Starline 2000

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 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 regulation 18. The provider failed to support care workers adequately to ensure they had appropriate knowledge and skills to meet people’s needs.

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 positive culture of safety. There were systems and processes in place to manage accidents and incidents. The registered manager discussed these with care workers and developed plans for improvements. Care workers told us there were staff meetings and they had individual supervision in which incidents and accidents were discussed to ensure learning was shared.

The registered manager coordinated with healthcare professionals to ensure people received continuity of care to meet their needs. They shared relevant information about people’s healthcare needs and sought support from healthcare professionals for example, home enteral nutrition (HEN) team consisting of the dietitians, nutrition nurse specialists, and speech and language therapists (SALT), and occupational therapist to maintain safe care for them.

The provider worked with people and healthcare professionals; people were protected from the risk of abuse. One relative told us, “Oh yes (my loved one) trusts all of their carers to support them safely. I feel quite confident that my loved one feels safe with them (care workers).” Another relative said, “Yes, we have had a very stable team of carers for 5 years who are very reliable and understand my (loved one’s) needs.” Care workers completed safeguarding training and were aware of the action to take if they suspected someone had been abused including reporting their concerns to the registered manager. Care workers were aware about the procedure for whistle blowing and whom to report and escalate concerns. The provider had a policy and procedure for safeguarding adults from abuse.

There were systems and processes in place to manage and follow up on accidents and incidents. The registered manager told us there had been one safeguarding incident since the previous inspection and the matter was being investigated by the provider and the local authority safeguarding team. This incident was subject to further investigation by CQC as to whether any regulatory action should be taken. As a result, this inspection did not examine the circumstances of the incident.

People were protected from avoidable harm. A relative said, “They (care workers) are well trained and use the hoist safely.” One member of staff told us, ‘I make sure I don’t attend to (name of person) alone to manage risks when hoisting them.” The registered manager completed risk assessments and risk management plans that included guidance for care workers. For example, about how to manage hoisting and mobility, A percutaneous endoscopic gastrostomy (PEG tube feeding), eating and drinking, choking, catheter care, suctioning, skin integrity, fire, and skin protectant ointment (creams). Risk were reviewed periodically or as and when people’s needs changed.

People's care and support was provided in a safe environment. The provider carried out a risk assessment of home environment, including fire, safety of the hoist and mobility equipment and gave guidance for care workers to provide care to people in a safe environment.

The care workers were not always supported adequately to ensure they had appropriate knowledge and skills to meet people’s needs. We found the deputy manager had signed and issued training certificates in the capacity of a trainer to care workers to evidence that they have received training in 34 different topics. We found the deputy manager did not have suitable qualifications, specialised knowledge, accreditation, and experience to deliver trainings in all the 34 different topics to care workers. This placed people at risk of unsafe care and support.

We received mixed feedback from people. One relative said, “No, I don’t think many of the carers know what they are doing correctly, safely or competently. Especially when they are hoisting, repositioning and feeding vis PEG feed. They do not know how to use the PEG feed tube correctly. It does worry me.” Another relative told us, “Yes, I think the carers do know what they are doing. The majority appear to be confident and competent.” A third relative commented, “Yes most definitely the carers are competent when supporting my (loved one)”.

People had a range of needs which included: Epilepsy, PEG feed, administration of medicines via PEG tube, stoma care, catheter care and suctioning, learning disability, hoisting and moving and handling. There were no supporting evidence to suggest care workers have received the above specialist trainings.

In response to our feedback, the provider told us they took help from external trainers for training and competency assessments of care workers. However, the provider was not able to provide sufficient supporting evidence to reflect external trainers competence, names of specific trainings they have given to which care worker and when, including if any specific competency assessments that were completed. We were not assured that care workers received mandatory trainings and additional training according to the specific needs of people.

Notwithstanding the above, care workers told us they had completed trainings that was relevant to people’s needs. Care workers demonstrated how they supported people in a safe way. One care worker said, “My manager does the training for everything and sometimes brings someone to train us in the office.” Another care worker told us, I did trainings and induction, personal care, medication, companionship, record keeping, moving handling, safety, peg feeding, suctioning, and catheter management”.

The provider did not follow safe recruitment practices and had not ensured appropriate pre-employment checks were completed satisfactorily before care workers were employed. For example, a care worker was employed with a start date 22 December 2023, however their Disclosure Barring Service (DBS) was with another company at the time and not with the provider Starline 2000. In response to our feedback, the provider completed DBS check and told us they shall not repeat this failure in the future. Another care worker was employed without satisfactory right to work status. In response to our feedback the provider confirmed that the care worker had stopped working. A third care worker’s employment history dates and the dates of employment mentioned in their reference did not match. We could not be assured that the provider operated safe recruitment practices.

The provider supported care workers through induction and regular supervision meetings.

People were protected from the risk of infection. Care workers understood the importance of effective hand washing, using personal protective equipment (PPE) and disposing of waste appropriately. This protected people from infection and cross-contamination.

At our last inspection the provider had failed to ensure safe administration and management of as required (PRN) medicines. We recommended the provider review their practice. At this assessment, we found we found the provider had made the required improvements.

People received their medicines as prescribed.We looked at people’s medicines records and found no discrepancies in the recording of medicines administered and this provided a level of assurance that people received their medicines safely, consistently and as prescribed. Care workers were trained and deemed competent before they administered medicines. The provider had a system to monitor and audit people’s medicines on a regular basis.