Radis Community Care (Gloucester)

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.

This service scored 59 (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 listened to concerns about safety and investigated and reported safety events. However, we found the lessons learnt and improved practices had not been fully embedded into staff practices.

Systems were in place for staff to report any incidents and concerns to the management team. All incidents were reviewed and logged by the registered manager. The incidents and any lessons learnt were discussed with staff during supervisions and staff meetings. Lessons learnt handouts had been created and shared with staff to develop their practices and to help prevent further incidents. However, practices implemented to drive improvement after incidents had not always been effective, for example, incidents relating to the breakdown of people’s skin had continued to occur.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

Radis Community Care (Gloucester) provided several services to support people to remain living in their own homes including daily support with personal care and support for family carers to have regular breaks. The service worked with health and social care partners to offer a rapid response service for people requiring basic clinical monitoring, with the aim to prevent hospital admissions. An emergency support service was also provided for people when their primary family carer was admitted into hospital to help them remain in their own home.

The registered manager described how they obtained information about people's needs and risks from people, their families and health and social care partners as part of their initial assessment to ensure they could meet people's needs. Protocols existed to facilitate information sharing among health care partners when emergency services were needed. Advice and support were also obtained as needed from the provider's clinical nursing team.

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. They did not always 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 always share concerns quickly and appropriately.

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. However, we found some aspects of the service's safeguarding systems needed further development to ensure people would be fully protected from abuse.

Staff had received training in safeguarding adults and children; however, it was unclear whether the provider had evaluated the suitability and level of this training in relation to the specific safeguarding responsibilities of staff and managers. The provider’s safeguarding policy lacked essential information, including contact details for the local authority safeguarding team and reference to the local safeguarding framework. As a result, staff may not have had access to the necessary guidance to appropriately escalate safeguarding concerns.

Safeguarding concerns had been recorded by the registered manager and reviewed by the provider’s safeguarding lead. However, the service would benefit from the appointment of a designated safeguarding lead at a local level to act as a point of contact, offer advice, and support staff in line with the local authority’s safeguarding procedures.

People and their relatives felt safe using the service. One relative said, “We feel very safe as 2 regular girls visit” and a person said, “I have 1 daily visit every day for personal care, washing, dressing and getting up, I use a wheelchair, feel very safe, no abuse, care is very good.”

The provider was not consistent in their approach to understand and manage people’s risks. People's support needs and risks had been assessed as part of their initial assessment. However, there was not always a consistent approach in the review of people's risks in line with their changing needs. Environmental and personal risk assessments were in place; however, risks management plans relating to people’s personal risks such as risk of falls or skin breakdown were not always personalised. They provided staff with general information about the measures needed to manage people's risks but lacked personalised information to manage people's individual risks.

Staff were knowledgeable about people’s care needs and risks and knew the importance of escalating any concerns about changes in people’s well-being to the managers of the service. However, staff records of their care delivery and the measures taken to mitigate risks, such as repositioning to avoid skin breakdown, was inconsistent or not always legible. We saw evidence of staff recording breakdown on people's skin on body charts and the actions that had been taken such as contacting the district nurses. However, people's care and risk management plans had not always been updated to reflect people’s current needs or recommendations made by health care professionals. This meant the registered manager could not always be assured that people receive care which was focused on their needs and risks.

People and their relatives told us staff provided care which was safe and met people’s needs. One relative said, “All equipment is handled safely and brilliantly, carers are diligent applying his creams after his wash, skin integrity is now good, there was a problem a couple of weeks ago but with their care it is healing nicely.”

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

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.

Recruitment checks had been completed for all newly appointed staff prior to them commencing their roles. However, one staff file was found to be incomplete, lacking a full employment history. This was identified during the inspection. Following the inspection the provider submitted evidence that appropriate action had been taken to address this concern.

We received mixed views from staff about their training, support and care visit times. One staff member said, “Training and support could be better. There is a lack of communication and there should be more travel time.” However, another staff member said, “I think training is good and they always ask us if we need any additional training.”

Staff had undertaken both mandatory and role-specific training, which was centrally monitored to support timely completion and ensure alignment with individual roles and responsibilities. However, some training modules were found to be overdue. Furthermore, the training matrix lacked sufficient detail, including the level of training completed, expiry dates, and required time frames for refresher training. This limited the registered manager’s ability to effectively monitor staff compliance with training requirements.

Systems were in place to monitor staff supervisions; however, there was inconsistency in the frequency with which supervisions were carried out. Oversight of the supervision matrix was inconsistent, impacting the provider’s ability to ensure staff received regular and meaningful supervision in line with their policy.

In addition, probation review meetings had not consistently been conducted during staff probation periods, contrary to the provider’s own policy. Annual appraisals had not been completed for all staff. However, this had been recognised by the provider and was documented within the service improvement plan.

We saw evidence staff received spot checks. This allowed the managers to have assurances around staff response times to ensure people were supported in a timely manner. However, spot checks had been carried out inconsistently, and there was a lack of clear oversight regarding who held overall responsibility for monitoring and ensuring their completion.

Systems were in place to plan staff rotas and people’s care call times. People were mainly positive about the reliability and punctuality of staff. For example, one person said, “I can get hold of the agency anytime or my daughter in law would contact them. Good communication, never had a missed call, 1 carer visits, lets me know if going to be late, has time to sit with me and chat for a few minutes which is really nice, well trained”

However, some staff reported that they did not consistently receive their visit schedules in a timely manner. This issue had been identified and was being addressed by the provider. Although people had generally not raised concerns regarding the timing of their care visits, a review of rosters identified a small number of discrepancies between scheduled and actual visit times. The registered manager had agreed to strengthen oversight of the electronic monitoring system to ensure regular identification and resolution of such issues.

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 did not raise concerns regarding staff practices in relation to infection prevention and control. Staff had access to appropriate personal protective equipment (PPE) and demonstrated confidence in its correct usage. Staff had undertaken training in infection prevention and control (IPC).

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.

People raised no concerns about the management and administration of their medicines. They told us they had received their medicines as prescribed and at the appropriate times. One relative said, “Medication is in dossette boxes or tablets we have sorted in a tray; staff only give from the dossette box but check she has taken the ones in the tray.” Staff were aware of their roles and responsibilities in administering people’s prescribed medicines. One staff member said, “We are not allowed to give medicines that’s not prescribed, so we have to phone the office.”

However, we found some inconsistencies in people’s medicines care plans and Medication Administration Records (MARs), including the lack of documented clinical rationale for prescribed medicines and the absence of protocols for the administration of 'as required' (PRN) medicines. Additionally, MARs had been transcribed but not countersigned, which does not align with best practice for medicines safety.

People’s medicines records did not always describe the role of family members in medicines-related tasks such as ordering, collection, delivery, and disposal of medicines. However, the provider had identified further improvement was required in the safe management of people’s medicine records as part of their service improvement plan and was taking action to address the shortfalls in the management of people’s medicines.