Callquest For Care

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 people’s safe care and treatment and staffing.

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.

The provider did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice.

Staff had not received appropriate on-going development for their roles to ensure their skills were safe and remained up to date. Despite this, there had been no recent accidents or incidents at the service. Staff told us about an accident that had taken place a year ago and explained they action they took to ensure the person was comfortable while waiting for emergency services. There was a process in place to support staff to record accidents and incidents. A log was also in place so that the registered manager could keep track of any accidents and incidents and review them to ensure action was taken to prevent re-occurrence or address any pattern or trends, but this had not yet been needed.

There was limited auditing, and quality assurance in place for other aspects of the governance for the service to ensure that learning and improvement took place. Following assessment feedback, the provider showed willingness to improve, although this was reactive rather than embedded practice.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

The registered manager completed initial assessments with people when they started using the service. This helped to form their initial risk assessments and care plans. A staff member said, “If there is a new person, they always give me the new guidelines what the needs are and what is required of me.”

The registered manager worked with other professionals to ensure people’s needs were met such as GPs, pharmacy and district nurses. Staff gave examples of when they had identified issues with people’s care and the action they had taken to raise concerns with other professionals. Relatives confirmed concerns were escalated appropriately. This helped ensure people received appropriate care and support to manage their needs safely.

However, improvements were needed to ensure care plans and risk assessments were regularly reviewed and updated to support safe transitions and continuity of care.

The provider had not always ensured staff understood safeguarding and were aware of how to identify possible safeguarding concerns or the action to take if they had concerns.

Although staff had completed an induction when they started working at the service, they had not received mandatory training in safeguarding. Staff did not consistently have the knowledge to recognise and respond to abuse. Staff did not know the possible signs of abuse and told us they had not received safeguarding training, despite the providers policy stating staff should receive this training regularly. We discussed this with the registered manager who confirmed the staff member had “little knowledge of safeguarding”. The registered manager took action immediately to enrol staff on safeguarding training to support their knowledge.

Staff said they would report concerns to the registered manager or emergency services, but this relied on informal knowledge rather than structured training. No safeguarding concerns had been reported by the provider, however gaps in staff understanding increased the risk that concerns may not be recognised or acted upon appropriately. We did not find evidence of possible safeguarding concerns which had not been raised during the inspection.

People and people’s relative told us they felt the service provided safe care.

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.

The registered manager had not ensured all risks for people had been assessed such as risks around catheter care, skin integrity risks or risk of falls. Some people had specific health conditions which has also not been risk assessed.

Care plans or guidance were not always in place for staff to follow in relation to people’s risks. For example, around what catheter care was needed, possible signs of infection or other catheter complications such as blockages or bypassing. There was also no guidance for the actions for staff to take to escalate or mitigate risks. People’s care notes lacked details to demonstrate that the care, which staff and people told us was given, had taken place or to demonstrate that risks associated with people’s care had been monitored and mitigated. Despite this, we saw evidence that staff had identified past complications with people’s catheters and taken action to escalate this to relevant professionals.

Where people were at risk of their skin integrity deteriorating, there were no effective risk assessments or care plans in place to inform staff how to monitor or mitigate these risks for people. People’s care notes did not demonstrate that skin integrity was checked or what care was needed to manage the person’s skin integrity such as input from district nurses when a person had a pressure sore. Despite this, feedback received was that staff noticed concerns in people’s skin integrity and referred these to other professionals when required.

The registered manager took action following the assessment to put risk assessments in place and further detail about people’s care and support needs was recorded.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider supported people to live safely in their home environments, although formal risk management processes required improvement. Environmental risk assessments were in place and did not identify significant hazards. Records did not always consider all aspects of people’s care, such as the use of equipment or management of specific risks within the home. Staff described maintaining clean and safe environments by completing tasks such as cleaning, changing bedding, and ensuring required equipment was used. People’s risk assessments and care plans did not contain reference to equipment in place such as airflow mattresses and ensuring these were in working order. While people and relatives did not raise concerns about safety in the environment, improvements were needed to ensure environmental risks were fully assessed, documented and regularly reviewed.

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.

Care and support for people was provided by the registered manager and 1 carer. People and relatives told us care calls usually started on time however they did not always last the full duration. People and relatives told us they did not mind not having their full care visit if the provider billed them for the actual care delivered.

People’s daily records did not always demonstrate when staff were leaving care calls earlier because contemporaneous records of some people’s call times were not kept. This meant the provider could not maintain effective oversight of care call delivery.

Where people required support from 2 staff this had not always taken place as required. We checked this with the registered manager who told us this had happened once as the service did not have additional staff to provide cover. This put the person and the staff member at potential risk of harm although we did not find any evidence of harm in relation to this. The registered manager told us they had contacted other agencies to establish relationships for if future cover was needed.

The carer, who had worked for the service for a long period, told us they had not received all relevant training to support them to carry out their roles. We raised this with the registered manager who told us they planned to do staff training this year but following the assessment feedback started to enrol staff on relevant training courses such as safeguarding and medicine administration.

The registered manager worked closely with the carer to deliver care which provided them oversight of the staff members care practice although this was not formally recorded. Feedback from people and relatives was that staff had the skills needed to provide their care and their needs were met.

Staff were recruited safely. The provider carried out pre-employment checks such as seeking references from previous employers and ensuring staff had Disclosure and Barring Service checks prior to supporting people to ensure staff are safe to work with people.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection prevention and control practices were followed, although they were not always formally evidenced or supported by training. Staff described maintaining hygiene through handwashing, use of personal protective equipment and cleaning practices. Policies were in place outlining expectations, and feedback from people indicated appropriate action was taken when there were concerns about infection, such as contacting health professionals. However, infection control risk assessments were not consistently documented in care records, and staff had not completed formal training in this area at the time of the assessment. This meant systems were not fully assured, despite generally safe practice being reported.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The registered manager had not ensured that medicines were administered safely and in line with NICE guidelines (National Institution of Care Excellence). Staff had not received training to administer medicines and did not have their competency assessed. The registered manager enrolled staff on medicine administration training following the assessment and evidenced this had been completed.

Staff had secondary dispensed people’s medicines at the request of the person and their relatives. This is where medicines are removed from their original packaging and repackaged. Although feedback received was positive about the medicines administration process this practice leaves potential risk that people would not receive their correct medicines as prescribed. We raised this with the registered manager who took immediate action to contact the persons GP and Pharmacy to arrange the medicine to be dispensed in a way that removed the risk of this practice happening in future.

Medicines records had not been kept in line with the providers own policy. Medicine administration charts had not been signed when medicines had been administered which meant the provider could not be assured people had been given their medicines as prescribed and increased the risk of medicine errors such as overdose which placed people at risk of harm.

People’s medicine administration records did not contain all relevant information to support safe medicine administration in line with NICE guidance and the provider policy such as when correct frequency of medicines or whether medicines were ‘when required’ (PRN) medicines and PRN medicines did not have associated administration protocols to guide staff on when these medicines might be needed. Medicines requiring specific instructions also did not have these listed which meant people might not receive their medicine in the most safe or effective way.

The registered manager took action following the assessment to review people’s medicine administration records and ensure these, and staff practice were now in line with NICE guidance and the providers policy.