Paramount Options 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.
The service was in breach of legal regulation in relation to people’s safe care and treatment, medicines being managed safely, risk management and reporting safeguarding concerns.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
The provider had a process for the recording of incidents and accidents, but the outcomes and actions taken to reduce risk were not always recorded and reflected in people’s care plans.
When people had experienced a fall, their care plans were not always updated to reflect the cause of the fall and provide guidance for staff on how to reduce the risk of reoccurrence.
If a person had a number of incidents and accidents recorded due to a specific additional support need, their care plan was not always amended to record the incidents and identify actions and outcomes. This meant staff did not always have the learning from the investigation of incidents.
Staff told us information following an investigation of an incident was shared with them, but no evidence was provided to support this and the incident record form did not indicate this had occurred.

The provider worked with people and relatives to have a safe transition to receiving care at home. The nominated individual explained they reviewed the information provided by the local authority to assess the person’s support needs. Senior staff met with the person and their relatives to complete an assessment of support needs. Care plans identified healthcare and other professionals that were involved in the person’s care. People confirmed that, if required, staff supported them to attend medical appointments.

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.
The provider had a process and procedure for the reporting and investigation of safeguarding concerns, but this was not always followed. During the assessment, we identified incidents which should have been reported to the local authority safeguarding team that had not been reported. This was raised with the nominated individual, and they submitted the safeguarding concerns as well as notifications of the referrals to the CQC.
A previous safeguarding concern which had been referred to the local authority showed that the provider had followed their safeguarding process. The provider had worked with the local authority during the safeguarding investigation. The actions identified from the safeguarding included the provider meeting with staff but there was no record of that happening and the other actions taken to reduce risks.
People told us they felt safe when they received support from staff with their comments including, “I feel perfectly safe”, and “That is one thing I like about them; I feel perfectly safe with her and treat her like my own”.

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.
The provider had developed risk management plans for some aspects of people’s care, but risk assessments were not always completed with guidance for staff. People’s care plans identified the medical conditions the person was living with, but risk assessments had not always been put in place. This meant staff did not always have guidance on how to support the person and the possible impact of a medical condition on how care was provided.
A person’s care plan identified they were allergic to antibiotics and healthcare professional need to be informed of the allergy, but the care plan does not indicate which antibiotics the person was allergic to. Where staff were supporting people to attend activities outside of their home, such as going shopping or attending appointments, risk management plans were not always developed.
If a person required support with repositioning due to issues with their mobility, their care plan indicated staff should reposition but there was no guidance on how to do this. Staff did not always record when they had provided this support.
People’s care plans indicated staff undertook tasks including checking blood sugar levels, oxygen levels, use of EpiPen for allergies and sterilising oxygen masks. The training records did not demonstrate that staff had undertaken training to provide this support. This meant there was a risk that these care activities were not always completed in line with best practice.
The provider had completed some risk assessments including falls, skin integrity and supporting the person with their mobility.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
The provider completed an environmental risk assessment, but these did not always include possible risks associated to their care. Personal emergency evacuation plans (PEEPS) were not always developed to provide staff with guidance on how to support the person in case of an emergency. Where a PEEP had been developed, they had not been updated to reflect any changes in care need. Where a person required support with the use of oxygen, the fire risk assessments did not indicate this and provide staff with mitigation.
Environmental risk assessments identified possible risks related to flooring, electrical and gas appliances as well as the external environment of the person’s home.

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.
The provider had a recruitment process to identify applicants suitable for role of providing support. The provider carried out checks on proof of identity, criminal record, references from previous employers and the applicants right to work in the United Kingdom.
Staff undertook a range of training, but the provider could not demonstrate that staff had completed training to support some specialist aspects of the care people required. Staff had their competency assessed following training and were supported through supervision and team meetings. People told us they felt staff had appropriate training to provide support. They told us, “Their training is good; from my point of view”, and “They are well trained and they have got used to my habits too.”
People told us staff usually visited at the agreed time, and they were contacted if the staff member was running late. The nominated individual explained the electronic call monitoring system (ECMS) indicated if staff were late in logging their arrival for a visit. The ECMS would record any late or missed calls, but the nominated individual confirmed they did not undertake an audit of the visit records. We reviewed the record of all visits completed in a month and we found the majority of visits occurred at the agreed time.
People told us staff usually stayed for the agreed length of visit with their comments including,
“They ask if there is anything else to be done; they will do anything for me”, and “They do stay for the full duration of time and sometimes run over, it depends on what they are doing.”
People and relatives said they were visited by the same group of staff who they got to know and they understood their care. Their told us, “It was one of my requirements that I have the same carer. The only time I have someone different is when she is on holiday or off sick”, and “Most of the time I have the same carer during the week and a different one at weekends. One stands in for the other if they are off sick or on holiday.”

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 confirmed staff used personal protective equipment (PPE) when they provided care. A person said, “They do wear their Masks and everything.” The nominated induvial explained staff completed infection control training annually and supplies of PPE were delivered to the person’s home. This was confirmed by people receiving support, “Yes, they do wear PPE and Paramount drop their stocks here.” The nominated individual explained compliance with infection prevention and control was reviewed during spot check visits at people’s home.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.
The provider had a number of policies in relation to the management of medicines, but these were not always followed. Medicines administration records (MARs) were not regularly audited to ensure medicines were being administered as prescribed and recorded appropriately. The nominated individual for the service confirmed the MARs for people receiving support with their medicines had not been reviewed for 6 months.
Where a person had been prescribed a medicine to be administered as and when required (PRN) staff were not always provided with guidance on how and when to administer the medicine. The MAR for 1 person indicated they had been prescribed medicines to be used in case of an allergic reaction. Staff had completed the MAR indicating the medicines had been administered regularly but there was no record of the person experiencing a medical need for the medicine.
Staff had completed a MAR indicating they had administered medicines for the person 4 times a day but there were only 2 visits scheduled
Where a person was prescribed a medicated skin patch which staff were required to apply as part of the administration of medicines. When reapplied, the new medicated patch should be applied to a different area of the skin to reduce the risk of irritation. Staff were not provided with guidance on how to appropriately apply the patch and staff did not complete a body map to record the locations.
A person’s care plan indicated their relative assisted with a medication requiring a regular injection. The medicine administration record charts had been completed by a staff member indicating they had assisted with the injection. The did not reflect the care plans and the provider did not provide evidence to show the staff member had received appropriate training.
The list of medicines in the care plans and medicines risk assessment did not reflect the medicines currently being administered.
Staff had completed MAR charts but had crossed out and scribbled over information recorded which meant the records were not clear.
Staff confirmed they had completed training for the administration of medicines. Following training a competency assessment of the staff member’s knowledge was completed.
People and relatives confirmed that, if required, staff supported with the administration of prescribed medicines.