Best2 Care Ltd – Gravesend Office

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 requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

Staff were aware of the systems for reporting incidents and understood the importance of escalating concerns. A staff member told us, “Any incident at all, no matter if it looks small. We always talk to the registered manager about it and maintain a detailed report.”

Records showed incidents were reviewed by the management team and learning was identified where appropriate. For example, when staff identified a potential hazard during a visit, they managed the situation safely, followed the provider’s procedures and informed the person's relative. Learning from the incident highlighted the importance of completing environmental safety checks on arrival and remaining calm when managing potentially risky situations. Staff meetings were used to discuss incidents, identify lessons learned and reinforce good practice.

The provider monitored incidents, reviewed trends and patterns, and used this information to inform risk management and improve practice. Incident records demonstrated that concerns were reviewed, actions were taken and opportunities for learning were considered to help keep people safe.

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.

Prior to accepting a package of care, the registered manager completed an assessment to determine whether the service could safely meet the person's needs. The provider sought additional information when referral information was unclear or incomplete and worked with commissioning teams and social workers to ensure care packages accurately reflected people's needs. Where the provider identified proposed care hours as insufficient to safely support a person, they challenged this and requested reviews or additional provision. The provider also recognised when needs exceeded the scope of the service and did not accept referrals where risks could not be safely managed. For example, the registered manager described declining a referral where a person was at significant risk due to regular self-harming behaviours.

The provider worked collaboratively with external professionals, including social workers and mental health services, to support people's wellbeing and safety.

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.

People and relatives consistently told us they felt safe with staff and trusted them. A person said, “I feel safe around them as I know them and trust them.” Another person told us, “I trust them and they help me feel safe emotionally.” A relative told us having familiar carers was “pertinent” because their loved one recognised the carers and appeared relaxed and comfortable in their presence.

Staff received safeguarding training and demonstrated an understanding of their responsibilities to protect people from abuse and neglect. They knew how to recognise potential signs of abuse and understood the procedures for raising concerns. The registered manager was knowledgeable about safeguarding processes and worked with relevant health and social care professionals to ensure concerns were acted upon appropriately and people remained safe.

The provider worked well with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were in place and identified risks relating to people’s health, safety and wellbeing. These provided staff with clear guidance on managing risks associated with mobility and transfers, mental health conditions, catheter care and pressure damage. Mental health care plans included information on recognising signs of deterioration or relapse and the actions staff should take in response. However, we noted that potential triggers were not always documented. We discussed this with the registered manager, who assured us this information would be added to strengthen the guidance available to staff.

Staff demonstrated a good understanding of people’s individual needs, including their mental health needs. They were able to describe the early signs of relapse, the support they would provide and when additional professional support would be sought. One staff member explained that a person refusing to eat was often an early indicator of deterioration and described using reassurance, involving relatives, and seeking guidance from the registered manager and mental health team where appropriate. Relatives told us people were supported by a consistent team of carers who knew them well, enabling staff to recognise and respond promptly to changes in people’s wellbeing.

People and relatives consistently told us staff understood individual risks and took appropriate action to keep people safe. One person said staff helped ensure they were “steady on my feet” when supporting them with personal care and bathing. A relative described staff as “very vigilant” and said they were able to recognise when their loved one might be in pain or experiencing difficulties, ensuring support was provided in a timely way.

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

Environmental risk assessments were completed to identify potential hazards within people's homes and to ensure staff had information about how to work safely. These assessments considered factors within the home environment that could affect the delivery of care and helped staff understand any measures required to reduce risks.

The provider-maintained records of equipment used to support people with their care and mobility needs. Equipment logs showed items such as profiling beds, rollator frames, Sara Stedy transfer aids and other moving and handling equipment had been checked and were within their service or inspection dates. This helped ensure equipment remained safe to use and supported the delivery of safe care.

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.

People and relatives told us staffing arrangements worked effectively and described care staff as reliable, knowledgeable, punctual and responsive to changing needs.

Staff rotas demonstrated visits were scheduled effectively, with sufficient travel time between calls and no overlap in planned visits. Records showed staff generally spent the allocated duration of visits with people and that people were supported by a consistent group of staff who knew them well.

The provider carried out recruitment checks to ensure staff were suitable to work with people using the service. Staff files contained evidence of employment history checks, explanations for gaps in employment, Disclosure and Barring Service (DBS) checks, references and confirmation of staff's right to work in the UK before employment commenced. However, we found 2 instances where applicants had no previous care experience, references were sometimes obtained from friends or family members. Whilst this provided some assurance about the individual's character, it may not always offer an independent assessment of their suitability for the role. We discussed this with the registered manager, who acknowledged the importance of obtaining references from individuals able to provide objective information about a person's character, conduct and reliability.

Staff told us they felt supported in their roles and had access to training, supervision and development opportunities. A staff member said, “I get monthly supervision. I had 6 weeks training and shadowing for 10 days working alongside an experienced staff member. It was paid.” Training records showed staff had completed a wide range of mandatory and role-specific training, and competency assessments were undertaken to help ensure staff had the knowledge and skills to provide safe care.

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.

People spoke positively about how staff maintained cleanliness within their homes. A person told us staff put items away and emptied bins after providing support, while another said staff were respectful of their home environment. This demonstrated staff helped maintain clean and tidy living spaces.

Staff received training in infection prevention and control and told us they had access to appropriate personal protective equipment (PPE) to carry out their roles safely. Daily care records showed staff used PPE when providing care and support. In addition, staff practice was monitored through spot checks, which included observations of infection prevention and control procedures to ensure staff followed good practice and minimised the risk of infection transmission.

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.

People and relatives told us about the support they received with medicines. A person told us staff prompted them to take their medicines as prescribed. Another person explained they managed their own medicines but knew staff could provide support if needed. A relative told us staff ensured their loved one received their medicines as prescribed and said the provider carried out regular medication checks. Another relative explained they chose to manage medicines themselves, although staff were available to assist if required.

Staff received medicines management training, and their competency was assessed to ensure they could administer and support medicines safely. The provider had policies and procedures in place to support safe medicines practice. Records of medicines administration and support provided were maintained. Medicines audits were completed regularly to identify any errors and monitor compliance.