Care Outlook (West Wickham)

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 inspection we rated this key question requires improvement. At this inspection the rating has changed to requires improvement. This meant people were not safe and were at risk of avoidable harm.

We found the provider to be in breach of 2 legal regulations relating to safe care and treatment and safe and effective staffing.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

.At our last inspection in 2022, we identified that in relation to accidents and incidents, the provider failed to disseminate learning to staff.

At this inspection, we found that there has been some improvements in that lessons were learnt and learning was cascaded to staff where there were incidents and accidents. However, further improvements were needed.

The provider did not have a robust system to ensure all incidents were always logged appropriately. We found some incidents that were not reported to CQC or investigated to prevent a recurrence. For example, a person was found to be suffering a medical emergency by a staff member and was admitted to hospital. Subsequently a safeguarding concern was raised by healthcare professionals, but this was not reported to CQC.

Support was provided to people who experienced distress and behaviours of concern. However, there was no effective system in place, to identify trends and patterns so learning took place and to more effectively assist staff in safely supporting people. Staff we spoke with confirmed they did not always report behaviours or, if they did, recorded it in people’s daily notes. One staff member said, “No, I do not note any behaviours anywhere.” Another said, “I record behaviours in daily notes if someone is being really difficult. I don’t report it.” This meant, there were missed opportunities to identify themes, trends or factors that could trigger or reinforce acute behavioural incidents. Therefore, learning and best practice could not be shared with staff on how to support people safely and effectively in relation to their individual needs.

The provider did not have effective systems to ensure continuity of care. Assessments of people’s needs were carried out prior to joining the service to ensure their care needs could be met. However, there was no effective system in place to ensure people had their needs reviewed when they returned home from hospital, to ensure their support remained safe and appropriate.

For example, one person who had suffered a medical emergency had been admitted to hospital. Following their return home, the provider had failed to carry out a review to establish whether there was any change in their care needs and to include any information to support staff to recognise early warning signs of a seizure which left staff uniformed about what symptoms to be aware of. If no changes were needed, it had not been established whether there were any shortfalls in the person’s current needs and how these could be mitigated to prevent future hospital visits. Therefore, we could not be assured that the person’s care plan and risk assessments contained the most recent information about people’s health and risks to support staff to care for them which potentially placed people at risk of harm.

There were systems in place to safeguard people, the provider told us there had not been any safeguarding incidents since the last inspection.

There were safeguarding policies and procedures in place and staff were trained to recognise and respond to concerns, potential abuse and harm. Staff we spoke with could describe the different types of abuse and reporting procedures if they had any concerns. They told us they were confident any concerns would be managed appropriately.

People told us they felt safe, and staff told us they were able to recognise potential abuse. Comments from people included, “I feel safe with the carers” and “Yes [person] is safe with the carers.”

At the last inspection in April 2022, we identified a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Risks to individuals were not consistently assessed or mitigated. At this inspection, the provider had not taken sufficient action and remains in breach of this regulation.

Risks to people’s health and safety were not always identified or managed. This included mental health conditions, dementia, asthma, fire, allergies, mobility and falls.

One relative said their family member needed two carers per visit due to limited mobility, but this support was not consistently provided. We checked this person’s care records, which documents that 2 staff members are required to support them to mobilise. This meant this risk had not always been mitigated.

Dementia care plans were not always in place. Staff lacked understanding of dementia types and how they impacted people. One staff member said, “[Person] has dementia, but not too much, [person] just forgets at times,” Another staff member said, “[Person] has dementia, which is getting worse I don’t know the type of dementia [person] has. [Person] doesn’t communicate, just sits in a chair and smiles.” We raised our concerns with the manager who began implementing dementia care plans. We will check progress at the next inspection.

A risk assessment for a person with behaviours that caused distress stated for staff to monitor triggers, offer support, use de-escalation techniques and ensure safety and crisis prevention. However, staff spoken to were unclear on triggers, de-escalation techniques to use, or what safety and crisis prevention was.

Repositioning charts showed people were not always repositioned as required, increasing the risk of skin damage. Repositioning charts were not regularly monitored and analysed, and audits completed by the provider did not identify this poor practice.

Following the inspection, the provider sent us updated risk assessments and risk management plans. We will check that these have been implemented for other people using the service at our next inspection.

The provider did not always detect and control potential risks in the care environment. Fire risk assessments were not always robust and individualised. They did not always include guidance for staff on the actions to take in the event of a fire, whether the person should be supported to evacuate if safe to do so, or any other actions to take, such as closing doors, to ensure the safety of the person and staff.

We spoke to staff about fire safety and asked what they would do if there was a fire in their presence. We received mixed responses. One staff member said, “I would ring 999, make sure windows are open, and then I would carry [person] out of property.” A second staff member said, “Dial 999 and then I would help [person] out.” A third staff member said, “I’d call 999, yes of course I would evacuate [person] by walking them out.” A fourth person said, “I’d call 999, shout for neighbours to help, and I would carry out [person] out.” This showed that staff were not given clear guidance for helping people evacuate from their individual environments in the event of a fire.

