Archived: Staffordshire

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

The provider had a supportive learning culture in place and staff felt able to ask for support. However, the action in response to concerns was not always evident in people’s care records. People’s care was flexible to help them accommodate involvement from other professionals. However, improvements were needed to ensure records reflected the information staff needed to be aware of about people’s health conditions. Staff were aware of their safeguarding responsibilities but the recording of concerns, referrals and action taken needed improving. People felt safe when staff supported them, and staff felt they knew people well. Improvements were needed to the detail in some people's care plan, we found some were detailed whereas others were less personalised. Risks associated with people’s homes had been considered. There were enough staff to support people. Two staff needed to complete their outstanding training, so they were compliant with the courses set by the provider. Staff were overall recruited safely but records needed to be more robust. Staff had access to, and used, Personal Protective Equipment (PPE) when necessary. People were mostly supported safely with their medicines, but staff would benefit from guidance in place being strengthened.

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.

People did not have any specific feedback about Learning culture.

Staff told us they felt they could report concerns and ask questions, and they were supported. One staff member said, “They [the office/management] handle it in a way that makes you feel like its learning, not to make you feel bad.”

There was a record of accidents and incidents which had occurred. The record stated action had been taken, but it was not always clear what action or if lessons had been learned to reduce the risk of reoccurrence. There had been incidents involving 1 person, and it was not clear their care plans had been reviewed and lessons learned following these incidents.

People told us they were supported to access other health professionals, when needed. Staff were not always directly involved with people’s health needs, as people either managed this themselves or had support from relatives, but the care was flexible from Staffordshire to enable this. One person said, “I had a hospital appointment, and they changed their time to suit me.”

Staff told us they recorded information about each care call on paper in people’s homes as well as on their phone application (known as an app). One staff member said, “We leave the paperwork in the houses, and we write down what we have done and the family. We have a system on the phone as well.” This ensured people and their relatives were kept up to date following the staff visit.

Partners did not have any feedback to share about Safe systems, pathways and transitions.

Some people’s care plans needed further details about what staff should do to identify and escalate concerns. One person required support with their nutritional needs, but there was no escalation plan in place if the person had a reduced food and drink intake. The same person also had missing information about their mobility needs.

Some people’s care notes contained limited detail about what support they had received; therefore, it was not always clear if people were supported in line with their care plan. The nominated individual explained staff recorded the details of support people received in 2 places: on an electronic system and in handwritten notes. Staff were not always recording who was present during calls in the handwritten notes, where more than 1 staff member was required. For example, 1 person’s care plan detailed the requirement of 2 staff members to support them with their mobility, however, their handwritten care notes showed the documentation for 1 member of staff only. However, the electronic records did show 2 staff were present. Despite this, there were not always enough details in some care notes, whether they were handwritten or electronic. We raised this with the provider, who looked into the concerns and confirmed it was an issue with the way staff were recording visits on the system. The provider explained they had a staff meeting to reiterate the importance of recording and told us they gave examples of best practice, for staff to follow.

We found, however, some care notes were detailed and covered individual tasks completed by staff.

People and relatives told us people were safe with staff. One person said, “I feel safe with them [staff], they are always nice with me.” A relative told us, “We have the regular staff and my relative feels comfortable with them.”

Staff understood their safeguarding responsibilities and knew how to report concerns. One staff member told us, “We can’t force people we see, to do what we want, they say what they want, and we always do that.” Another staff member said, “I had safeguarding training, and I know I would call the office straight away if anything was wrong, then they ask us to do incident reports. I know I can phone social services if I need to, but I don’t think I will need to, the office is good.”

Staff recorded information about incidents on incident forms which detailed any safeguarding concerns. Some safeguarding referrals were recorded clearly; however, some we reviewed did not clearly state if concerns had been referred to the local safeguarding authority. We checked with the local authority, and they confirmed they were aware of incidents, some were shared by the provider and others they became aware of from other sources, such as other professionals or relatives. Records we reviewed, demonstrated investigations took place as staff had completed witness statements, but it was not always possible to determine what action had been taken in response to investigations. The local authority said the provider worked with them when concerns were reported. We found, however, improvements were needed to the recording and evidencing of reporting and action taken in response to concerns.

People felt safe while being supported by staff. One person said, “The staff have been coming for years, they look after me well.” Another person said, “Two staff support me, and they stand either side of me, so I feel safe and secure when they move me.” One relative said, “My relative feels safe with them.”

Staff knew people’s needs well and were able to tell us how they supported people. Staff told us they were able to access information about people’s needs on the application (known as an ‘app’) on their phone. One staff member said, “All the information is on the phone, all the care plans and everything, its good.” Another staff member told us, “I think the service users are safe and they can go to the company if they want to, as well.”

