Bespoke Care (Sheffield) Limited

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 remained good.

This meant people were safe and protected from avoidable harm.

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 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. The registered manager was open and transparent and wanted to ensure good outcomes for people. Accidents and incidents were recorded and monitored to identify recurring themes and trends. Where incidents had occurred, corrective actions were implemented to address root causes and mitigate future risks. Lessons learned from these events were communicated to staff through regular team meetings, formal communications, and supervision sessions.

The provider 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. People’s needs were assessed before support commenced with involvement of both people and their families. However, issues with the process for transferring information into the electronic care plan had resulted in some care records detailing historical or inaccurate information. This had been picked up prior to our visit and action was being taken to ensure all care records contained up to date and accurate information.

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 shared concerns quickly and appropriately. Records showed safeguarding concerns were reported promptly to the local authority and the Care Quality Commission (CQC). People and their relatives told us they felt safe with the support provided by Bespoke Care (Sheffield) Limited. One person told us, “I can honestly say I have had different carers, but most of the time it's the same ones and there’s not a bad one amongst them.” Another person told us, “I don’t feel unsafe in any way.” Staff had completed safeguarding training and the provider’s policy guided staff about how to recognise and report abuse. Staff told us they felt confident to raise concerns if they felt people were at risk. One staff member told us, “I would report the concerns about the individual to my manager and follow up. If nothing is done, I would escalate my concerns to CQC.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, some care records were out of date due to historical or inaccurate information being included. This issue had been identified and care plans for those people affected were to be reviewed to ensure they were up to date and accurate. Where people were on a modified diet more information about their assessed level of diet needed to be included. Risk assessments were not in place for all people using paraffin-based products unless they were identified as a smoker. This was a recording concern, and we found no evidence of harm to people. The registered manager actioned all concerns raised immediately. Staff completed a range of training to assist them in managing risks. One staff member told us, “When someone becomes distressed, I use distraction techniques like reminiscence or gentle activities rather than confrontation.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The environment was assessed prior to support starting and reviewed at intervals to ensure safety of the individual and staff. Where equipment was in place systems were in place to ensure checks of equipment were completed regularly. Staff had received training in health and safety and knew how to assess and report environment risks. One staff member told us, “I learnt how to use hoists when moving people, correct handling techniques that don’t injure service users and carers and safe use of wheelchairs.” A person told us, “I use a trolley to get around the flat and a walking frame when I go outside. Yes, they make sure I have them with me.” Reminders were also on the electronic app for staff on how to keep people safe. For example, staff to scramble key safe numbers after use.

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. We received mixed reports from staff about the support they received and changes since the new provider had taken over with some feeling they were kept in the dark. Staff generally expressed no concerns about staffing levels, but we received mixed feedback around some rotas being overly busy or overly spaced. One staff told us, “I would like to see more realistic time given between visits. It helps carers provide safe, unhurried care and ensures clients receive the attention they deserve, while also reducing stress for staff.” We reviewed electronic records of visits completed and queried some call details with the provider. Documentation clarified the issues and confirmed call monitoring was completed. The provider agreed to keep travel times under review. We received mixed feedback from people and relatives about consistency. One relative told us, “They are never the same carer… and [person] does get upset. Another person told us, “At one bit I was getting ten different carers but now its limited to being about four. They are all quite aimable.” Overall people felt that staff were reliable and generally on time. One relative told us, “If they are going to be late, more than an hour they will give [person] a ring to let [person] know. They do most of the time (be on time) but they do report if they don’t.” Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. The process for seeking and tracking reference requests from past employers was being reviewed at the time of our visit to ensure compliance with safe recruitment standards. Training records showed staff completed a range of training to support people effectively including specific training to meet individual needs, such as specific health conditions and training around learning disability and autism. Training was refreshed at regular intervals in line with good practice guidelines. Some staff commented that they would like more face-to-face training. We discussed this with the provider, and they confirmed a mix of both face-to-face training and e-learning were planned at induction and throughout recruitment.

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. Staff received training in infection prevention and control (IPC) and policies were in place to manage the risk of infection. No concerns were raised by staff, people or families about the availability of personal protective equipment (PPE) or the management of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Some issues were raised by staff and one relative regarding delays with ordering. The registered manager confirmed issues with ordering had been discussed with the local authority and revised systems implemented to address concerns raised. We noted that staff were sometimes entering the wrong codes on medicines administration records. This had been picked up by provider audits and regular reminders given to staff about correct use of codes. Risk assessments for paraffin-based creams were also required for some people to address the potential hazard of these products transferring onto clothing and increasing flammability. Detail around STOMP (stopping over-medication of people with a learning disability, autism or both) were not currently included in the medicines policy. The registered manager agreed to address all issues raised. Staff received training in medicines administration, and their competency was formally assessed. People were supported by staff who followed established systems and processes for administering, recording, and storing medicines safely. Overall feedback from people and their families confirmed that medicines were provided as prescribed and on time. One person told us, “Yes they check my medication for me so I don’t make mistakes…there should be four hours between the first lot of tablets and the next lot, and it hasn’t been a problem.”