Kemfa Services Limited

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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

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 improvements had been made, and the rating has changed to good. This meant people were safe and protected from avoidable harm.

The service was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment and the service was no longer in breach of this regulation. Staff now assessed and mitigated risks. and people had thorough care plans to guide safe practice. There were systems in place to protect people from abuse. There were enough staff to ensure people’s safety and meet their needs.

This service scored 75 (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 positive culture of safety, based on openness and responsiveness. Staff listened to people’s concerns about safety and reported any issues raised to the registered manager. The registered manager had an overview of all accidents, incidents and complaints which had been responded to or investigated where required. Lessons learned were shared with staff to continually identify and embed good practice.

People and relatives told us they could raise any issues they had concerns about and were confident they would be listened to and action taken where needed. A family member said, “When I have raised concerns with the Office particularly [name of staff member], they really listen and have visited me to discuss everything and document in the care plan and sends me a copy.”

The provider worked with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured.The provider worked with people, those close to them and professionals to establish their plan of care. There was a collaborative and joined up approach enabling a safe system of transition for example when people were discharged home from hospital. They made sure there was continuity of care, including when people went in and out of hospital. The registered manager told us, “Before discharge, we confirm equipment is in place, care plans are updated, and medicines lists are accurate, reducing the risk of readmission.”

People’s care and support needs were fully assessed by the registered manager prior to the start of their service to ensure their needs could be met. People confirmed they were involved in their plan of care to be provided. A person told us, “I was involved in the plan, and it has since been reviewed and updated.”

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 had introduced a robust safeguarding system and put in place a designated safeguarding lead to focus on people’s health and safety.

Where concerns were raised, they were investigated and referred appropriately to the local authority and the Care Quality Commission (CQC), quickly and appropriately. The provider analysed safeguarding concerns to identify themes and trends, learning from them to reduce the risk of reoccurrence. The registered manager told us, “The staff are far more aware, and we have all talked a lot about what a safeguarding feels like and what a safeguarding looks like so I feel staff would be more aware of raising things that were a safeguard concern.”

People and relatives told us they felt safe with the staff who supported them. A family member said, “The staff are very respectful and mindful of their safety.” Another told us, “I generally think my [relative] is safe with the staff.”

Staff had received online and face to face training in safeguarding people from the risk of abuse. Staff understood their responsibilities to report concerns about abuse and whom to report to. They felt confident the registered manager would take the necessary action to help protect people. A staff member told us, “I had to raise a safeguarding. I spoke with the person using open ended questions like, “Can you tell me what happened.” I called 999, alerted my manager in charge of safeguarding, then reported the concern to my manager in a well detailed note. I had done all I should have done.” Another staff member said, “I would look at the nature of the abuse and assess and unpick what was happening. I would escalate any concerns to my line manager straight away and usually fill in a report. I would also let the person and/or family know I was escalating the concern. We have also been told we can report to the local authority if we felt the company were not listening, but all managers take all concerns seriously.”

The provider worked with people and relatives to understand and manage risks so that care meets their needs in a way that is safe and supportive and enables them to do the things that matter to them.

Risks regarding people’s care and support needs were assessed at the start of service delivery and reviewed every 6 months thereafter unless a person’s needs changed. People were informed about any risks and how to keep themselves safe and staff understood how to support people safely. Risk assessments were proportionate and centred around the individual and their specific needs. A staff member told us, “On the system we use, you have to download all the information and tick that you have acknowledged all the risks and information about the person.”

Risk assessments were undertaken, when a risk was identified such as people taking their medicines, supporting people to access the community safely, falls, stoma and catheter care and safe moving and handling. A family member told us, “[Relative] feels safe when using the hoist with the staff. They would tell me if they didn’t.” Another family member said, “The staff use equipment to get [relative] out of bed and all works well.”

At the last assessment care plans were not up to date and lacked information about risks to people’s health and safety. Care plans had been improved and now contained guidance for staff in how to manage risks associated with people’s care and support. The provider’s new electronic management system enabled information to be monitored and updated more effectively to manage risks. Staff could access and record information quickly using the system. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The service had developed a consistent team of permanent staff to support people which meant staff knew people well and were aware of any associated risks relating to their care and support. A professional told us, “A key area for improvement I observed was staff competency, particularly in escalating concerns to ensure timely intervention and risk management.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. During the initial assessment visit to a person at home, a risk assessment of the environment was undertaken to ensure it was safe and accessible. This included the use of any equipment, security of the home, any restrictions or space constraints or risks caused by the room layout.

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 received an induction to the service and shadowing staff to meet people they would be working with. Training was appropriate and relevant to their role. This included topics required from the last assessment such as catheter and stoma care. We noted condition specific training had been provided, in addition to the basic core training, such as support to people with Parkinson’s, epilepsy and diabetes. A staff member said, “I have received regular training, including recent refreshers in safeguarding, moving and handling, and medication administration. The sessions were practical and helped me to feel more confident and better prepared to carry out my responsibilities safely.”

