Archived: Comfort Call- Leeds

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• 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. We checked to see if: There were effective systems, processes and practices in place to make sure people are protected from abuse and neglect. That risks were assessed, and mitigating actions put in place. There were appropriate staffing levels and skill mix to make sure people receive consistently safe, good quality care that meets their needs. This key question has been rated requires improvement. We reviewed 4 quality statements for this key question. We have identified a breach in relation to safe care and treatment due to risk assessments lacking detail and medicines not always being managed safely.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

People told us they felt safe, and one person said, "I am safe with them (staff)." One relative told us, "[Name] is safe with them (staff), [Name] smiles and says ‘my friends are here’ [Name] doesn’t normally smile."

Staff told us they knew what to do if they were concerned about abuse. One staff member said, "If I have any safeguarding concern, I will report it to my supervisor or lead. Part of our rules is to ensure you report any abuse you see.” Staff received training in safeguarding adults to ensure they had the knowledge to keep people safe.

The registered manager was clear on their responsibilities and duties to identify and report any safeguarding concerns. There were processes to support staff in reporting concerns to the relevant safeguarding authority when required. This included having safeguarding and whistleblowing policies in place. However, we did identify one person who was being restricted of their liberty and the appropriate processes had not been followed. Following a discussion with the manager a risk assessment and referral to the local safeguarding had been completed.

Most people and relatives told us they felt safe how their care was provided and that risks were managed well. People's comments included, "Yes, I feel safe. Most of the time they [carers] know what they are doing. I am hoisted into a wheelchair and get personal care. The staff are all very nice;" A relative commented, "Yes the service is safe. They get her out of bed and shower her at the right temperature. There’s only one carer. There hasn't been any falls or bed sores. We have amazing carers."

Staff were aware of risks associated with people’s care and knew how to support people safely. Their comments included, "When someone has a fall, I will immediately call the ambulance. If the clients say they are not in pain or hurt, we will call the GP, inform the office and document it in our notes" and " When someone has a fall, we don’t move them, we call emergency and inform the office. Whilst the ambulance is on their way, I don’t leave the service user, stay with them and give the assurance." The registered manager and care coordinators demonstrated a good understanding of people's needs and how risks are managed. However, during this inspection we found examples were risk assessments and records of care provided required further detail.

Risk assessments were not always detailed. For example, when people required bed rails, this was not always recorded on their risk assessments. After our inspection, the registered manager sent us evidence that this had been rectified. We found details about people's support with specific care tasks was in their care tasks and not in their risk assessments. This meant that although there was guidance for staff on how to support people, for example to mobilise, being hoisted or manager their stoma, the full risk assessment had not been completed with details of the risks, impact and actions to mitigate those risks. Some people using the service required staff to support them to move by use of a hoist. We reviewed people's care plans and risk assessments and the information in these had not been updated in relation to when equipment used to move people had received safety checks. After our inspection, we reviewed evidence confirming all equipment used was safe to use. Evidence from inspection indicates that this demonstrates a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

People gave mixed feedback about staffing levels. Some people and relatives told us staff did not always arrive on time or stay for the full duration of the care visits; some people told us this impacted on their day to day choices. People’s comments included, “The carers don’t come on time. It varies. On weekends the morning call can be at 12.00pm. It’s so late. It’s a little inconvenient, especially if I have visitors coming or phone calls to do. Weekly visits can be late by an hour. It messes up my day’s routine. On another occasion the carer came very early at 6.10am in the morning” and “The carers can go, possibly, within 5 minutes. At times it’s inconvenient.” Relatives told us, “They don’t always stay the full time, some of them are very quick. Sometimes they are in and out very quickly. It could be 10 minutes for a an half hour call” and “Some of them do stay the full time and have a very good rapport but some are in and out and do not stay the full time.” People told us they enjoyed their regular staff team, however people/relatives did not often knew who was going to visit. Their comments included, “[Person] has dementia but she can describe who has been but we don’t know who is coming when and [person] really struggles with this.”

Staff told us they had enough time to spend with people and enough time to travel between care visits. Their comments included, “I get enough time to travel between visits” and “I am given enough time to travel between visits.”

We found staff did not always stay the full duration during care visits and these were not continually carried out on time. The systems in place had not always been effective in alerting and ensuring action was taken to investigate concerns. After our conversations with the registered manager, action was taken to investigate concerns and update the rotas. There were also plans to optimise the rotas and feedback was being gathered from people to ensure this was completed in line with people's preferences. The service had systems to recruit staff safely. This included gathering references and undertaking a Disclosure and Barring Service (DBS) check. The DBS check identifies any convictions a person has or whether they are barred from working with vulnerable adults.

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.

We received mixed feedback from people and relatives in relation to support provided with medication. People and relatives told us, "They [staff] give me my medicines and I take them. They have to record them. I can't fault the carers” and "One carer [name of staff member] is very good and checks everything about medication and keeps in contact. She helped to get some tablets changed to patches because [person] has trouble swallowing, has had a SALT assessment.” However, two relatives shared concerns about medication that needed to be taken at particular times. One relative told us, "We had had significant issues around timed medication which have very recently improved. I feel that they haven’t kept us informed so they could be an hour or more late (for timed medication) so that we could have stepped in. It has improved recently."

Staff told us they had received training to administer medication and would report any medication issues to the office/manager. The registered manager told us about recent medication errors that had been identified and the actions they had taken to ensure people were safe and staff were applying their training correctly. However, during this inspection, we found medication was not always safely managed.

Medicines were not always managed safely as the medication policy was not being followed. For example, one person was administered paracetamol 4 times a day but the required 4 hour gap was not always followed. Another person was restricted in accessing their medicines however, there were no assessments recorded to determine how this decision was made. We reviewed medication care plans and medication administration records for a service user and although errors were not identified, we found there was a lack of detail to ensure staff had clear access to the instructions to administer a medication that had a variable dose. Medication audits were not effective as they did not identify the issues we found on inspection. Evidence from inspection indicates that this demonstrates a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We have not found people were harmed, however lack of medicines oversight had put people at risk.