Metro Homecare Ltd

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 safe care and treatment and staffing.

This service scored 47 (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 demonstrate a proactive and positive culture of safety. The provider had not analysed call monitoring data to understand and address concerns with staff punctuality. The provider missed opportunities to identify learning, despite having systems such as electronic care planning and medicines records, which had highlighted issues relating to punctuality. As a result, people did not always receive care when they needed or wanted it.

Safety concerns were discussed as part of staff briefings to support learning from practice. The provider investigated concerns raised about some aspects of the care they delivered. However, quality audits undertaken by external professionals found concerns the provider had failed to identify and address themselves. This meant lessons were not always learnt to ensure good practice was embedded.

The provider did not always effectively maintain safe systems of care, in which safety was monitored. Systems did not always ensure continuity of care. Whilst people we spoke to told us they received care, there were instances when staff who were not due to work had to be called because the provider had failed to arrange alternative staffing. They told us, “When a temporary staff member didn’t turn up, I had to phone up and was told there had been a problem. I think the person who was meant to be coming was sick and they did not organise a replacement. They were very sorry but by this time it was too late, my [relative] had already helped me up”.

The provider’s care planning system was detailed and included information about people’s health needs. However, the information recorded within it did not always contain all people’s health needs, such as allergies they had.

Staff we spoke with were able to describe the systems the provider had in place to deal with emergencies. This included systems to record information to inform relevant professionals about the safety and welfare of the people they supported.

The provider worked well with people and healthcare partners to understand what being safe meant and how this could be achieved. They focussed on improving people’s lives or protecting their right to live in safety from avoidable harm.

The provider reported safeguarding concerns to the partner agencies they worked with. Concerns were immediately investigated in a transparent way with findings shared with all parties involved in people’s care. The provider reviewed the findings of safeguarding incidents and shared their findings with the staff. Staff received safeguarding training and were able to tell us about the different types of abuse.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care that met people’s needs in a safe and supportive way which enabled people to do the things that mattered to them.

People’s risk assessments did not always contain all relevant information. For example, risks related to the side effects of people’s medicines were not recorded. This meant staff may not have been able to identify and respond to an adverse reaction. Information relating to the signs and symptoms of an allergic reaction were not always recorded. This meant staff may not know how to recognise and respond to an allergic reaction to ensure the person’s safety.

Despite this, staff understood about risks and how to keep people safe whilst balancing the need to keep people as independent as possible. A staff member told us, “I might have to support a person to prepare a meal and watch them to make sure they are safe, for example, but I get them do as much of it as they possibly can, which is important for them.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider carried out an initial risk assessment before supporting a person, ensuring the environment was safe for the person and for the staff supporting them. The provider continued to assess safety in people’s homes and worked with them to address any concerns they had.

Staff told us about the range of equipment they supported people to use, such as walking frames and hoists, and, about the importance of using this equipment correctly to make sure people were safe. A staff member told us, “We receive training about how to make sure people are safe when they are moving. This helps prevent falls and other injuries which would be terrible for them if it happened.”

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not work effectively together with people to provide safe care that met people’s individual needs. Records from the provider’s own systems showed 23 staff members had worked for more than 4 consecutive weeks without a day off, raising concerns about staff wellbeing and their ability to provide safe care.

Some people had been assessed as requiring support from 2 staff for physical assistance; however, the provider’s data demonstrated some of these visits were attended by only 1 member of staff. This meant people were not always supported by sufficient staff numbers to meet their needs safely. Some medicines people took were required to be given at consistent times but owing to lateness this did not always happen.

Whilst people and their families were generally positive about the staff who supported them, some expressed concerns about inconsistent staffing arrangements. A person told us, “The regular people are good, I don’t have a problem with them. There were a few that weren’t regular, completely hit and miss and I wouldn’t know if they were going to turn up.”

The provider had clear, robust recruitment procedures in place. This meant staff were recruited in line with current legislation which included, for example, references from previous employers and criminal records checks.

The provider assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly. Staff worked alongside people to keep the home environment clean by undertaking additional domestic tasks.

The provider had policies and procedures in place to protect staff and ensured they had adequate supplies of personal protective equipment to minimise risks of infections. Staff were trained in infection prevention and control and understood they needed to report any concerns if they arose.

The provider did not ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. People did not consistently receive their medicines at the correct time. The provider’s call monitoring data evidenced in some cases people received their medicines late due to poor timekeeping by staff. This posed a potential risk to people’s health and wellbeing. The provider had not identified and addressed these concerns despite their electronic medicines administration systems highlighting such concerns.