People’s care plans contains personalised information about them, to help staff understand people’s needs. However, we found there were some instances of contradictory information. For example, 1 person’s care plan stated they needed support from 1 staff member to transfer in or out of bed, however, further records also referred to the person needed 2 staff members for all transfers. The same person’s moving and handling risk assessment also had information regarding the requirement of a piece of equipment to support their mobility, but no further details were added about this. One person had a care plan in place which told staff to refer to the linked risk assessment, but this was not in place; therefore, there was no guidance for staff to follow in this area. The same person also had a health condition staff may need to respond to if the person became unwell, but there was no information about what to do if they became unwell. People had not come to harm as a result of these omissions, but it is important staff have access to required guidance to follow. Another person had support needs in times of distress, their care plan did not always reflect all of the techniques staff may need to help support the person. This person had come to harm as a result of an incident when they were distressed; however, the provider acted appropriately in response to the concerns being reported to them. This same person also had a detailed care plan in place for a health condition, so staff knew how to respond. Therefore, care plan reviews and updates were required to ensure omissions were identified and addressed so all plans were consistent and detailed.

People did not share any feedback with us about Safe environments.

Staff did not share any feedback with us about Safe environments.

The provider completed environmental risk assessments of people’s homes, so staff had guidance, such as if there were pets, or other potential risks staff needed to be aware of. When people were supported to go out in the community with staff, this was also risk assessed in relation to road safety and any equipment needed to keep people safe in the community.

People told us staff were mostly on time, and they saw regular care staff. One person said, “The staff come 7 days a week, they aren’t late unless there’s a little problem, but the office calls me.” One relative said, “My relative is not worried about the carers, they always turn up, they aren’t really late, and it is reasonable, they have never a missed a call. They [staff] are there for the amount of time they should be.”

People also felt staff were confident in their role and knew what they were doing. One person commented, “Staff definitely [know what they are doing] because they are consistent and know how I like to be supported.”

Staff felt they were able to fulfil all their calls and spend the correct amount of time with people. One staff member said, “We don’t need to rush, every person has their own duration of time, and we spend the time with them.”

Staff also felt they received enough training to carry out their role. Staff confirmed they received an induction and had the opportunity to shadow other staff to learn the role. One staff member told us, “We have training, I’ve done medication, manual handling, safeguarding, so much training. If there is anything confusing, any problems, we can contact the office, and they are there to help us.” Another staff member said, “I did shadowing and I did training with the management. I think I have the training I need for now.” Surveys carried out by the provider showed staff had repeatedly fed back they wanted additional training. The provider had a plan in place to address this.

Staff confirmed they had their suitability checked when they started employment with the service, one staff member said, “I had interview, I had references, training, and an induction. There was a DBS done; everything was in order.” Another staff member said, “I had an interview and references and a DBS.”

Staff were generally recruited safely but there were some discrepancies between some records. We found, for example, consent forms signed by the staff member after the purpose of them had been completed (such as seeking references or completing Disclosure and Barring Service (DBS) checks). Other dates within files were also unclear, such as start dates, and the dates contracts of employment were signed. There was an example of a staff member having conflicting information in their recruitment records and there was no record this had been explored by the provider. Some staff also had multiple addresses within their recruitment file and there was no record about these changes. DBS checks help employers make safer decisions about employing staff, it includes checks on staff member’s criminal records.

We found, however, other checks were in place such as copies of identity records, checks on staff member’s criminal records, whether staff had the right to work in the UK and employment history. The management team acknowledged some improvements were needed to staff files, but they had prioritised care to people, rather than paperwork.

Staff training records showed not all staff had completed training about people with a learning disability and/or autism. One staff member was noted as not completing the majority of the training set by the provider but was noted as an active staff member. Another active staff member had completed only a proportion of training courses. The majority of other active staff were noted as being fully trained. Some staff completed some specialist training to ensure people could be safely supported, for example, where people needed physical intervention during times of distress, or if someone had specialist nutritional needs.

People we spoke with provided limited feedback about infection prevention and control. One person told us, “The staff always wear gloves, masks and aprons before they do anything.”

Staff told us they had access to enough Personal Protective Equipment (PPE) to protect themselves and reduce the risk of cross infection. One staff member said, “We always have enough PPE, we never run out.”

Records showed most staff had received training in infection prevention and control and food hygiene.

Not everyone had support with their medicine from the staff at Staffordshire, but those who did told us they were supported well. One person said, “They [staff] write everything down and I always have my tablets, I haven’t run out.” Another person said, “The staff give me my medicines, they make sure I have my medicines and a fresh cup of water.”

Staff told us they received medicine training and felt confident to administer people’s medicines. One staff member said, “I do give medication, and we make a note of everything. If I have any worries about medicines, I call the office to talk it through, everyone I see has the medicines no problems, they never say no.” Another staff member told us, “I had a lot of training for that [medicines].”

People’s medicines were not always managed safely. Whilst we found, there was guidance in place for staff to follow when applying people’s topical medicines and most people’s records included protocols for their ‘when required’ medicines. We found some discrepancies between people’s care records and also with their Medicine Administration Records (MAR). For example, 1 person’s care plan referred to the person’s family being responsible for supporting them with their medicines. Further records detailed staff were to support with their ‘when required’ pain relief and inhalers, however, there was no guidance in place to inform staff of the administration of this. A person had a ‘when required’ medicine prescribed which was being recorded as administered as a regular dose and this had not been escalated for review by a relevant medical professional. We also found some discrepancies between the medicines listed on 1 person’s MAR and the medicines recorded in their care plan. Whilst we found no harm identified, as a result of this, clear records are required to ensure people receive their medicine as prescribed.