Pivotal Home 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 the management of people’s medicines and also safe recruitment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Safety events had not always been reported to external agencies as required.

Systems for identifying and notifying CQC of key incidents had not been effective. These were all submitted during the assessment and measures taken to ensure future compliance. People had not been harmed as a direct result, and actions had been taken by staff after each incident to keep people safe.

Staff told us there was an open learning culture. They were encouraged to report any incidents or accidents to senior staff. Supervision records contained a section on how to escalate risks. The accident and incident records we reviewed were detailed and thorough and recorded the actions taken to keep people safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We received both negative and positive safeguarding information about the service. The provider did not always share concerns quickly and appropriately.

Staff were supported through their induction and training to understand their safeguarding responsibilities. We discussed safeguarding with 4 staff and checked their learning in practice. They all understood their responsibilities and how they should report concerns. They were confident managers would respond to any concerns raised.

Staff training included training in the Mental Capacity Act and Equality Diversity training. Restrictions were kept to a minimum and some best interest decisions were made to support people safely.

Health and social care professionals currently involved with the service told us the registered manager raised safeguarding concerns when required. The registered manager was unable to provide us with any documentation related to these safeguarding. Processes to record this needed to improve. The registered manager agreed to implement improvements.

Safeguarding concerns were raised about the care provided by the service prior to the assessment. These related to people who were not using the service at the time of the inspection.

Medication policies and procedures had not been effective. Processes had not been followed correctly to ensure people’s medicines were ordered, administered, recorded, stored and disposed of safely. Audits had failed to identify these shortfalls.

The medicines administration records (MARS) did not tally with the medication in stock. There were no gaps on the MARs, but an excess of medication which could not be clearly explained. There was no booking in system to check the medicines delivered were correct and any excess medicines had not been returned to the pharmacy as required. We could therefore not be fully assured the medicines had been administered correctly

Additional concerns were raised about time critical medication. Measures were taken during the assessment to update the medicines care plan and the MARs to mitigate these risks.

Staff had received training and had been assessed by the registered manager as competent to manage medicines safely.

The provider did not always detect and control potential risks in the care environment.

Environmental risk assessments to assess the safety of the home had been completed. There was information on smoke alarms, escape routes and how to switch off the electricity, water, and gas supply in an emergency. However, improvements were needed to ensure roles were clear between the provider and people’s representatives to ensure people who lacked capacity had a safe environment. For example, it was unclear if the boiler needed servicing and if it had been serviced. The registered manager agreed to review their role in relation to the safety of premises to ensure a more robust approach was in place in future.

We spoke to 4 members of staff. They told us they were suitably trained to use moving and handling equipment and they felt safe working in the community and their needs had been considered.

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.

Staff were not recruited safely. The provider had requested references for new staff by telephone, but the process was not robust as there was no documentary evidence from the referee. The provider had not requested applicant’s full employment history to ensure they could review any unexplained gaps in their employment. Processes in place to check applicant’s health and fitness to work were not compliant with the Equality Act 2010.

Staff received induction and training and were positive about the support they received. However, the systems in place were not clear and we were not assured staff were receiving the correct observations and support to progress in their role. The registered manager made changes during the assessment to improve the documentation.

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.

There was evidence of up to date and ongoing infection, prevention and control training and regular spot checks on staff to ensure compliance.

We spoke to 4 staff about infection control, and they understood what infection, prevention and control was and could explain how they used their training in practice.

Staff told us stocks of Personal Protective Equipment (PPE) were readily available to use as required and we observed it being used during a home visit.

Medication policies and procedures had not been effective. Processes had not been followed correctly to ensure people’s medicines were ordered, administered, recorded, stored and disposed of safely. Audits had failed to identify these shortfalls.

The medicines administration records (MARS) did not tally with the medication in stock. There were no gaps on the MARs, but an excess of medication which could not be clearly explained. There was no booking in system to check the medicines delivered were correct and any excess medicines had not been returned to the pharmacy as required. We could therefore not be fully assured the medicines had been administered correctly

Additional concerns were raised about time critical medication. Measures were taken during the assessment to update the medicines care plan and the MARs to mitigate these risks.

Staff had received training and had been assessed by the registered manager as competent to manage medicines safely.