Sylvan Home Care Services - Bromborough Branch

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.

Lessons were not always identified as highlighted during this inspection. Quality and provider performance issues regarding the electronic call monitoring system had been occurring for a sustained period of time without any improvements or learning. People and their loved ones said they were comfortable raising and discussing concerns with management. One person told us, “We have no issues about speaking to the office and we always get immediate feedback or changes if we need them.”

Care plans and daily documentation did not always reflect coordinated care and support in partnership with people, their families, and healthcare partners. For example, we saw that in care records, tasks were marked as complete within a shorter time frame than that commissioned by the Local Authority to meet the individuals assessed need and this meant the provider could not be assured of the quality of the service being provided or that people were being safely supported as planned. We discussed this with the provider, and they told us they would take immediate action. We also found that the provider completed audits but none of these highlighted this issue. Senior staff conducted visits to assess people’s needs and determine the appropriate level of support required. 

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 manager demonstrated a clear understanding of their responsibilities in safeguarding people from harm and abuse. Procedures were in place to identify and address safeguarding issues, enabling timely action. The provider's system for monitoring accidents and incidents was in place and there were opportunities for learning. Staff confirmed they had received safeguarding training and knew what action to take in the event of suspected abuse. They demonstrated a strong understanding about risk management and risk escalation processes. Staff expressed confidence that management would respond appropriately to any safeguarding issues raised. 

The provider worked with people to understand and manage risks. However, the provider could not be assured that they provided care to meet people’s needs that was timely due to the inaccuracies of the electronic recording complete by staff. There was evidence of people participating in the planning of their care and risk management. Staff involved people in conversations about any changes to their care plans, risk assessments and care plans addressed specific health requirements. For example, we saw that one person required a specific method for transferring and with ongoing conversation between the person and their loved one, management and staff adjustments were made to make it safe as possible for the person and the staff involved.

The provider detected and controlled potential risks in the care environment. Staff and leaders escalated any risks identified then adapted their support to keep people safe. People told us staff maintained their home environment to a high standard when this was part of the agreed package of care. Risk assessments were undertaken on people’s living environments and this ensured potential environmental risks to both people and visiting care staff were identified and measures were implemented to mitigate any identified risks.    

The provider did not always make sure staffing deployment was effective and proportionate. We saw some staff worked excessive hours over a short period of time, and this impacted the safe delivery of care. Additionally, we saw poor practices for recoding of calls log in and log out times for multiple calls which did not match the planned times. With staff completing a large amount of work hours and inaccurate call logs the provider could not be assured of their processes and could not be certain all planned calls were being completed safely as agreed. Staff were able to complete calls due to consistent cancellation of calls. The rotas we reviewed illustrated, calls with no travel time between them, double up calls within limited or no overlap and this was a failure of the management of the service and in particular the coordination and deployment of staff. The manager told us due to difficulties of managing staff hours and the numbers of people they support meant they could not manage the schedules efficiently. Although the manager told us they were aware of this issue we could not find evidence any meaningful work to address these issues had taken place. This meant that the service was being coordinated around the staff’s availability and not the people using the service. This was a breach of Regulation 18, staffing. We shared our concerns with the provider, and they told us they would take immediate action. The provider made sure there was qualified, skilled and experienced staff, who received effective support, supervision and development.

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. Staff indicated they had received training focused on infection prevention and control, including refresher training, and confirmed they had sufficient access to personal protective equipment (PPE). Protocols were implemented to protect people from the risks associated with insufficient infection prevention and control measures. People and their loved ones conformed that all staff wore appropriate PPE and followed good practices to minimise the risk of relatives and friends, professionals and others visiting from spreading infection.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Records showed medicines were given safely and as prescribed. The managers completed audits and had identified additional support for staff when required. One person loved one told us, “It is very important to me that the medication (blister pack) is given by a professional. Carers tell me if she has had pain killers. I have no concerns.”