Aroma Care - Cotswold

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 Requires Improvement. At this assessment the rating has changed to Good.

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.

Safety was a priority for the service. This involved people and their families as well as staff, so any risks were managed in a way that met people's needs and preferences. People and relatives told us they or their relative felt safe with the care provided. For example, a relative commented, “My [relative] feels safe with the way they are cared for.” There were regular reviews of risk assessments and management plans, which were updated as needed. There was a clear process for reporting, investigating, reviewing and learning from accidents, near misses and other concerns. The management team checked accident and incident reports to ensure any necessary action was completed following each occurrence. The managers reviewed and analysed accidents and other incidents quarterly, to identify possible trends that might prompt further changes to practice. People, relatives and staff were encouraged to raise concerns, and to report accidents and near misses. They felt comfortable doing so and told us they were confident managers would listen to them. The management team took concerns seriously, welcoming the opportunity to learn lessons and put things right. This learning was put into practice. For example, the manager had conducted a spot check which led to identifying concerns with how staff were using a hoist in a person’s home. The manager made a referral to the occupational therapist to come and conduct a review, which led to recommendations on how to safely hoist the person over uneven flooring. The manager then updated the care plan, risk assessment and sent a memo to all staff on the electronic care app to ensure everyone was aware of the changes. The manager continued to seek feedback from the person and their family about how the changes were working. The managers understood the duty of candour. They ensured staff kept relatives informed of people’s accidents, incidents or health concerns. Relatives confirmed they were kept informed about what was happening. For example, relatives commented, “The manager, or a senior member of staff do spot checks on the care staff regularly making sure they are doing what they should be” and “We are usually kept informed of [person’s] condition and any changes and if the GP needs to be called it is done.”

The service 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.

The manager told us, “Anyone new will have a pre-admission assessment with myself, I will introduce the company, give the person a service user handbook, explain what we offer as a company, ask about their preferences (gender of staff, call timings, etc.). We look at the available staff and try to pick a staff member who is compatible with the person. Staff will go and introduce themselves to the person before the package goes ahead. People are then called after the first visit for feedback.” Staff told us they read through the care plans to ensure they had all the information they needed to provide support safely. A relative told us, “A full assessment was carried out before [person] started using the service and the care plans are reviewed at least yearly or if [persons] condition changes.” Another relative told us, “In the 5 years since we started using the service it has never really let us down.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff were knowledgeable about their safeguarding responsibilities, understood how to recognise abuse, and how to report this. Staff told us, “If I had an issue, I would call the office”, “I would look out for signs people were hurt or were behaving differently. I have completed my safeguarding training” and “I would not hesitate to speak up if I was concerned about abuse.”

Some people told us they had concerns around how to contact the office if they needed to report something. Comments included, “I have no information of how to get in touch with the manager. I don’t have a folder or even a telephone number to ring. This hasn’t been a problem yet but what would I do if I needed them” and “I don’t know the number for the office, I have to wait for the staff to come and then I tell them.” We found some instances where information was not always passed on in a timely manner and the systems in place were not used appropriately to alert the manager resulting in a delay to them being made aware of concerns. We also found areas for improvement in how safeguarding concerns were referred to. For example, we found one person had an injury which was documented using terminology which indicated the injury was quite serious, however, upon review, this did not accurately describe the injury. This had led to confusion for the provider on whether it met the threshold for a serious injury, requiring CQC notification.

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

Risk assessments were in place to manage individual risk and were updated after incidents and accidents. However, we found some improvements were needed. For example, a person who required support with preventing falls did not have a correctly updated risk assessment in place to guide staff with what care and support the person required. We also found one person did not have a risk assessment in place detailing why they preferred staff to lock their door when leaving and giving consent for this. We found one person’s care documentation lacked clarity for staff on when to apply cream. We found one person who required re-positioning did not have a re-positioning chart in place. The lack of monitoring, and information in the care plan meant staff had no guidance to ensure they could support people safely, this placed people at risk of harm. These concerns were all brought to the manager’s attention and actioned. However, the provider’s own systems had not picked up on this outside of the inspection activity.

