Choices Homecare (Rotherham North & Doncaster)

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 managing risks posed to people and staffing.

This service scored 53 (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. Staff had access to policies and information about how to report accidents and incidents, however we could not be assured these were always followed. Whilst we found no harm to people, we found incidents which were not recorded on the incident trackers, to ensure managers reviewed and actioned. For example, we found an incident relating to a minor injury which was not appropriately reported and reviewed. We also found some complaints made via CQC which were not effectively recorded and reviewed.

The provider did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. Some records contained conflicting and incorrect information about people's needs, and some information was missing from people's care records, such as information about their health diagnosis and how this was managed. It could not be evidenced people had always had pre assessments undertaken by the service prior to them receiving support.

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. The provider did not always share concerns quickly and appropriately. Some improvements were required to ensure the service appropriately monitored safeguarding concerns. Whilst we found no harm to people, records were not always up to date to allow senior staff to effectively monitor and review all safeguarding incidents. We found some gaps in safeguarding logs, and we found some incidents which we had not been notified about. Staff told us they felt able to whistle-blow and understood their responsibilities to keep people safe. We received mixed feedback from people about their care and support; however, most people told us they felt safe. One person said, “I feel safe with them [staff], but sometimes I have to initiate conversations with them.”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In homecare services, this is done through the court of protection. The service was working within the principles of the MCA, staff were trained in relation to the MCA and people had their capacity assessed.

The provider did not always work well with people to understand and manage risks. Whilst we found no harm to people, some records lacked robust information, and some records contained incorrect information about risks posed to people. For example, one person’s care records did not include accurate information about the moving and handling equipment they needed to use. Another person’s care plan did not provide clear guidance on how staff should monitor their food and drink intake. It also did not contain detailed or robust instructions for staff about the actions they should take if this person was at risk of choking. This placed people at risk of harm and did not ensure their needs were met safely. A relative said, “[Name] will not want to eat. Staff won’t question them not wanting to eat. The experienced carers will try to prompt.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People were supported in their own homes. People had risk assessments in place which detailed potential risks posed to them from their environment. Where people had pets there was also a risk assessment in place to ensure people and staff were protected from risks.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. We could not be assured people received support from staff for their allocated times. We found several incidents where call times were cut short, the providers internal audits had recognised this; however, this remained a concern at the time of our assessment. Some staff told us they did not have enough time between care calls and were often rushed, and some people told us staff did not stay for their allocated times. A person said, “Odd ones [staff] stay for the allocated time. Some get to me on time and some are up to 30 minutes late.” A staff member said, “The rota is such a mess, if 1 staff goes off sick it messes everything up. We can’t stay for allocated call times, otherwise we would never get home, it is rushed.” Staff were not adequately trained or skilled to support people safely in accordance with their assessed needs. Following our assessment, the manager told us they planned to review call times, and staff rota’s to ensure people received care for their allocated times. Staff were recruited safely and all appropriate pre-employment checks were in place. Staff were provided with an induction and shadowing opportunities.

The provider did not always assess or manage the risk of infection. The provider had infection, prevention, and control [IPC] policies and procedures in place. However, there was a lack of monitoring relating to staff adherence to these. There were no effective governance processes to monitor, assess, or ensure staff were following infection prevention and control (IPC) guidance. We received mixed feedback from people and relatives. 1 person said, “Staff wear gloves and aprons.” Whilst a relative said, “Some staff wear gloves and aprons.” Another person said, “Staff don’t always clean and tidy up.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Whilst we found medicines were mostly managed safely, however improvements were required to records prescribed creams. For example, 1 person's cream was not detailed on their medicine’s administration record (MAR) chart, and another person had a change in prescribed creams which was not changed on their MAR chart. Staff were overdue medicines training and observations of competencies to administer medicines. Staff consistently recorded MAR chart entries, including clear documentation when people refused their medicines. People had medicines risk assessments and care plans in place which detailed how they liked to take their medicines.