Midlands Care Direct

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.

This is the first assessment for this newly registered service. This key question has been rated Good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had established systems and processes that managed any type of incident. Records confirmed the actions staff had taken in response to incidents and the registered manager's approach to learning to reduce further reoccurrence. This included working with the person to discuss what went wrong, identifying any contributing factors, reviewing risk management strategies, and implementing appropriate actions to help prevent similar incidents from occurring in the future. Lessons learned were shared with staff to promote continuous improvement and safer outcomes for the person using the service.

Staff confirmed there was good communication and support in how incidents were managed, and a positive approach to learning. A staff member said, “There is a positive approach to learning from incidents. The manager will arrange a meeting to discuss any incident and any changes, lessons learned with staff.”

The registered manager told us how the consistent approach of staff meant the likelihood of incidents was reduced. They provided an example of how known risks were managed positively, balancing the person's independence with their safety. For example, staff supported the person to remain as independent as possible when preparing meals and snacks, while ensuring appropriate measures were in place to manage any associated risks. This enabled the person to maintain choice and control without compromising their safety.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The provider commissioned an external healthcare professional to complete the pre-assessment process. This involved a face-to-face assessment with the person, as well as consultation with those who knew them well, including family members and relevant health and social care professionals.

The assessment process ensured people's needs, preferences, strengths and risks were thoroughly explored before a service was offered. Information gathered was used to determine whether the provider could safely meet the person's needs and identify any additional resources required, such as staff training. This helped ensure people received safe, personalised care and support from the outset of the service.

Transition plans of how a person was introduced to the service was based on the individual person’s wishes and needs. The person using the service told us of their individual circumstances prior to joining the service and confirmed an assessment of their needs were completed before they received care and support.

Records confirmed staff worked collaboratively with the person’s health and social care professionals to promote openness, effective monitoring and appropriate oversight of their care and support. Information was shared in a timely way, and staff sought guidance from relevant professionals when changes in the person's needs, wellbeing or risks were identified. This helped to ensure care remained responsive, coordinated and focused on achieving positive outcomes for the person.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The person using the service told us they felt staff supported them to remain safe. However, they acknowledged that at times they made decisions which increased risks to their safety and wellbeing. They explained how staff supported them during these situations. They said, “I have no restrictions on me and come and go as I please. However, staff will go and look for me to make sure I’m keeping safe. I know they do this and I’m pleased they do.”

Staff received annual safeguarding training. They had access to the provider’s safeguarding policy. Staff were knowledgeable about different categories of abuse and their responsibility in protecting people from abuse and avoidable harm.

A staff member said, “Safeguarding is about protecting the person from abuse and harm and neglect, any concerns we record and report immediately.” Staff gave examples, and records confirmed, of actions they had taken where the person had experienced safeguarding incidents whilst in the community. This included reporting to the local authority safeguarding team, police and the person’s external multidisciplinary team.

The provider’s service user guide provided people with information about what they could expect from the service, and this included information about safeguarding. This included guidance of what this means and how to report any safeguarding concerns.

At the time of the inspection, the person using the service did not have a Community Deprivation of Liberty Safeguard (DoLS) in place that imposed restrictions on them for their safety.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, improvements were required in relation to staff guidance.

Risks had been assessed and plans were in place to guide staff in supporting the person safely. However, we found some aspects of the risk management documentation lacked sufficient detail about the specific actions staff should take to manage and mitigate identified risks. For example, the guidance for staff in relation to the risk of self-neglect was incomplete. Whilst records identified the risks associated with the person's lifestyle choices, they did not consistently set out all the additional monitoring, observations or interventions staff should undertake to help reduce these risks and support the person's wellbeing. We discussed this with the registered manager who agreed to review the risk assessments and improve guidance for staff.

Despite this, the person had not experienced any harm, and staff demonstrated a good understanding of the person's individual needs and known risks. We concluded this was a recording issue rather than a failure in care delivery. Risks were effectively managed in practice through the support of a consistent and experienced staff team who knew the person well.

The person also demonstrated an awareness of how some of their lifestyle choices could negatively impact their health, wellbeing and safety. Staff worked alongside them to ensure they had access to information and advice about these risks, enabling them to make informed decisions. This approach respected the person's right to make their own choices while promoting their independence and supporting them to remain as safe as possible.

