Allfor Care Croydon

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• 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.

At our last assessment, we found the service was in breach of legal regulations in relation to people’s safe care and treatment, safeguarding, duty of candour, staffing, fit and proper persons employed, notifications, and good governance. At this assessment, we found improvements had been made and the provider was no longer in breach of regulations.

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.

At our last assessment we found a lack of a learning culture. This was particularly evident in the leaderships failure to address late and missed care visits. At this assessment, we found improvements had been made to the electronic monitoring system [EMS] and leadership oversight. Improvements to the EMS included the automatic generation of alerts should care staff fail to arrive on time at people’s homes. This enabled office-based staff to take action to ensure people did not experience missed calls by, for example, redeploying another member of staff.

Senior staff continuously monitored the EMS. The combination of software functionality upgrades and increased, real-time management oversight meant that missed care visits to people had been eliminated and punctually had improved. A person told us, “The timekeeping is good.” We reviewed over 9,000 scheduled care visits and found none had been missed.

The provider reviewed accidents and incidents, including near misses. These reviews were used to clarify facts, identify causes, assess responses and determine the actions required to prevent reoccurrence. Lessons learned were discussed at weekly office meetings and shared with care staff through team meetings and online communications.

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.

At our last assessment we found people were not always supported through a safe transition and pathway into the service. This was because people were not always supported with initial comprehensive assessments within 72 hours of their new service starting. At this assessment we found there had been no new transitions into the service. However, the provider’s assessments and care plans had been updated to an electronic care record format to enable initial and subsequent assessments to be undertaken. Office-based staff received training in assessment and care planning and the use of electronic care records. This meant that the provider had the systems, processes and training to support safe transitions into the service.

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.

At our last assessment, we found that people were at risk of harm because of missed care visits. At this assessment, we reviewed the provider’s electronic management system and found people were not experiencing missed care visits. This was confirmed by a relative who told us, “They [care workers] have never let us down and they turn up in all weathers.”

Also at our last assessment, we found the provider had failed to recognise a complaint as a safeguarding concern which should have been raised with the local authority and reported to CQC. At this assessment, we found that complaints were reviewed and responded to appropriately and safeguarding concerns were shared with the local authority’s safeguarding team and CQC when required.

People were safeguarded from abuse and improper treatment. People told us they felt safe. A person told us, “I have no concerns whatsoever.” The provider had up-to-date safeguarding policies and procedures in place. Office-based staff, managers and care staff undertook safeguarding training to identify types and signs of abuse. Staff understood the actions they would take should they be concerned about people’s safety and welfare. A member of staff told us, “My responsibility is to keep people safe from harm, danger and abuse.”

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.

At our last assessment, we found that people’s risks were not always assessed and managed. At this assessment, we found people’s risks were assessed and reviewed to mitigate the risk of them experiencing avoidable harm.

People’s risks were assessed before they received a service and these were regularly reviewed. Risk assessments covered a range of areas including people’s health, mobility, skin integrity and environment.

Where people were at risk of falls, specific assessments were undertaken with people. These included people’s preferences for how the risks should be managed. When required, office staff made referrals for specialist assessments by healthcare professionals and managers ensured staff were trained to use any specialist mobility-supporting equipment.

Where people were identified to be at risk of developing pressure sores, referrals were made to healthcare specialists. Staff followed their guidance, which was detailed in people’s risk assessments and care plans. Staff actions to protect people’s skin included supporting people to reposition regularly and recording observations in people’s electronic care records, which were reviewed by managers.

Staff had guidance in care records to keep people safe when presenting with specific risks associated with their health needs. For example, people diagnosed with epilepsy had risk assessments in place. These were personalised and provided important information, including common triggers, seizure patterns, the support required following a seizure and the circumstances that would require staff to call the emergency services.

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

At our last assessment, we found that health and safety audits were not always effective because they did not always identify and address shortfalls. At this assessment, we found a range of health safety checks were undertaken by office-based staff and reviewed by leaders to ensure timely identification and resolution of issues.

Environmental health and safety checks included fire risk assessments and environmental hazards such as sharp objects, hot surfaces, or unsecured furniture which could lead to people falling. Health and safety checks were audited by leaders to confirm they were robust and that all actions were completed.

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.

At our last assessment we found that staff recruitment records were not complete, training records were not accurate, and staff were not always supervised in line with the provider’s supervision policy. At this assessment, we found improvements had been made.

People received their care and support from staff who the provider recruited using robust recruitment practices. These included reviewing job applications, interviewing candidates, checks against criminal records databases, taking up references and verified employment histories. The provider confirmed the identities of staff along with their eligibility to work in the UK.

New staff received an induction during which they received training and worked under the supervision of experienced colleagues (shadowing). A member of staff told us, “Shadowing helped me a lot.” Staff completed a probationary period, at the end of which their employment status was confirmed. Staff received on-going training in a range of areas to support people safely and effectively. Managers assessed staff skills and knowledge through checks in supervision and observations of care practice. The provider maintained accurate records of staff training, including when refresher training was required. This meant that people received their care and support from trained and supervised staff.

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.

At our last assessment, we found that staff did not support people in line with their training and the providers policy to control and prevent infection. At this assessment, we found improvements had been made. The provider ensured that staff received infection prevention and control training and wore personal protective equipment such as single-use gloves and aprons when meeting people’s personal care needs. A person told us, “Staff wear gloves and aprons.” Another person said, “They are very clean.” And a third person told us, “The carers always wear shoe covers and are very respectful of my home.” Managers carried out observations of staff to ensure they were following safe hygiene practices.

The provider made sure that medicines were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At our last assessment, we found that missed and late care visits had a negative impact on some people’s medicine regimes and people’s medicines records contained insufficient information. At this assessment, we found that improvements had been made. Upgrades to the provider’s electronic management system enabled managers to schedule care visits efficiently. This meant that care visits were planned to ensure people received their medicines on time. The improved electronic care records system alerted office-based staff if people had not received their medicines as planned, enabling them to take prompt action.

People received their medicines from trained staff and supervised to administer people’s medicines as instructed by the prescriber. Staff completed people’s medicines administration record (MARs) appropriately and these were audited by managers. MARs contained accurate and important information about people. For example, people’s allergies were highlighted and there was information about the potential side effects of medicines.