A & T (Salisbury) Ltd

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.

This service scored 59 (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.

Leaders told us there had not been any accidents or incidents, but if these occurred in the future, they would discuss what could have been done better. Staff told us accident reports were located inside each person’s care plan, but they had not needed to use them. They said the forms contained a section on further action needed to ensure safety.

Leaders told us people would raise any concerns informally within general conversation. They said the concerns were immediately addressed but not recorded. This meant they could not identify themes and trends and improve practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services. Leaders told us they worked well with other health and social care professionals to ensure safe systems and transitions.

Each person had a ‘Grab’ Sheet to enable key information to be shared with professionals in the event of the person moving between services. However, examples of health conditions were identified alongside the actual conditions the person had. This was misleading and increased the risk of misinformation being shared.

People’s wishes of whether they wished to be resuscitated in the event of an emergency were also not clear. Leaders told us they would review the format to ensure the information was easier to read.

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.

People told us they felt safe with staff and with them in their property. Relatives confirmed this. One relative told us “Oh my word, of course my [family member] is safe with them, very much so. They are competent, trustworthy people. We have no worries at all”.

People and their relatives said they would have no hesitation in raising any concerns with leaders if needed. They were confident appropriate action would be taken, and their concern would be satisfactorily resolved.

There was a safeguarding policy, and staff had received safeguarding training. However, whilst leaders had completed the same training, they had not completed safeguarding training for managers. This did not ensure they were up to date with their management responsibilities in safeguarding.

Staff told us they would inform leaders if they saw any potential abuse. This included any hostility or tension between family members or any injuries or changes to a person’s mood.

The provider did not always work well with people to understand and manage risks. Staff 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. Records did not identify the risks people faced, so appropriate control measures to enhance safety could not be determined or implemented. For example, risks associated with showering, such as falling when stepping in and out of the shower or slipping on wet surfaces, were not identified. This did not ensure safety was promoted.

Staff told us risk assessments were in people’s care plans, but they were unable to discuss any risks people faced. This did not ensure shortfalls in safety would be adequately managed, which placed people at risk of harm.

Staff said they did not support ‘high risk’ people, as leaders did this, but explained one person who could be “nasty or nice, dependent on their mood.” They said they had a “positive mindset” and tried not to let the person’s mood affect them. Written guidance to ensure a consistent approach when supporting the person was not detailed in their care plan. Some medicines were stated as ‘high risk’ but the reasons for this or measures to enhance safety were not documented.

The provider was in breach of legal regulation in relation to risk management.

Leaders told us they would review their risk assessment format to ensure it contained the required information.

The provider did not always detect and control potential risks in the person’s environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Leaders told us they respected each person’s home environment but would speak to them if any hazards were identified. They were confident the discussions would enable a satisfactory outcome.

An environmental risk assessment had been completed and formed part of the person’s care plan. However, the information was limited and lacked detail. For example, one assessment stated household chemicals should be locked away, but the person’s consent and how this would work in practice had not been identified. This meant the risk associated with chemicals had not been adequately mitigated and safety was not assured.

Leaders had completed training but had not undertaken practical training to move people safely. They said they would address this. We did not assess recruitment practice as there had not been any new staff or any intention to expand the staff team.

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. Leaders completed people’s care and support on a day-to-day basis. Due to this, they knew people well and positive relationships had been built. A small team of established bank staff provided cover when leaders had other commitments This meant people were always supported by staff who were aware of their needs and preferences.

People and their relatives told us the staffing arrangements worked well. They described staff as “amazing” and “They are the best things since sliced bread.” People said leaders were always on time but would contact them if running late.

Bank staff told us they were well trained, although said much of their training had been completed with their other employer. Leaders told us this was not the case, and staff had completed the agency's own training.

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 told us staff wore personal protective equipment when supporting them and their uniforms were always clean. One person told us, “They are very on top of cross contamination.”

Staff told us they had received training in infection prevention and control and gave examples of good practice. This included regular hand washing and making sure an open wound was covered to minimise the risk of a foreign body entering. Staff always wore face masks if they or the person they were supporting had signs of a respiratory illness.

Leaders told us about the management of a person's catheter. However, this support and how to minimise the risks of infection were not clearly identified in their care plan.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Information within care plans did not clearly show how people liked to take their medicines or the support they needed. For example, phrases such as ‘needs prompting to take their medicines’ did not show what this meant in practice. Another example we observed was 1 person liked leaders to leave their medicines out for them to take later, but details and the risks associated with this were not identified in their care plan. This meant there was a risk of people not receiving their medicines safely and as prescribed.

The medicine administration records were clear and showed each medicine’s prescription. Leaders and staff had appropriately signed the records to show they had given people their medicines as prescribed. However, one person was taking a regular daily dose of their ‘as required’ pain relief without the prescriber being informed. This increased the risk of a potential health condition not being identified or treated appropriately.

Records showed leaders and staff had completed online training in the safe administration of medicines and their competency was assessed. Leaders told us they always ensured people had adequate stocks of their medicines and would follow up any delays with local pharmacies or GPs. A relative confirmed this and said staff went “above and beyond” to ensure people had their medicines as needed.