Examples of positive risk taking included, how the person was supported to develop their independence in preparing food and drinks. Additionally, how staff supported the person to improve their physical heath by supporting and encouraging them with known physical activities they enjoyed such as waking and attending a gym. The registered manager said, “Staff worked with [name] to establish regular routines, accompanied them initially where appropriate, and gradually encouraged them to attend activities with reduced support as their confidence increased. This promotes both wellbeing and independence while managing identified risks safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Staff supported the person to manage their tenancy and report any repairs or maintenance issues to their landlord. The person using the service told us the landlord responded promptly to any concerns raised. They also explained how staff supported them with health and safety matters within their home. Records confirmed routine health and safety checks and audits were completed, including checks relating to fire safety.

This meant environmental risks were identified, monitored and addressed in a timely way, helping to ensure the person lived in a safe and well-maintained home environment while maintaining their independence.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. However, shortfalls were identified in the provider’s systems and processes that assessed and monitored staff competencies.

The person who used the service told us they were confident staff were sufficiently trained, knowledgeable and competent. They told us they received consistent care and support. They said, “New staff are always introduced before working with me. I have a staff team that all support me regularly. I don’t know who is coming each day, but I know them all so it's alright.”

Staff recruitment records showed the provider had not consistently followed its recruitment policy, which required two references to be obtained before staff commenced employment. We also identified an issue relating to information contained within staff contracts regarding contracted hours. This was discussed with the registered manager during the inspection, who took action to address the matter and improve oversight of recruitment and employment records.

Staff training records confirmed staff had completed the training the provider considered necessary for their roles. This included training in learning disability and autism awareness, as well as mandatory Oliver McGowan training. However, the registered manager confirmed staff competencies had not been completed in any training topic area. This meant the provider could not be assured that staff had the necessary knowledge, skills and competence to effectively apply their training in practice and carry out their roles safely and consistently. As a result, there was limited oversight of whether training had been understood, embedded into practice, and maintained over time. We discussed this with the registered manager who agreed to review their systems and processes and introduce competency assessments.

Staff had regular spot checks to provide assurance that care and support was being delivered in line with the provider's policies and procedures, and to identify any areas where additional support or development was required. Staff had an annual appraisal and opportunities to meet with the registered manager to review their work, training and development needs.

Staff were positive about the support they received. A staff member said, “We have an annual appraisal with the registered manager and regular supervisions, these are very helpful, you are asked how you're doing, is everything okay. It's also used as an opportunity to check our understanding of certain topics such as safeguarding. We also have regular staff meetings, and the registered manager is always around, contactable and responsive.”

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.

Staff had received infection prevention and control training and had access to the provider’s policy. Staff were provided with personal protective equipment (PPE) and cleaning materials.

Staff supported the person with daily cleaning. Regular monitoring, audits and checks were completed by the registered manager. This included staff spot checks to ensure infection prevention and control practice was safely managed.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. However, some improvements were required to ensure medicines were consistently managed safely.

Whilst staff had received training in medicines management, including administration, they had not had their competency assessed. This was a concern because the provider could not be fully assured that staff were consistently applying their training and administering medicines in line with best practice. Competency assessments are an important part of ensuring staff have the knowledge, skills and confidence required to carry out medicines-related tasks safely and effectively. Following our feedback, the registered manager took immediate action to address this and implemented competency assessments.

The person who used the service confirmed the staff supported them with their medicines and this included, ordering, collecting, storing and administering their medicines. They also told us they received their medicines at regular times but acknowledged this was sometimes variable depending on if they were at home or not.

Medicine Administration Records (MARs) showed handwritten entries had not been reviewed and signed to confirm the information had been accurately transcribed. This is important because transcription errors can lead to medicines being administered incorrectly, omitted, or administered at the wrong dose, potentially placing people at risk of harm.

MARs and care plan records also showed the prescribed times for medicines were not recorded. In addition, staff had not been provided with information about the purpose of each medicine or any potential side effects to monitor for. This meant staff did not have access to complete information to support the safe administration and monitoring of medicines.

Daily records showed the person had been administered a course of antibiotic medicine. However, this had not been recorded on the MAR. This meant there was not a complete and accurate record of medicines administered, increasing the risk of errors and reducing the provider's ability to effectively monitor and audit medicines management. Accurate and contemporaneous records are important to ensure people receive their medicines as prescribed and to provide assurance they are being managed safely.

Although we found no evidence the person had come to harm, improvements were needed to strengthen medicines records and oversight. The registered manager acknowledged these issues and took action to address them during the inspection.