One to One Community Care

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 remained 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.

The service was previously in breach of the legal regulation in relation to safe care and treatment and how people’s medicines were managed. No improvement was found at this visit and the provider remained in breach of this regulation in relation to management of medicines and overall safe care and treatment.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Lessons were not always learnt to continually identify and embed good practice. Although accidents and incidents were recorded for each individual, there was limited review and analysis of incidents at service level to identify themes and trends and mitigate future risk. There were not effective systems in place to share learning from incidents within the staff team to improve safety and embed good practice.

People’s care records did not always accurately reflect their needs or provide sufficient guidance to staff to allow them to support people safely or provide accurate or up to date information if shared with other parties. New referrals were assessed face to face to ensure people’s needs could be met and information was gathered from both people and their relatives. Information collated did not always transfer through to the care plan to inform staff of need-to-know information to support people effectively. Poor records in some care plans increased the risk of care pathways and transitions not being safe as the information being shared was not always accurate or up to date. However, people received support from a small consistent staff team who knew them well which supported good continuity of care.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. However, people’s care records did not accurately reflect their needs or detail how the service was working with the principles of the mental capacity act. Effective systems to identify and provide robust oversight of accidents and incidents including safeguarding’s were not in place. Records showed safeguarding concerns were reported to the local authority, but notifications were not always submitted to CQC.People told us they felt safe with the support they received and could raise concerns if they needed to. One person told us, “I definitely feel very safe…No never any abuse of any kind ever.” A relative told us, “Yes [Name] is very safe.” Records evidenced that staff had undertaken safeguarding training and staff told us they had received the necessary training and understood their responsibilities to keep people safe. A staff member told us “If I suspected abuse I would report my concerns to my manager. I would record factual information including dates, times and evidence witnessed. I would ensure the individual is safe.”

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Effective systems to provide complete oversight of risk including accidents and incidents were not in place. Incidents were not being reviewed at service level or follow up completed. Care records lacked detail and up to date information to allow staff to have the guidance to support people appropriately and mitigate risks. For example, some people needed support with health conditions, but there was no reference to this in their care plan. Risk assessments were not robust and were missing key information about how to care for people safely.Reviews of care plans and risk assessments were not embedded into practice to ensure continuous improvement and monitoring of outcomes for people. We found no evidence that people came to harm because of poor risk management. However, we could not be assured that all people supported were being provided with the correct level of care to keep them safe.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.Records did not always give clear information about environmental risks or clear guidance on the safe use of equipment. However, staff told us of the measures they took to ensure people were kept safe and that they were suitably trained to use moving and handling equipment and they felt safe working in the community and that their needs had been considered. A staff member told us, “I ensure their premises are safe and secure.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, the systems in place did not always provide clear oversight to ensure safe and effective staffing. Recruitment procedures were in place. However, it was noted that some areas of the process needed closer scrutiny. For example, to ensure there were no gaps in a staff member's work history, references were always completed, and application and interview records were retained and accessible. We shared this information with the Registered Manager who agreed to action. Clear oversight of staff training was not in place at the time of our visit. However, this was actioned by the Registered Manager at the time of our visit and training records submitted showed staff were up to date with essential training and attended regular updates to ensure their knowledge and skills were maintained. Some records of supervision and appraisal were present in individual staff files. However, there was no matrix in place to provide an overview of supervision or evidence regular supervision was taking place or a record of team meetings. The Registered Manager agreed to action this. Staff however, told us they felt well supported and felt confident to raise any concerns. A staff member told us, “I feel very supported by my manager and other staff. This could be a phone call or going into the office.” We received mixed comments from people and families around call times. A relative told us, “Visits last 20-30 minutes and carers stay their allocated time and arrive on time.” Another relative commented, “Timing can be difficult as [person] would like them earlier in the morning as sometimes [person] has already got themselves up before they arrive.” People and families told us they were happy with the staff that supported them. Comments included, “[Name] sees the same 4-5 carers and has a good relationship with them” and “Yes, I would say the carers are well trained.”

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. No concerns were raised by staff about the availability of personal protective equipment (PPE). One staff member told us, “Yes, we have access to full PPE. We also have a rucksack which contains everything we need to do our calls.” People and their relatives raised no concerns regarding infection control. One relative told us, “They wear gloves and good hygiene always.” Another relative commented, “Carers are very hygiene aware, wear gloves and keep everywhere clean and tidy.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines records lacked detail, had conflicting information and were not always up to date meaning people were at risk of receiving incorrect medicines. It was often unclear who was responsible for administering medication and where discrepancies had occurred there appeared to be no record of follow up. People prescribed creams and patches did not always have body charts in place to assist staff to know where to apply or to record rotation in accordance with the manufacturers’ directions and where they were in place they were not always completed. Records of ‘when required’ medicines were not in line with best practice guidance. Medicines audits were not robust and had not identified the issues we found during our visits. There was a lack of adequate oversight from leaders in relation to medicine optimisation. This meant people were being placed at risk of harm from poor medicines management.