Staff were not always aware that people smoked or of the fire risks when people smoked within their homes, namely when they were in bed. For one person who smoked in bed, a staff member told us, “I have not seen person smoking, [person] doesn’t smoke, I think it could be their family that are smoking.” This placed the person at the risk of potential harm as staff did not know the person smoked, or how the risks should be mitigated.

Staff were not aware that there were fire risks associated with flammable prescribed creams that were administered by staff or how to mitigate these risks. One staff member said, “Creams are not flammable.” Another staff member said, “Creams prescribed have no fire risks.” This lack of knowledge and understanding by staff, placed people at the risk of potential harm.

At the last inspection in April 2022, we identified a breach of regulation 18 (Safe and Effective Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as staff were not always deployed to meet people's needs in a timely manner. At this inspection, the provider had not taken sufficient action and remains in breach of this regulation.

The service used an electronic call monitoring system (ECM) to record staff attendance and staff punctuality. Management oversight was ineffective as we found discrepancies in call times and punctuality and could not be assured people received care in line with their needs.

Analysis of ECM data from 1 March to 31 May 2025 showed 6% of calls were over 45 minutes late. ‘Time critical’ medicines were not always administered as required. These medicines must be given at specific times to be safe and effective; delays or missed doses can lead to serious harm.

People experienced inconsistent care. We received mixed feedback about staff punctuality, knowledge, and training. Many people and relatives said staff were often late and didn’t stay the full allocated time.

One person said, “[Staff] are often late, sometimes up to an hour. This week they didn’t show at all.” Another said, “My call is 10am, but they come between 8–9am.” A third said, “I had two missed calls last month but didn’t report them as the office is hard to reach.” A relative said, “No one calls if carers are late,” and “The timing between visits is erratic.”

Some people felt staff didn’t stay for the allocated time. One person said, “None of them stay the full 30 minutes at lunch.” Another person said, “Carers are told they don’t need to stay the full 45 minutes if there’s nothing to do.” However, other people said, “Staff stay the full time,” and “[Staff] are on time and not rushed.”

Feedback about staff training was also mixed. One person said, “Relief carers need more training and should shadow my regular carer.” A relative said, “New carers don’t know the routine and cause distress.” Another said, “New staff should accompany experienced carers.” Other people told us staff were well trained and understood health needs.

Recruitment processes were effective and consistently implemented. The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development.

We saw the provider had infection control policies and procedures in place and staff received training in infection prevention and control. There was appropriate personal protective equipment (PPE) available for staff to use when delivering personal care. People and their relatives told us that staff wore aprons, gloves and shoe coverings when supporting them.

At the last inspection in April 2022, we identified a breach of regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, as medicines were not always safely managed. At this inspection, the provider had not taken sufficient action and remained in breach of this regulation.

Medicines were not always safely managed. Electronic medicines records (eMARs) showed that two people did not always receive their medicines during the planned times for their care calls.

Both people’s care plans documented that they were prescribed time-critical medicines. Although staff told us people taking time-critical medicines were prioritised, two people’s records did not have any specific times stated and these medicines were frequently recorded as given outside of their planned care call times. There were variations in recorded administration times for people prescribed medicines for Parkinson’s disease, pain and epilepsy.

For the second person having their medicines administered at consistent times 4 times a day due Parkinson’s disease. eMARs showed that they were administered their time-critical medicines outside of the scheduled times on 55 out of 90 occasions. Therefore, we could not be assured staff were administering medicines in line with current guidance to ensure the person did not experience symptoms of their Parkinson disease or a deterioration in their health and wellbeing. This placed this person at the risk of avoidable harm.

Staff said there were issues with handheld devices used to record people’s medicines, not synchronising with the eMAR system. Therefore, we could not be assured people achieved the best outcomes by receiving their medicines at appropriate times.

Diabetes risk assessments provided information about how to recognise when people experienced low or high blood sugar and what action to take to support them. However, other risk assessments did not always contain enough detail. For example, risk assessments for the use of prescribed medicines, such as creams, did not always identify fire risks associated with paraffin-based products.

One person, allergic to a particular medicine, and a prescribed topical cream, did not have a risk assessment in place or guidance for staff on how to mitigate the risks.

There was contradictory information in one person’s medicine care records. Records noted that the pharmacy dispensing the person’s medicines had been contacted to dispense the medication in a blister pack to make it easier for the service user to manage, However, the person did not self-administer medicines, staff administered all their medicines.

Medicines audits undertaken were not effective as they did not identify the shortfalls we found at this inspection.

Staff were trained and assessed as competent to support people with their medicines.