positively about the staff and reliability of the service commenting “They are very timely. If they are going to be late because of traffic they let me know” and “They always arrive on time, very reliable.” The provider would also complete visits to people and had a good understanding of their needs.
People told us they were treated with kindness and compassion in their day-to-day care. Comments from people, their family members and health care professionals were very positive about staff and told us they were caring, including “I am very happy with them. They do everything I need doing” and “I am very pleased with them. They give excellent care.”
Complaints and concerns were taken seriously and used as an opportunity to improve the service. There had been no complaints since our last inspection. People and their relatives told us “If I have any niggles I ring the office and they are very helpful” and “I would speak to the manager. She is very good.”
The service is registered as an individual provider and did not have a condition requiring a registered manager to be in place at this service, as the provider was in day to day control. The individual provider is responsible for the day to day running of the location, and has the legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run. People, their relatives and staff referred to the provider as the manager, but throughout this report we have used the term provider. The provider was accessible and approachable throughout our inspection.
Staff had not received the appropriate training relevant to their role. We identified gaps in the training records. Where staff had received training some of this had been completed but dated as far back as 2006.
Care plans did not provide enough information about a person and their health condition. Risks to people were not fully documented and action plans had not been put in place for staff to follow.
The provider did not have effective systems in place to monitor the quality of the service. This had been started previously but had not been consistently completed. The provider confirmed that she was more comfortable with the hands on caring side, than the paperwork part of the job.
The provider took measures to keep people safe. This included a handbook which helped people identify staff on care visits. New members of staff met with people prior to supporting them. Staff told us they would not hesitate in reporting any concerns to the provider. There were safe recruitment processes in place to ensure that only suitable staff were allowed to work with vulnerable adults.
People were supported to access healthcare services to maintain and support good health. Staff were vigilant in noticing changes in people's health conditions.
People and relatives were very complimentary about the caring nature of staff. Staff were knowledgeable about people's needs and we were told that care was provided with patience and kindness. People's privacy and dignity was always respected.
People were encouraged to give feedback on the service they received and were able to discuss their care needs on a regular basis with the provider.
The provider was a very visible and available presence for people and completed regular care visits. Staff spoke highly of the provider and her approachable nature and felt confident to discuss any concerns they had.
We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report.
The provider sent us an action plan which described how they planned to meet the compliance actions. At this visit we saw improvements had been made. The quality of the service was being regularly monitored, detailing actions to be undertaken and when completed.
The provider had introduced new documentation to ensure any changes to a person's care had been clearly recorded.
One person said they had never been involved with a domiciliary agency before but they were very pleased with the service provided by Safe Care. They said the provider had visited them and discussed their care needs.
A relative described how the care staff put their family member at ease when they supported them with their personal care. They said it 'lessened the embarrassment' for them.
People said they were well supported by the care staff. A person who had recently been staying in hospital said 'I feel safe now I'm back in my own environment'. Another person said they felt 'perfectly safe' with the care staff.
Staff told us they were trained to undertake their daily duties. People described the staff as 'competent' and 'well trained.'
People told us they felt confident to raise any concerns or worries with the provider. We saw the provider kept a record of any concerns raised.
We had concerns as there were no systems in place for regularly monitoring the quality of the service, such as the analysis of accident and incident forms, medicines and complaints. We found there was insufficient detail in risk assessments and care plans to ensure people's wellbeing.