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

People had effective environmental risk assessments which explored and identified all the risks individuals faced, such as when a person had mobility issues, used equipment to help them move about, or had pets. Even though the provider was not responsible for the maintenance of people’s properties, they identified and made plans to try and manage associated risks and share concerns with other organisations when it was appropriate to do so. For example, we saw numbers for service engineers for hospital beds and mobility equipment signposted in people’s care plans. Where people required support for cleaning their properties, this was clearly noted in care plans and details of who was responsible for what and on which days was documented. Care plans also included specific details of where cleaning products were stored and how they were labelled. Care plans we reviewed also contained specific information on whether a person had smoke alarms, fire extinguishers or fire blankets, when the smoke alarms had been tested and by whom and detailed how people could evacuate in the event of a fire.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff told us they received regular training that enabled them to meet people’s individual needs. Comments from staff included, “I had induction training and shadowing. I spent many, many days shadowing, I had to do online courses. I did face to face Moving and handling and I did medicines training.” People told us, “The carers are understanding about [person’s] condition, and they seem to manage [person] very well.” All of the staff we spoke to told us they were subject to regular spot checks and participated in supervisions they found useful. Staff told us, “They do sometimes come for spot checks to see how things are done in the field. Sometimes they are unannounced, but sometimes they will call and tell you. During my supervisions we discuss my training, my goals, etc.” All appropriate recruitment checks had been completed. We found the interview notes for staff did not always contain appropriate answers to questions. For example, one staff was asked during interview “What do you understand by confidentiality?” The staff answered, “Whatever you see, you don't say it, it's a secret.” This was brought to the manager’s attention who informed us they would escalate this, as interviews were conducted by another department within the organisation. We received mixed feedback on staff arrival times for care calls and for staff staying for the agreed time. While some people told us staff stayed over the agreed time to ensure they had everything they needed, other people told us the staff were late and left early. One person told us, “The time the carers come is quite consistent and if there is a problem with them being late, I usually get a phone call to let me know” while another person told us, “They [staff] don’t always stay the full time.” One relative told us “[staff] come on time, and nothing is a trouble to any of them” while another relative told us “Staff are late and my [relative] tries to get themselves ready but forgets to dress appropriately, I know in the big scheme of things my [relative] is ok but if this is the best they can do it’s not good enough.” We found the way rotas were scheduled required improvement. We analysed 3 rotas and found although staff were given sufficient time to take breaks within the rotas, they were not always given enough travel time and rotas contained timings which staff were not capable of working. For example, we found one staff member was scheduled to finish their shift at 21:30, however, due to the lack of travel time in the rota, they would not be able to finish on time. In another rota, staff were required to travel for 29 minutes between 2 calls but were only given 10 minutes to do so. We also found staff were starting later than the agreed start time and making up the time later in the day by not taking their full break times. For example, one staff member was scheduled to have the first call of the day at 06:50 but the staff did not log into the call until 07:32. This was found to be the case in all of the rota’s we analysed. This had not been picked up by the provider during monitoring of staff working patterns and logging into care calls. Although this did not demonstrate good scheduling practices, we could not find a direct impact on people’s safety.

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’s relatives did not give any negative feedback about how staff helped people to maintain a safe living environment. Staff received training in infection prevention and control and the provider had suitable policies and procedures in place. The managers completed visits to people’s homes to check how people were supported, including how staff followed good infection prevention and control practices. Relatives told us, “The carers wear PPE at all times” and “Staff wear PPE when required.” We found the manager had completed environmental risk assessments which clearly described any concerns staff may need to be aware of and what to do.

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.

The provider had appropriate medicine policies and procedures in place. The provider had appropriate systems and processes in place for staff to administer medicine safely and conduct regular spot checks. All staff were up to date with their medicines spot checks at the time of the inspection. Care plans identified if the person was able to manage their own medicines, were supported by relatives or if they required staff to administer them. People’s care plans included a list of prescribed medicines indicating the dosage, the frequency of administration and any side effects. Relatives told us the staff administered people’s medicines safely and as prescribed. Relatives told us, “[Person] requires help with their medication and are given this daily” and “[Person] needs help with their medication, and I know the carers will make sure they always get it on time.” People told us, “I have the carers 4 days a week 3 times a day, they help me get my food and help me get my tablets as I sometimes forget to take them” and “The carers do whatever I ask them to and importantly they make sure I get my food and my tablets.” Staff completed records to demonstrate medicines had been administered as prescribed. Staff confirmed they completed training on the administration of medicines. One staff member told us, “Last week I went to Nuneaton for medication and risk assessment training. We also have spot checks.” At the time of the inspection, we found limited numbers of people were taking regular time sensitive medications, and these were being administered appropriately. We saw evidence of good practice, for example one staff member called the office to ask for clarity about when a medication which was required ‘once a day’ was meant to be administered as it was not clear on the Medication Administration Record (MAR). Clarification was sought from the person’s pharmacy and GP and their MAR was updated.