Keem Healthcare 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.

This is the first assessment for this service. This key question has been rated requires improvement. This meant people were not always safe and protected from avoidable harm.

The service was in breach of legal regulation in relation to people’s safe care and treatment at the service.

This service scored 59 (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 did not always have a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. However, lessons were not always learnt to continually identify and embed good practice.

A lack of provider oversight had impacted on how learning events were identified, which then led to improved practices. We found a lack of effective record keeping and monitoring of 1 person’s skin integrity meant learning lessons could not be taken. This was because there was a lack of recorded information to demonstrate if improvements to the condition of the person’s skin were made or not. It also meant, other healthcare professionals may not have a true picture of the support this person received to assess the effectiveness of their treatment plans.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, but they did not always manage or monitor people’s safety. This could have some impact on people when they moved between different services.

One person’s care relied on other health professionals’ input. For this person, we found their care information required more specific details to ensure when other professionals were involved, staff had a true picture of how the person was presenting. Gaps in care plans and incomplete risk assessments meant staff provided care that was not always in line with the person’s care plan. For another person, their records needed improving to ensure they were reflective of their current presentation and needs. When a health professional was involved, there was a lack of records to prove, how the person’s condition was being maintained. However, we were confident people did see other health professionals and specialists to ensure their health and wellbeing was supported as much as possible.

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 registered manager knew when and how to raise concerns of poor practice. The registered manager said staff received safeguarding training which gave them confidence staff knew what to do to keep people safe. The registered manager gave us an example of how they recognised 1 person could be at potential financial risk. They worked with the person to find a solution to help safeguard their finances. This helped protect that person from financial concerns.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s changing needs that was safe, supportive and enabled people to do the things that mattered to them.

We found risks to people’s care were assessed but not always recorded accurately or monitored. We saw people’s risks relating to their individual circumstances were considered, however there was a distinct lack of risk management strategies and actions to keep people safe. For example, 1 person had a catheter, but there was limited guidance to inform staff of the signs to look out for that could indicate the person was at risk. For example, signs of blood in urine, odour and safe positioning of the catheter bag. Another person had their drinks thickened to help manage their choking risk, yet we found staff gave the person normal fluids. A recent meeting with speech and language therapy confirmed the person had capacity to understand the associated risks, but there was no care plan or risk assessment that recorded this, especially how staff should record the person’s wishes in their daily records. This person also had some behaviours that could put themselves and others at risk, but there was no recorded information or strategies to manage this known risk. Speaking with staff showed us they knew how to support people, but clear and accurate records would ensure staff provided consistent and safe care.

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 risks within people’s own homes were identified at the start of the assessment process. There was information in people’s care plans to manage aspects of a person’s home where risks existed. For example, such as telling staff where certain utilities were in case of an emergency to turn them off. In 1 example, a person smoked and the registered manager invited the fire service to speak with the person to tell them of the potential risks of smoking in their home and how smoking in bed increased the risk.

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.

The registered manager was confident staffing levels met people’s needs. The service supported 2 people and there was enough recruited staff available if new packages of care were taken on. The registered manager used an electronic system that allocated staff to care calls and monitored staff arrival and departure times. The registered manager told us they constantly checked this system throughout the day to ensure staff had logged in and out of their allocated calls and had stayed for the required duration. There were enough staff to support people, and the registered manager’s care call system showed people received care from a small and consistent team, meaning staff knew people well.

The provider had effective processes to ensure all safe recruitment checks had been completed prior to staff starting with the service. Recruitment checks included staff identity checks, references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This helps providers make safe recruitment decisions. Observed practice of staff and staff supervisions and training, helped the registered manager know staff remained safe to meet people’s needs. Staff confirmed training was undertaken which helped them provide the care people needed.

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.

The registered manager was confident staff wore appropriate personal protective equipment (PPE) such as gloves and aprons. The registered manager ensured staff had sufficient stocks of PPE by completing regular checks. Staff told us they wore PPE and, in some cases, they wore a face covering to minimise the risk of cross infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The provider had assessed 1 person was able to administer their own medicines. The other person was reliant on staff to administer their medicines. We looked at examples of medicine administration records (MAR) and found this person consistently refused most of their medicines. Although this person was known to refuse their medicines and had capacity to make their own decisions, there was no information in the person’s records that told staff, what to do or how to encourage the person to take them. The person’s care plan stated staff had to encourage the person to take specific medicines, but this was not recorded as being done. We asked the registered manager to clarify this, and they said the information in the care plan was not correct.

There was insufficient oversight of medicines management, and checks had not identified the high number of refusals or gaps in recording. This meant the provider could not be assured medicines were managed safely. This resulted in insufficient guidance for staff to safely manage repeated refusals, including when to escalate concerns, which increased the risk of people not receiving essential medicines.