Brighter Home Care

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• 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, the management of people’s medicines and staff development.

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.

We found staff had alerted management to concerns about people’s safety and risks, and managers had taken appropriate actions, including informing the relevant authorities as well as working with people to overcome any issues. For example, staff assisted one person to clean their house after it had become unsafe to live in. However, these incidents had not been notified to CQC in line with the provider’s statutory duty.

Whilst actions had been taken to address incidents, there was limited evidence of any lessons learnt and reflective practices. Staff told us they called their managers for support; however, there was not always a consistent approach in management communication after an incident or complaint to ensure staff were updated of any learnings from incidents or the sharing of good practices. The registered manager did not routinely analyse incident, accidents and safeguarding for any trends to enable them to take informed decisions and actions to improve people’s safety.

People and their relatives reported staff had been responsive when incidents had occurred. For example, one relative said “That incident with the medication was worrying, but it showed that they’re keeping an eye on things. Since then, it’s been better managed".

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

The registered manager told us the majority of people using the service had been referred by the local authority. Information from the local authority about people’s needs was initially used to assess if the service could meet people’s needs. This was then followed up with the person and/or their relatives as appropriate, to inform the package of care and care plan. However, significant information about people’s personal details, key professionals and relatives, people’s consent to care and medical interventions were not fully recorded. This meant staff did not have access to relevant information in the event of an incident or emergency. People and their relatives’ views about their involvement in developing and reviewing their care plan varied. For example, one person said, "I was fully involved in my care plan right from the beginning. Someone came to assess my needs before the care started, and I’ve been part of every review since“. Whilst another person said, “No one ever came to do a proper assessment. As far as I know, there’s no care plan in place at all. I’ve just been left to manage without any clear support structure."

The registered manager said they worked closely with local external professionals to ensure people’s care requirements were fully understood to ensure continuity of care. They provided an example of supporting a person to move into a care home.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff said they would report any concerns or allegations of abuse to their managers. The provider shared safeguarding concerns to the relevant authorities quickly and appropriately; however, they had not notified CQC of allegations of abuse.

The provider had not always assured staff and managers had received updated safeguarding training appropriate to their role and responsibilities.

Most people and their relatives reported feeling safe whilst being supported by staff. We received comments such as “He feels safe with the carers. They’re respectful to him and our home. If there was ever a problem, I think he’d know who to tell – and I definitely would” and "We feel completely safe with the carers. They are trustworthy, respectful, and treat our home with care". However, a few people reported the service was inconsistent and felt the need to monitor the service to ensure their safety.

The provider was in breach of the legal regulation relating to safe care and treatment. People were at risk of not receiving appropriate support to manage their personal needs and risks. The provider had not ensured people’s care records were complete and accurately reflected their risks and consent to care. This meant people were at risk of not receiving consistent and appropriate support from staff to manage their risks as there was a lack of written guidance to direct staff on how to manage and mitigate people’s risks.

People’s care records and risk assessment and management plans lacked detail and the recommendations made by health care professionals. Information on how to recognise a decline in people’s specific risks and the actions staff should take were not explicitly recorded. For example, the care plans of people who were at risk of skin breakdown did not fully describe their current skin integrity status, how they should be supported to help mitigate further risk and the support and equipment needed to help to reduce further risks. Whilst falls and catheter protocols were in place; we found them very basic and did not provide staff with a clear and personalised measures to follow in line with national based guidance.

There was limited evidence that people’s care records had been reviewed, updated and consent had been gained by people or in line with the principles of the Mental Capacity Act 2005. Therefore, it was difficult to verify the accuracy of people’s care records, and that people had consented to the care being delivered to them.

We reviewed staff documentation of the care they provided and found they were not always legible or described the support provided to mitigate the risk such as repositioning. However, most people reported that staff managed people’s risks well. One relative said “Yes, staff help manage personal risks very well. He’s very unsteady on his feet, but they’re careful and make sure he doesn’t fall. If anything’s wrong, they usually get in touch with us or call a district nurse if needed. We’re kept in the loop about changes in his health”.

The provider was in the process of implementing an electronic care management system which would assist staff and managers to comprehensively record and monitor people’s personal information, care and risks.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider was in breach of the legal regulation relating to safe and effective staffing. The provider had not always ensured staff were skilled and qualified to carry out their role safely. The provider did not operate an effective probation and induction system to ensure new staff were trained and assessed as competent to support people with the regulated activity.

Whilst staff said they felt supported and trained, we found staff had not received current training in mandatory and additional subjects. Staff supervisions were not always completed on time and not always recorded in detail. Spot checks and staff competency assessments on staff practices were inconsistent. Managers had not always received training appropriate to their senior role to enable them to effectively assess the staff team and fulfil their responsibilities.

People and relatives reported mixed views about the skills of staff who supported them. Some people were confident in the training staff had received; whilst others felt apprehensive about the skills of the staff who supported them. One person said, "I don’t think they’ve had the right training—certainly not for dementia or for understanding physio instructions. I often feel like I’m the one training them as we go."

Whilst most people said staff arrived on time, some felt visits were too short, with staff not staying for the full duration. The provider did not operate effective systems to monitor staff’s care calls. This meant the registered manager could not be fully assured people received their care calls as planned. Some staff expressed dissatisfaction with the systems used to communicate their care call schedules and told us there were frequent delays in accessing their work schedule.

The provider was in the process of implementing an electronic care management system which would assist them to oversee staff development and their daily schedules.

Staff were mainly recruited from overseas. Safe recruitment practices were mainly being used. The registered manager agreed to review their recruitment systems on how they would manage any potential risks when they had insufficient information about staff conduct during their recruitment process.

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. The provider’s infection, prevention and control (IPC) policy was basic and did not contain relevant information regarding current IPC practices. This meant staff did not have access to current and national guidance on current infection practices and the actions to take in the event of an outbreak.

People and relatives raised no concerns about staff infection control practices and said staff consistently wore personal protective equipment (PPE), such as gloves and aprons, and washed their hands regularly.

The provider had not ensured all staff had received IPC training. Staff IPC practices were not regularly monitored in line with good IPC practices to help prevent and manage the spread of infection when supporting people.

The provider was in breach of the legal regulation relating to safe care and treatment. The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People’s medicines care plans lacked detail about people’s medicine support needs, preferences and any shared responsibilities in the management of their medicines.

There was limited information about people’s medicine risks and the management of people’s topical creams and medicines to be administered ‘as and when required’.

Systems used to monitor the administration of peoples of medicines and the completion and accuracy of the MARS were not effective. People’s MARS were checked monthly. This meant the registered manager could not be assured in real-time that people had received their medicines. Risk assessments for people who self-administered or partially self-administered their medicines and people who may refuse their medicines were not in place.

The provider had not ensured all staff had received medicines training or regularly monitored staff medicines management practices to ensure people received their medicines as prescribed.

The provider was in the process of implementing an electronic care management system which will assist them to comprehensively record and monitor the administration of people’s medicines.