Expectation Care Limited

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 people’s safe care and treatment and safeguarding at the service.
 

This service scored 44 (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. Leaders did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
Some incidents recorded in people’s care plans were not included on the incident or safeguarding log. In some cases, there was no evidence that there had been any actions taken following an incident. There was also limited evidence that learning from incidents, concerns or complaints was shared with staff.
The service did not always demonstrate learning from safeguarding concerns. Following an enquiry by the local authority, the safeguarding outcome identified that care refusals were not managed in line with guidance and were not escalated. During the assessment, we identified people who may refuse care and support. There was no evidence of escalation for these concerns.
However, managers showed changes made to recording to reduce risk and prevent repeat concerns. They had also introduced additional checks.
Staff showed us the systems in place to support quality monitoring. The electronic care system allowed leaders to review care calls and medicines in real time. It alerted leaders if tasks were not completed or if medicines were late or missed.
 

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They 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.
Records did not show that referrals to partners were made in a timely and effective way. For example, there was no evidence that staff had completed training and competency assessments by a registered nurse before completing a clinical, specialised healthcare task for someone.
One person’s care plan recorded that following an incident an Occupational Therapy (OT) referral was made. However, there was no record of an OT assessment until nearly a year later.
One person’s care plan stated that a dietician had adjusted their fluid intake however there was no date as to when this was.
However, people told us that when their care started that they met the manager and were involved in the development of a care plan. Relatives told us that staff had supported their family member when they had moved out of hospital or a care home.
 

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.
The provider did not have effective safeguarding systems in place. Incidents and allegations of abuse were not always reported to the local authority or CQC. These included falls with injury, unexplained bruising and risks from family members.
Records did not always show that concerns were fully investigated or that action was taken to reduce risk.
Care plans updated following falls, injuries and changes required did not include follow up actions, professional input or reviews.
In some cases, decisions that limited people’s movement were not supported by a clear assessment or evidence that the person was involved.
External feedback from the local authority highlighted the need for stronger records when there were differences of opinion. There was no clear evidence this had been actioned.
However, people told us they felt safe with staff and they were treated well.
 

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.
Risks to people’s health and safety were not always assessed, recorded or managed. Care plans and risk assessments did not always give staff clear guidance.
Care records did not always include important clinical information. Some health conditions were recorded in one part of the care plan but not reflected in risk assessments or guidance for staff. This meant staff may not have understood how conditions affected people.
Risk assessments were not detailed enough. For example, moving and handling guidance did not always describe the correct equipment, safe method or the person’s ability. One care plan recorded the person was at risk of involuntary contractions. However, there was no guidance on triggers, frequency or actions for staff.
Care plans did not always reflect people’s needs. Some records showed conflicting information about eating and drinking support. There was no clear guidance from professionals where referrals had been made. This meant staff may not be providing safe or consistent care.
Records did not always show that people were involved in decisions. For example, where people were supported to stay in bed to reduce risk of falls, there was no evidence of an assessment to balance safety with people’s choice and independence.
Risk assessments were not always updated. Some assessments were out of date or incomplete. This included emergency plans, nutritional assessments and equipment checks. Care records also contained gaps such as missing dates.
The provider had not identified or addressed these concerns. Systems were not effective in ensuring risks were assessed, monitored and managed. This placed people at risk of unsafe care.
However, people felt confident staff knew how to support them to mitigate risk.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.
Care plans did not always include important, up-to date information about people’s equipment needs. There was a lack of clear guidance for staff around how to use equipment correctly to meet statutory requirements and support people to stay safe.

However, property risk assessments had been completed to identify hazards in people’s homes and to guide staff on how to work safely in that environment.
Specific assessments were in place for the use of emollient creams.
Personal emergency protocols were also recorded. These gave guidance on what action staff should take in the event of an emergency to support people’s safety.
 

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.
There was a lack of evidence that poor performance was managed appropriately.
Despite staff telling us that there was a positive learning culture, there was a lack of evidence that all staff had opportunities to learn from incidents.
Spot checks had not always been completed to ensure staff were delivering safe care.
There were gaps in training and competency assessments. Records showed staff supported people with specialist tasks such as rectal medicines. However, there was no evidence staff had been trained and assessed as competent by a suitable professional. Information provided by managers about who completed this task was inconsistent.
However, staff said there were enough staff to meet people’s needs. They confirmed they had travel time and breaks. Rotas supported this. Staff found training useful and felt confident in their role after induction. Recruitment practices were safe to ensure that all staff, were suitably experienced, competent and able to carry out their 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.
People told us staff wore appropriate personal protective equipment, demonstrated good hygiene and washed their hands.
Infection prevention and control (IPC) policies were in place that staff had access to and staff completed annual training.
However, care plans were lacking information about IPC when carrying out tasks and how to manage concerns about people’s hygiene.
 

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.

The provider did not ensure clear medicine protocols were in place. Care plans did not give staff enough guidance. One care plan did not include information on ordering, storage, administration, recording or disposal of controlled drugs. Guidance for as required (PRN) medicines was limited. There was no clear plan for how these medicines should be managed outside visit times or how this would be shared with the person, their family and staff. There was also no guidance on using other approaches or positive behavioural support techniques before administering medicine to reduce someone’s anxiety or how often these medicines should be reviewed.
Medicine audits and checks were not effective. Audit records often showed no concerns, but comments later identified issues such as poor recording, storage concerns and labelling errors. There was no evidence of follow up, actions or review in response to these findings.
Daily records were not always accurate. Medicines were recorded as given when they had not yet been taken. Records also showed medicines marked as administered when notes stated they were not required. This meant records did not clearly reflect the care provided.
However, people we spoke with had no concerns with how staff administered their medication and staff felt confident supporting people with medicines.