Centred Healthcare

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.

This is the first assessment for this service. This key question has been rated 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.
 

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 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.

Safety incidents were not appropriately investigated or reported. For example, when bruising was identified it was logged on a skin mark record, but no cause was identified and no referral was made to health or social care services. Risks were not always dealt with, for example risks associated with moving and handling were not assessed or escalated to the relevant professionals. When there was an incident or complaint there was a lack of evidence of actions taken or discussions held with the person, staff or other professionals.

However, people felt confident raising concerns. One person said, “I can speak to the office staff, [registered manager], I can even call direct to the carers and speak about anything. Can call at any time.”

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.
For people with complex health needs there was not always a collaborative, joined-up approach to safety that involved the person, along with staff and other partners in their care. This included a lack of communication and referrals to health and adult social care services.

People had introductory meetings and visits from the registered manager when they were referred to the service and individual initial assessments were completed. However, updates and reviews did not always have a multi-disciplinary approach, and important information was not always shared with the person or other people involved in the person’s care.
 

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. The provider did not always share concerns quickly and appropriately.
Daily records for 1 person noted unexplained injuries with no evidence of speaking to the person or reporting to health or social services. These records contained unclear information about the date injuries were identified and details were not transferred to an incident record. The registered manager raised concerns about a lack of action taken by other professionals but there was no evidence of escalation of these concerns or attempts to share information or arrange a discussion, meeting or review.
When staff were unsure about a person’s understanding of a decision regarding their safety no mental capacity assessment was completed. Not all staff demonstrated an understanding of the Mental Capacity Act 2005, but they did promote people’s choices.
People told us they felt safe with carers and knew who to raise concerns to.
Care staff attended annual safeguarding training and felt comfortable raising concerns.
 

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.

Care plans and risk assessments were person centred and involved the person and family members if appropriate. However, there was conflicting information relating to moving and handling in 1 person’s care plan, meaning staff did not have all appropriate guidance in place to support this person safely. Guidance for staff was not always in line with best practice, and this was not addressed in the care plan, risk assessments, daily records, review records, meetings or correspondence with staff or other professionals.
 

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.
One person’s home environment risk assessment stated a moving and handling risk assessment had been completed. However, this did not reflect the moving and handling concerns the registered manager had identified. The document stated there was equipment in place however, the last date of inspection was several years ago, and no further checks were recorded. Staff competency assessments are required to ensure staff can perform moving and handling activities safely. However, only 1 moving and handling competency check was seen as completed and had been completed several years ago.
 

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.

Staff recruitment records were missing information, for example full employment history. Recruitment documentation including statement of terms and conditions, interview records, and induction records were also missing from some files.

Despite being registered to support people with a learning disability and autistic people the training matrix only showed that 3 members of staff had received appropriate training.

When there were concerns regarding moving and handling, no spot checks were carried out that checked staff followed safe procedures.

However, staff told us they felt supported and we saw evidence that staff had opportunities to discuss their learning and development and any concerns during supervisions and staff meetings.

Following feedback from CQC the provider advised they would address all the gaps in the recruitment files, rollout specialist training to all staff and complete quarterly spot checks.
 

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.
Care plans included guidance for staff to ensure infection prevention measures were followed for example, around hand washing, cleaning surfaces and use of protective equipment.
Staff understood the infection prevention and control (IPC) policy and procedures, said they had enough personal protective equipment (PPE) and they had completed IPC training.
One person told us staff were “very presentable, very clean. They do use gloves and masks and aprons as well.”
 

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

Paper based medication administration records (MAR) did not include cycle end dates or start dates, or explanations for gaps in administration records.

When there were directions for 1 or 2 tablets to be given, it wasn’t made clear on the MAR chart how many were administered. This question was on the MAR chart audit document but circled as not applicable. Demonstrating medication audits were not completed accurately.

For 1 person who had support with medication from both Centred Healthcare staff, family members and another service, there was no clear agreement as to how and who would record this.

Although spot checks were completed staff were not regularly assessed as competent to manage medicines safely.

There were gaps of between 6 and 9 months between medicine audits for 1 person and they did not identify the issues we found during the inspection.

However, people were involved in decisions around their medication and staff felt suitably trained.

Following our feedback the provider made a plan to redesign MAR charts, monthly audits, annual competency checks, and protocols for shared medication management responsibility.