Option Care 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 good governance at the service.

This service scored 56 (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.

Whilst staff told us they understood how to report incidents and accidents, we saw examples where staff had not escalated safety concerns to management. This meant that concerns about people’s safety had not always been shared and addressed in a timely manner. We saw evidence that management had discussed this with staff, however, more time was needed for improvements to this process to be reliably embedded.

We received mixed feedback from professionals about the providers ability to consistently investigate and report safety events. Some professionals told us they were concerned about the providers ability to recognise and resolve issues effectively when they occurred. However, in contrast, one professional told us, “We have had a lot of involvement in the past, and they are open to feedback and criticism and will try to improve.”

We were not assured that the provider had always acted upon safety events as expected and required. For example, one local authority who commissions care with the provider had identified concerns across multiple areas of the service relating to a proactive and positive safety culture. The provider was currently working with the local authority to address and respond to these concerns.

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.

We found mixed examples of how effectively the provider coordinated with other stakeholders as people moved between services. Feedback we received from partner organisations stated the provider had not always escalated concerns around changing needs or shared updates with partners as required. One stakeholder partner told us, “A more robust monitoring/observation of the care that is being provided…” would be beneficial. Conversely, one professional discussed the support the provider had offered and stated, “They have been responsive and flexible to the requirements of family.”

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.

One local authority who commissions care with the provider had identified safeguarding concerns across multiple areas of the service. The provider told us they had concerns about the delay from the local authority in sharing the initial safeguarding concerns with them. The provider was currently working with the local authority to address and respond to these concerns.

Professionals raised some concerns about the provider’s response to safeguarding enquiries, stating they did not always receive timely assurances that pro-active action had been taken to investigate concerns and keep people safe.

We received mixed feedback from people and their relatives about whether they felt safe receiving care from staff. Some people and their relatives raised concerns relating to safety and welfare, which we shared with the provider. However, one relative said, “I feel [my relative] is really safe. I feel I can sleep in the night and that it is ok.”

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.

There was not always a clear record to demonstrate that risks relating to people had been assessed and managed appropriately. For example, where someone presented significant risks with their behaviours, this had not been fully scoped in a risk assessment. In contrast, we reviewed a Positive Behaviour Support Plan (PBS Plan) for a person who was supported with behaviours of distress which clearly described the best way to support the individual to proactively prevent and manage any periods of distress. The lack of consistency within care plans and risk assessments meant that staff did not always have clear and consistent guidance on how to manage risk. This placed people at risk of being supported inconsistently.

Despite this, staff told us they felt they had enough information in people’s care plans to support them to manage risk. One staff member said, “Care plans and risk assessments provide information such as challenging behaviour, choking risk, falls risk, pressure damage and give correct actions and equipment used to reduce risk. There is enough information and time at my disposal to manage risk effectively and management is alert to any recommended reviews.”

The provider detected and controlled potential risks in the care environment. They made sure equipment supported the delivery of safe care.

Care Plans contained information about how to support people with equipment safely. They also included links to videos and additional information where appropriate.

There was an out of hours telephone based ‘on call system’ in place. Senior staff who operated it were able to access the electronic care planning systems remotely to coordinate care and respond to emergencies.

The provider did not always make sure there were enough qualified, skilled and experienced staff deployed. They did not always work together well to provide safe care that met people’s individual needs.

We received mixed feedback from people and their relatives about their care calls. Some people told us that staff were on time or advised them if they were going to be late, so they were aware. One person said, “They are not late and they have never missed a call, they always let me know”.Other people told us that staff arrived late and the visit felt rushed. One person said, “They are rushed. I feel I am not being washed properly.”Another person told us, “They are alright, I reckon they are overworked”.

We reviewed the provider’s call time data which corroborated these concerns. We found a number of occasions where staff had arrived late or not stayed for the full duration of people’s care visits. In addition to this we identified that where people required ‘double-up’ calls (where two care staff are required to attend one person’s visit at the same time), these had not always been done in a co-ordinated manner with limited or, sometimes, no overlap.

We saw no evidence of harm and the provider told us that they were assured people were receiving the right care at the right times. The provider told us the call data was unreliable due to technical errors. The provider advised they were using two systems to capture electronic call monitoring data and they had employed a consultancy to support with their call scheduling and oversight.

Staff told us they received effective training to deliver care safely and competently. One staff member said, “We are required to complete online training and face to face training. There is a right mix of training.”

We received mixed feedback from people about whether staff had sufficient training to meet their needs. One relative told us, “I don’t feel [the staff have] the right training and experience. I have raised issues along the way.” In contrast, another relative said, “The way they have handled [my relative] is great. They must be trained.”

Staff were recruited safely. All required checks were made before new staff began working at the home.

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 mostly told us staff wore appropriate personal protective equipment (PPE) and followed good hygiene practices. This included wearing gloves during support with personal care and changing gloves between care tasks to minimise the risk of cross contamination.

Staff confirmed they had received infection prevention and control training and had a good understanding about good practice in this area. Staff confirmed they had supplies of PPE in place. One staff member said, “We have plenty of PPE and I have had training.”

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.

There were systems and processes in place to administer medicines safely however, staff were not always following them and therefore they were not always effective in ensuring safe management of medicines. The service was operating 2 medicines administration recording systems: an electronic system and a paper system. The electronic and paper systems did not always contain the same information about medicines or contain all the information about administration times of time sensitive medicines. Staff did not record the medicines administration on the eMAR system until they left the house of the person, they were providing care for. This meant records appeared to show people were being given medicines too soon after the last dose or later than the prescribed time for time critical medicines. We were unable to compare the call times and the administration times to gain assurance, as the call monitoring system did not contain accurate information about visit times. We spoke to the provider who changed the recording system so staff could record the time of administration on the eMAR system at the correct time to ensure people’s records were accurate and complete.

Staff were not following manufacturer’s instructions when applying medicated pain patches. These patches need to be rotated to a different site on the body for at least 3 weeks to avoid skin irritation or build-up of the medicine in the skin. We shared this with the provider who took action to review their processes and ensure staff were rotating the patches correctly.

Care plans and risk assessments were in place to support staff to administer people’s medicines safely and contained some detailed information about conditions such as epilepsy and Parkinsons disease however, the risk assessments were not always reflective of people’s needs. Where one person required support at night time to take their medicines, their records stated they were fully independent. This had led to staff not following best practice when supporting the person. The provider addressed this concern and changed their arrangements with the person to promote best practice and safe administration of medicines.

The service completed medicines audits monthly. The system was not robust and had not identified the concerns we found during the inspection. For example, the provider had not identified where paracetamol for pain relief had not been added to the MAR charts in line with the prescription.