Caremark Cheltenham and Tewkesbury

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 75 (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.

Learning was embedded into everyday practice and formed part of the service’s ‘no blame culture’. The registered managers shared any learning with the staff team to improve their knowledge, skills and competency. Any incidents, accidents and events were recorded with actions taken in response and shared with the staff team for learning. They used trend analysis to identify areas for further attention. For example, following some medicines errors, which were appropriately managed and reported, staff had refresher training and there was an increase in monitoring and reflective practice. This showed a marked reduction of medicines errors during the following months.

Team meetings were held quarterly with learning topics such as ‘hydration in hot weather’ and ‘hand hygiene’. Several meetings were held in succession to cover all staff who had different rostered shifts and schedules. Staff also had the opportunity to share learning, advice and tips to other staff during the meeting, as well as requesting updates and outcomes on previously raised questions to the management team. Staff told us they knew how to report concerns and who to report them to.

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 registered managers told us their processes supported continuity of care at every stage where they collaborated with professionals to ensure safe transitions and reduced the risk of disruption or avoidable harm. They recently supported 2 people to transfer to alternative providers of care successfully, including visiting with the new provider to handover and allow the observation of established care routines.

One relative told us how the transfer of their family members care was problem free; they were very grateful and happy that everything was set up and in place before the care started.

Health and social care professionals we spoke with were positive about how people were supported, how advice and guidance was sought and how any concerns were shared. They acknowledged how the service was able to manage very complex care packages for people with high levels of need.

However, we had received some concerns from a health and social care professional regarding the start of care for one person. We also received concerns from two relatives regarding the care being provided for two other people. The registered managers were proactive and thorough in their investigations into these concerns and provided a full and detailed description of events and circumstances. We found they had acted quickly to make the necessary changes. They had also adapted their initial assessment protocol to ask specific questions to gain more accurate information around people’s needs which had not been previously fully shared by referring agencies.

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.

The registered managers had submitted appropriate safeguarding referrals to the local authority and notifications to CQC. The level of information shared with other agencies had been appropriate and sufficient to keep people safe. Stakeholder partners reported the service carried out thorough internal investigations alongside the more formal safeguarding team investigations.

As a result, they found solutions to make changes with peoples care arrangements to keep them safe and prevent reoccurrence.

All staff had completed safeguarding training. The provider had a safeguarding policy and relevant procedures in place. Staff completed safeguarding refresher quizzes and discussed answers to embed their safeguarding awareness and knowledge. Staff were knowledgeable about safeguarding, how to recognise the types of abuse and how to escalate their concerns. Staff were fully aware of raising concerns using the whistle blowing policy and were confident the registered managers would take action.

People and their families told us they felt safe with their carers and had confidence in the service as a whole to support them safely at home.

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.

Risk assessments were thorough, person centred and scored to easily identify the level of risk and what to do about it.

Staff were aware of the individual risks people faced and how to manage them. They had full access to the person’s care plan and specific risk assessments, which enabled them to anticipate and manage known risk safely.

The registered managers encouraged safe positive risk taking. For example, one person wanted to manage their own medicines administration but found this physically difficult to manage. The service sourced a specific piece of equipment to help which promoted independence and autonomy.

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

Staff were aware of people’s individual home environment risk assessments and how to manage the identified risks. Staff were fully trained in using equipment safely and effectively which was recorded in people’s care plans. The registered managers liaised with health and social care professionals to ensure people had the correct level of support including different types of equipment they needed. Staff had their manual handling competency assessed 6 monthly.

People and their relatives told us they felt safe with the carers in their homes. A person said, “Staff are confident and I feel safe” and a relative told us, “I know he is safe and they care deeply for him.”

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.

Staff recruitment was robust and all the necessary safety checks and records were in place. This included full pre-employment checks such as the Disclosure and Barring Service (DBS), right to work documentation, references and employment history. The service had a sponsorship licence in place, and some staff were employed under this scheme, who were well supported to integrate into the local community.

Staff had one to one support meetings with their line manager 3 times a year, annual appraisals and 3 spot checks undertaken to observe competency. Staff told us these aided their professional development as well as reaching personal goals.

The registered managers had a record of training each staff member had undertaken and a system to plan when refreshers were needed. There was a good level of compliance with a wide variety of training available as well as refreshers or supported person specific subjects. Staff feedback was very positive regarding the breadth and level of training topics and they told us they could ask for refresher training at any time. Staff told us the training made them feel competent and skilled. All staff had completed the required training in Learning Disability and Autism.

People and their families told us they thought staff were ‘respectful, well trained and competent’.

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.

The service had an infection prevention and control policy and procedure in place. Staff had full training in infection prevention and control techniques and procedures. Staff told us they had access to personal protective equipment (PPE), and they demonstrated a good level of understanding of how to safely use and dispose of PPE, as well as food and hand hygiene.

People told us the staff always wore PPE during their visit and disposed of it safely.

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 service had a medicines policy and procedure which was updated and reviewed in accordance with best practice and new guidance. People’s medicines were managed according to their needs. Individual arrangements were in place to make sure each person received their medicines appropriately and safely.

Staff had been trained in the safe handling, administration, disposal and recording of medicines. All staff who administered medicines had their competency assessed 6 monthly. Monthly audits were taken to check all medicines administrations. This meant any errors or themes were identified which could be addressed quickly.