At the last assessment, the provider was unable to provide records related to the safe recruitment of staff, staff training and staff disciplinary action. A robust system of managing staff competency to carry out their role had now been implemented, such as spot checks at the person’s home to ensure staff were competent in administering medicines and using equipment safely. Supervision, learning sessions, reflective practice and lessons learnt were more robust to support staff in developing their skills and abilities. Staff told us the registered manager and office staff were supportive and available should they need advice and support.

People and relatives told us that they had regular staff, who mostly turned up on time at the time requested. However, there were comments made regarding the times requested and the actual time staff arrived. We talked to the registered manager about this for them to investigate. Where there had been the occasional missed visits, we saw these had been investigated, action taken and apologies made. Where staff were late, people understood the reasons why but made comment that they were not always informed of this by the office, but it was getting better. A person told us, “They come on time, sometimes the office ring up to say the staff are running late.” A family member said, “Since the turn of the year, I have noticed that the staff are much better at telling the family if they are running late.”

The provider’s investment in an electronic call monitoring system had improved the monitoring of visits to people and managing missed or late calls. The system provided live information about where staff were, when they had arrived and left a care visit and travel time in between. It also alerted the registered manager and office staff if a staff member had not signed in to a care visit, so this could be dealt with quickly. A staff member told us, “I have never known a missed visit and if I am delayed due to an emergency, they will send a backup carer out to finish the round.” The registered manager told us this had reduced complaints about the service and improved communication between care staff, office staff, managers and people and their relatives.

Staff spoke positively about working at the service and did not raise any concerns regarding staffing levels. Rota arrangements had been improved. Trained office staff were now available to go out on calls if a staff member was delayed, so people did not miss their call. We saw this in action during our site visit. A staff member told us, “Rota arrangements are usually clear and shared in advance. There is consideration for travel time, and if I am running late, I can contact the office who support me in informing the next person. This helps reduce stress and ensures people are not left without support.”

Systems had been improved to the recruitment process of care staff. The registered manager was aware of the legal requirements when recruiting staff. Recruitment processes in place included the completion of appropriate pre-employment checks such as identification, references from previous employers and disclosure and barring service checks (DBS). This helps employers make safe recruitment choices.

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 and relatives did not share any concerns in relation to infection prevention and control procedures and confirmed staff used personal protective equipment (PPE) appropriately. A person told us, “All the staff are professional and wear PPE when needed.”

Staff had undertaken infection prevention and control training and were provided with PPE which could be collected from the office. A staff member told us, “We have enough PPE. We always get them from the office or the field care supervisors distributes to people, so they are there and available for them personally. Another said, “PPE is always available and used appropriately to protect both staff and people who use the service.”The provider had an up-to-date policy in place to support effective infection prevention and control and was following current guidance.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.At the last assessment, information relating to the safe administration of medicines was not clearly recorded in people’s care plans, protocols for how ‘as required’ (PRN) medicines should be given were not in place and call times did not leave enough time between people’s medicines to help ensure they were given in accordance with the prescriber’s instructions.

The management of medicines had improved. People had care plans and risk assessments which detailed what medicines they were prescribed and how they liked to be supported in taking them. The compliance manager and registered manager completed regular audits to ensure the system was safe, which included identifying any changes needed, shortfalls, errors and dealt with them quickly and effectively.

There were protocols within people’s care plans to describe when PRN medicines were to be administered or offered to people. The protocols gave staff guidance about when it was appropriate to administer PRN medicines for people to help manage their pain. The registered manager said that should an individual need to take their PRN medicines consistently for a 48-hour period the person’s GP was advised. This meant a review could be undertaken of a person’s pain medicines to help manage this and keep them comfortable.

The electronic management system identified if staff were running late and, where medicines were needed at a specific time, care calls were re-scheduled so that people’s medicine doses were not given too close together. Medicine administration records ((MAR) were paper records held in people’s homes until completed at the end of the month when they were returned to the office. The MAR charts were audited for compliance purposes and then scanned onto the system for an audit trail and ease of access.

At the last assessment, we identified staff did not have training in the safe administration of medicines for a person with epilepsy. No-one using the service at the time of this assessment had epilepsy, so it was not possible to assess this previous shortfall. However, training in epilepsy for all staff had been completed. People and relatives were appropriately involved in decisions about their medicines and the level of support they needed to manage their medicines safely.

All staff were trained to safely administer medicines; their skills were assessed in the workplace and regularly reviewed. Refresher training was planned for and carried out to help ensure staff skills were up to date. A staff member told us, “I feel confident administering medicines, as I have received training and competency checks. They watch me during spot checks; they check the medicines and the MAR’s.” Another staff member said, “I do administer medicines, and I did have supervision. I shadowed for a month and a half and was watched administering medicines before I did this on my own.”