Bikur Cholim Ltd

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.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety. They did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.
We saw that incidents, accidents and complaints were recorded. However, these were not always completed in full, reviewed for themes, trends and appropriate actions had not always been taken to aid learning and prevent re-occurrence to keep people safe. In addition, policies and procedures for managing safety events were not effective in line with current best practice.
 

The service worked with people and staff to ensure there was continuity of care. The service completed an initial needs assessment before people started using the service. They involved people and their relatives to develop a care plan. The completed care plans were shared with staff to guide the delivery of care and support. A relative commented, ‘‘The family were involved in the care plan, we discussed what the needs are, and a plan was put in place.”

Systems, processes and practices to protect people from abuse and neglect were not effective. Following safeguarding concerns, investigations were not thorough, and appropriate actions were not always taken to keep people safe. The service did not always share safeguarding concerns quickly or appropriately with the relevant safeguarding authority. As a result, potential abuse was not always investigated promptly, and protection plans were not always put in place to reduce future risk. Some members of staff had not received safeguarding training to ensure they fully understood the signs of abuse and neglect. However, people using the service told us they felt safe around staff and had been aware of who to contact if they had any concerns.

The service did not always work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Where risk management plans were in place, these were not detailed enough to ensure staff had all the necessary information to deliver safe care and treatment to people. For example, the service had not completed appropriate risk assessments on specialist pressure relieving and mobility equipment such as wheelchairs, hoists and specialist mattresses. Additionally, appropriate risk assessments had not been completed for risks associated with skin breakdown, choking, community access, falls, diabetes management, nutrition and hydration risks, mental and behavioural risks to help staff minimise behaviour that communicates a need, emotion or distress, and respond safely and consistently.
In addition, when people required support from staff to manage their PEG feeding and catheter, the care plan did not provide sufficient guidance on how to carry out the task safely to reduce associated risks such as infection, tube blockages, dehydration and urinary tract infections. PEG feeding is a method of providing nutrition through a tube inserted directly into the stomach for individuals who cannot eat or swallow safely. A catheter is a tube used to drain urine from the bladder. Failure to assess, monitor and mitigate risks placed people at increased risk of harm. We spoke with the registered manager, who informed us that they would update risk assessments where necessary and remind staff of the importance of completing them thoroughly to ensure people’s safety.
 

The service did not always detect and control potential risks in the care environment. They did not always make sure equipment supported the delivery of safe care. Staff had not ensured the regular servicing and maintenance of equipment. However, environmental risk assessments had been completed to promote a safe environment for people using the service.

The provider did not ensure staff were adequately trained, supported, or developed to maintain the necessary skills, qualifications, and experience for their roles. There were no robust and safe recruitment practices in place to make sure that all staff, including agency staff, were suitably experienced, competent, and able to carry out their role. Staff told us they had completed an induction programme before they were able to work independently. However, we found that for some staff, there was no documented evidence of spot checks, competency assessments, supervision or appraisal to assess their knowledge and skills. In addition, some staff had out-of-date mandatory training, and others had not received training that was appropriate or relevant to their roles. This included essential training required to meet specific care needs, such as PEG feeding, stoma care, catheter care, dementia, autism and learning disability.
In addition, there was no documented evidence of Disclosure and Barring Service (DBS) checks or Right to Work checks for some members of staff prior to them starting their roles. A DBS check is a record of a person’s criminal convictions and cautions. These checks help employers make safe recruitment decisions. We spoke with the registered manager, who told us they would review training arrangements to ensure all staff were up to date, and update employment checks and standards where required.
However, people told us there were enough staff to meet their needs, and that staff arrived at the planned time and stayed for the full length of the visit. A person using the service told us, “Staff always turns up, time keeping is very good and they have never let me down and always stay the length of time they should. They ask if there is anything else they can do for me before they leave.”
 

The service assessed and managed the risk of infection. There were policies in place and in line with best practice guidance around infection prevention and control (IPC), outbreaks and personal hygiene. Staff told us they understood IPC and wore personal protective equipment, such as disposable gloves and aprons, to help prevent and control the spread of infection to people. People using the service confirmed staff wore gloves and aprons during visits. A family member told us, “The carers always wear gloves, they are very tidy and dispose of their gloves after use”.

The service did not ensure that medicines were managed safely. Staff completed the medicines administration record (MAR) when administering prescribed medicines. However, some members of staff had not received training on administering medicines to ensure people received them safely. There was no individualised PRN protocol for people who required it, to guide staff on when to administer 'when required' (PRN) medicines and how to properly record their administration. In addition, for 1 service user, staff had not administered a prescribed medicine, and a substitute medicine was administered without documented consultation with the appropriate healthcare professionals.