16 Westmoreland Road Also known as Quality of Life Homecare Limited

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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

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 had systems and processes for recording and responding to incidents but there was not always a proactive and positive culture of safety. The provider investigated incidents and shared learning from these with staff on a case-by-case basis. However, there was not always a formalised or structured approach to analysing records over time to identify strategic themes, trends or opportunities for learning and service improvement.

Staff knew how to report and record incidents and accidents. They told us managers discussed incidents at team meetings and records showed these took place on a quarterly basis. The provider also used periodic newsletters and digital messaging to communicate lessons and information to staff.

The provider worked with people and other partners to establish and maintain safe systems of care but there was not always a strong awareness of people’s care risks and preferences when they started their care journey.

The provider followed protocols in place with statutory agencies for supporting people to move from hospital to home at short notice. They implemented a basic care plan with a person using discharge information provided to them as a person moved home, which they then updated when they further assessed the person’s needs. This meant it was not always clear if the provider had always gathered sufficient information about a person’s needs and preferences before commencing care. However, we saw the provider had recently introduced a number of improvements to people’s care and risk management planning to ensure people’s support was safe.

Feedback from people and relatives indicated they were generally happy with the transitions to the service.” Service records showed the provider made referrals to other services when assessing risks to a person’s wellbeing had increased. Care staff contributed to this. For example, a care worker said, “When a client is discharged from hospital, sometimes the amount of care time is not enough. I report this so the care package can be reassessed and increased.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately.

There were inconsistencies in relation to reporting safeguarding concerns to external partners. We found an instance where the provider had not notified the CQC of an allegation of abuse as required. This meant CQC was not always able to maintain appropriate regulatory oversight or be assured the provider had taken all necessary action to keep people safe. The provider worked with statutory services to investigate safeguarding concerns, and this was taking place at the time of our assessment. There were safeguarding policies and procedures were in place. Staff had undertaken safeguarding awareness training and knew how to raise concerns. For example, a staff member described how they had reported concerns about risks to a person’s wellbeing from another member of the public and the provider had responded to this quickly. The provider used staff meetings and newsletters to continue promoting safeguarding awareness. People and relatives felt people using the service were safe. A relative commented, “[The person] feels safe with the care staff and it gives me peace of mind.”

The provider worked with people and their relatives to understand and manage risks to people’s safety and wellbeing. Staff provided care to meet people’s needs that was safe and supportive.

The provider had recently introduced a number of improvements to how they managed risks with people to help ensure people’s support was safe.People’s care and risk management plans set out risks to people's safety and actions needed to mitigate those risks. Plans considered issues such as personal care, mobility, skin care and medicines, including if people were prescribed emollients that may present a fire safety hazard. For example, a person’s care plan was clear where two staff needed to position themselves when supporting a person to mobilise in their home to mitigate the risk of falls.There was guidance for staff about people's health conditions and how to recognise and respond if a person became unwell, such as a person who lived with breathing issues. People and relatives said they were involved in their care planning. Staff completed relevant training so they could support people safely, such as training in assisting and moving people, fire safety, first aid support, food hygiene and health and safety. A staff member told us, “I feel confident with using the equipment from my training.” The provider had business continuity plans in place to help the service continue in the event of a significant incident.

The provider had systems in place to assess risks in people’s home care environments and set out controls to mitigate these.

People’s risk management plans included fire safety and safe exits, flooring, tripping hazards, lighting, the use of appliances and how to access utility points.People’s plans also considered the presence of domestic animals. For example, a person’s plan informed staff how dear their pet was to them and how it may sometimes behave around others to ensure people and staff were protected from risks.The provider worked with other services, such as occupational therapists, to identify when people may need equipment to meet their care and support needs. The provider completed staff competency assessments to make sure staff knew how to support people with moving and handling activities safely.People and relatives did not report any concerns about care equipment and told us staff left their home environments clean and tidy. A person told us, “[The care worker] does a good job of cleaning such as tidying the shower and emptying the bin.”

The provider made sure there were enough staff deployed to meet people’s needs. They did not always make sure staff received effective supervision and support at all times.

Some staff provided live-in care and support to people in their own homes and service records showed some of these staff had worked 24 hour shifts every day for an extended period of time. The provider explained staff in these situations were not on shift all the time and were able to take breaks during the day, such as when a person went to their day centre, and could ask for more. However, the provider’s systems meant they could not be assured staff were always afforded enough time off to adequately rest between their care shifts. Staff we spoke with were happy with the hours they worked, though. A care worker said, “They will reduce my workload or give a day off if I need it, for example.” The provider used a digital rostering system to monitor staff attendance to reduce the risk of late or missed care visits. Some rostering data indicated this might not always be accurate and we saw the provider had taken action to address concerns about how staff used this system so their monitoring was effective.People and relatives said staff were mostly on time and stayed the required time for their care visit. They said staff called to inform them if they had been held up ahead of their care visit. However, some people said they were not always informed in good time if their regular carer was away and these shifts could feel rushed. Staff told us they usually had adequate time to meet people’s needs during their care visits. A staff member told us, “I have enough time allocated for care visits. I have plenty of time to get from one client to another.”

The provider had appropriate recruitment processes in place and staff completed relevant training so they could support people appropriately. This included awareness training for supporting people with a learning disability. People and relatives spoke positively about the skills and knowledge of the care staff. A relative told us, “The care staff are well trained. Due to dementia, [the person] keeps asking questions but they are patient.” Another relative said, “They seem confident and well trained.”Staff told us they felt supported by their managers and supervisors. A care worker said, “They always check and ask how I am. If I have some difficulty I speak to them and they respond straight away.” Staff said they attended periodic team meetings and visited the service’s office regularly as well. The provider repeated different teams’ meetings at various times to help ensure staff could attend. A staff member said, “We can learn from each other in these meetings.”

The provider assessed and managed the risk of infection.

Service records indicated staff had completed infection prevention and control (IPC) training. Staff were provided with personal protective equipment (PPE) to help keep people and staff safe and they told us they always had enough of this. Supervisors used periodic checks on staff to see how they used this. The provider had an IPC policy in place and they had reviewed this earlier in the year.People and relatives also told us staff wore their equipment when needed. Their comments included, “They use PPE and the care workers keep [family member] nice and clean” and “They wear PPE and work safely.”

The provider did not always have systems in place to make sure people received their medicines as prescribed and treatments were safe and met people’s needs, capacities and preferences. The provider promptly introduced a number of significant improvements to their medicines management and staff training arrangements to ensure this support was safe after we raised this with the managers. People’s care plans then set out appropriate information about medicines they were taking and the support they required with this. This included the details of the dose, how the person needed to take it, why the medicine was prescribed and potential side effects for staff to be aware of. We saw another person’s care plan was clear when their medicines were managed by their family and staff were not involved in this. Staff used digital records to note when they had supported a person to take their medicines and office staff checked these records regularly. Staff received training in safe medicines support management. Senior staff assessed care staff competency to provide this support safely. Staff told us they had completed medicines support training and found this helpful. A care worker said, “I feel confident with what I have learned. I know I have to be really on point with managing medication.” People and relatives told us their medicines support was well managed.