Evolving Care Ltd Leicester

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 69 (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 promoted a culture of safety and staff understood their responsibilities to raise, investigate and report safety concerns. Process were in place to support learning and improvement. During the inspection, we identified some governance concerns relating to medicines management and risk documentation. The registered manager responded positively to the feedback, demonstrated an understanding of the issues identified and provided assurances that actions were being taken to strengthen oversight and ensure risks continued to be managed safely.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

People and relatives told us they felt safe with the care provided. One relative said, “I can go away and know she is safe.” Another relative described the service as providing “A great feeling of security for the family” and being “reliable.”

Staff demonstrated a good understanding of safeguarding responsibilities. One staff member said, “If there is any risk of harm, I need to protect them and raise it as a concern.”

Safeguarding policies and procedures were in place and staff had undertaken safeguarding training. At the time of our inspection, no person had been granted or an application made to the Court of Protection for a Community Deprivation of Liberty Safeguard (DoLS). This occurs when a person lacks capacity to consent to their care and treatment. It protects people who can’t protect themselves.

The provider did not always have sufficiently detailed risk assessments in place to consistently demonstrate how risks were managed. We identified gaps within some risk assessments, including those relating to clinical needs such as catheter care and percutaneous endoscopic gastrostomy (PEG) management. A PEG tube is a feeding tube inserted directly into the stomach to provide nutrition, fluids and medicines when a person is unable to take enough orally. We also identified limited detail within assessments regarding how staff should support people during periods of distress where they expressed themselves verbally. However, staff demonstrated a good understanding of people's risks and were able to describe how they monitored, managed and escalated concerns appropriately. Staff also explained how they responded to changes in people's needs and provided reassurance and support during periods of distress. We discussed these findings with the registered manager who acknowledged the areas identified and outlined the actions being taken to review and strengthen risk assessment documentation.

People and their relatives raised no concerns about how health and care needs were met. One relative described how staff supported their family member during periods of distress, telling us, "Staff have been excellent, above and beyond. They have been exceptional, really calm and collected."

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

Environmental risks within people’s homes were considered as part of the provider’s assessment process. Assessments included factors that could impact the safe delivery of care, such as the home environment, potential trip hazards and arrangements for accessing the property. One staff member also described how they carried out checks of equipment prior to use to help ensure care was delivered safely.

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 had access to training relevant to their roles. While some formal competency assessments had not been completed, the provider had already arranged additional competency checks with external professionals.

Most people and relatives did not raise any concerns about care visit times or continuity of staff. One person told us there had been occasional variation in the timing of their morning visit and said they would prefer greater consistency in the staff supporting them. A relative also commented that improved continuity of staff would be beneficial. We shared this feedback with the registered manager, who told us they would review these arrangements.

The provider promoted continuity of care where possible. Staff told us they regularly supported the same people, which helped them understand individual needs and recognise changes in presentation.

People and relatives told us staff were competent and knowledgeable. One relative said, “They know their job.” Another relative described some inconsistencies during transfers but told us the management team had responded promptly by providing additional guidance and support to staff. They described the management team as “Tremendous” and confirmed improvements had been made.

Staff received supervision and appraisal, and safe recruitment processes were followed, including appropriate references and DBS checks.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning their care and treatment.

We identified some concerns regarding medicines management and recording. For one person, prescribed paracetamol was sometimes left for them to take independently; however, records did not always demonstrate appropriate intervals between doses or record when the medicine had been taken.

We also found inconsistencies in medicines records, including occasions where prescribed medicines had been recorded as "PRN not required" rather than refused, with no rationale documented. PRN medicines are prescribed to be taken 'as required' rather than at set times.

Some PRN protocols and topical cream guidance lacked sufficient detail to support consistent administration. Following our verbal feedback, the registered manager submitted updated PRN protocols.

The provider's audits had identified some discrepancies in medicines records and recognised that medicine specific guidance required further detail. However, not all of the concerns identified during the inspection had been recognised through existing oversight processes.

We also identified gaps in the oversight of transdermal patches. Although the provider advised they were not supporting anyone with patches, staff provided conflicting information, and patch management was not routinely included within medicines audits.

Despite these concerns, people and their relatives raised no concerns regarding the management of medicines and told us they felt their medicines were administered safely.