Athlone Care

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 remained the same.

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 and the ways people’s medicines were managed.

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.

There were systems in place to report incidents. When staff raised concerns, these had been investigated. For example, staff investigated how one person sustained a bruise and how they could reduce the risk of a similar injury occurring. Incidents were reviewed for patterns and trends and to learn lessons. Staff discussed incidents and incident reporting at team meetings to ensure information was shared and incidents continued to be reported as needed.

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.

The providers shared relevant information with partners and sought advice where needed. Staff had access to NHS England’s GP Connect. This system allowed staff to stay up to date with people’s health information, where appropriate and share information with people’s health care providers. The improved information sharing between health care partners and increased the opportunity for continuity across services.

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.

Staff had a good understanding of the signs of potential abuse and knew how to raise concerns. Staff told us they were confident action would be taken if concerns arose. Staff also knew how to blow the whistle if they felt concerns were not being addressed. People told us they felt safe with the staff who supported them. One person said, “They’re kind and caring, I do feel safe.”

Where people were being deprived of their liberty the appropriate safeguards were in place to ensure this was being done appropriately and people were protected from the risk of abuse. When people live in their own home this is done through the court of protection.

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.

Care plans varied in standard and level of detail. This needed to be improved so staff had access to relevant information when they provided support to people. Some care plans included a good level of information about people’s health risks. However, others were missing some information. For example, where people were at risk of constipation there were no risk assessments in place to inform staff how to support the person. We raised this during the assessment, and the provider started to address this concern updating care plans to add the information required.

Where people were living with diabetes there was some information such as the signs a person could be becoming unwell. However, care plans didn’t include information specific to the person such as if their blood sugar was normally stable of if they often had low or high blood sugar so that staff had this information. There was also a lack of information about what to do if staff were concerned.

Another person’s care plan for seizures included some information for staff on how to keep the person safe. However, there was nothing on how to manage any environmental risks during a seizure.

Some risk assessments did include a good level of detail and guidance for staff. For example, where people were supported to mobilise using a hoist, there was detailed guidance on how to support the person safely.

Staff knew how to provide support to people and were able to tell us what they would do to keep people safe if risks arose. People and their relatives told us they felt safe with the support they received. One relative said, “[My relative] is perfectly happy with them. [They] would tell us if there were any issues.” One person said, “I feel safe and if I didn’t, I would tell them.”

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 provider had systems in place to ensure people’s equipment was being maintained and was safe for staff to use. Staff also completed environmental risk assessments to ensure any potential hazards were identified and addressed. For example, checking if people had smoke detectors in place or if there were potential trip hazards. Where people were at risk from falls staff were reminded to ensure walkways were kept free from clutter.

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.

There was enough staff to provide people with support. Feedback from people was mainly positive with comments including, “They are calling at the right time and staying the length they should”, “They’ve never cancelled a call to my knowledge” and, “They are prompt and stay the time they should.” Staff told us they had enough time to support people and move between calls.

The provider had invested in providing staff with a wide range of training. This included mandatory training such as safeguarding, supporting people with a learning disability and autism, and infection prevention control. Staff had also completed training in specific areas such as supporting people with feeding tubes, catheters care and supporting people with emotional based behaviours. Some people used emergency medicines and staff had completed the training required to administer these.

Staff were positive about the training and support they received. One staff told us, “The training is continuous training. You can ask for additional training if you need any.”

Staff were also being supported to develop their skills and undertake further qualifications. For example, a number of staff were undertaking ‘Diplomas in Leadership and Management for Adult Care.’

Staff were recruited following safe recruitment practices which included checking people’s work histories, obtaining references and completing Disclosure and Barring Service (DBS) checks. A DBS check is an official background check used to review a person's criminal record and assess their suitability for a specific role.

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 had completed training in relevant areas such as infection control, hand hygiene and food hygiene to enable them to have the skills and knowledge they needed to support people safely and reduce the risk of infections spreading through unclean practices.

Staff had access to personal protective equipment as needed and people told us they used this. One person said, “They wear it all the time. I can’t fault them.” People told us staff also helped them to keep clean and keep their home clean where this was part of the planned care package of support.

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

We identified a number of concerns regarding how people were supported with their medicines. People did not always receive their medicines as prescribed.

One person’s medicine was missed on multiple occasions, and this had not been identified or addressed prior to the assessment. Another person’s medicines needed to be administered at set times during the day in order to be most effective and reduce risk for the person. Their morning care call had been scheduled later than the time the medicine needed to be administered and so the medicine could not be given on time. Staff had not discussed this with the prescriber to ensure it was safe to administer the medicine consistently late. Another person’s pain medicine was regularly given too early and was too close the previous dose, there was a risk to the person from having a dose of medicine before it was safe to do so.

When people were prescribed as and when medicines, ‘PRN’ there were no protocols in place to provide staff with the information they needed to support people safely. Some information was included elsewhere such as in the medicine administration records, however, some key information was not included. For example, the maximum dose safe to administer within 24 hours.

Staff had completed training in administering medicines and competency assessments. We raised our concerns about medicines during the assessment. The provided took action to address the concerns we raised. However, practices needed to be improved to ensure other concerns did not arise and go unchecked.