Totus Care 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. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 63 (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 did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Leaders had reviewed a recent safeguarding incident to identify lessons learned. However, the review did not fully consider the factors and circumstances that contributed to the incident occurring in the first place. As a result, opportunities to identify wider learning and preventative actions were missed.

We saw evidence of learning being shared with staff via a poster and staff told us that the incident and associated learning had been communicated to them. They said, “They are very open. We had a big team meeting the other day and they brought up the (recent) incident and shared learning from it.” However,formal analysis and evidence demonstrating the longer-term embedding of that learning required strengthening.

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.

People were supported through safe and effective systems, pathways and transitions. Relatives told us that new staff were given opportunities to shadow experienced carers before providing support independently, helping to ensure they developed the skills and confidence needed to meet people's needs safely. Staff members also confirmed this approach. One staff member said, “(before supporting someone for the first time) We would look at care plans and do shadowing.”

There were effective arrangements in place to support people's transitions between services. We saw that people had hospital passports and emergency grab sheets in place, which contained important information about their health, care and support needs. These documents helped to ensure that relevant information could be shared promptly with healthcare professionals and supported smooth transitions between the service and health settings. This reduced the risk of disruption to people's care and helped to promote continuity and safety.

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. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Systems to safeguard people were not always effective because the principles of the Mental Capacity Act (MCA) 2005 were not consistently applied. Where people were thought to lack mental capacity, not all relevant decisions had been assessed. For example, one person had not had their capacity to consent to the use of homely remedies assessed.

Mental capacity assessments were not always completed in line with the MCA Code of Practice. Some assessments lacked sufficient detail and evidence to demonstrate how decisions had been reached, containing only yes or no responses rather than recording the person's understanding, reasoning and ability to make the specific decision. In addition, some best interest decisions did not fully consider all available options or relevant factors when decisions were made on behalf of people who lacked capacity. This meant the service could not always demonstrate that decisions were being made in the least restrictive way and in accordance with legal requirements.

Staff had received safeguarding training and understood their responsibilities to recognise and report concerns. However, oversight of training required improvement. Five staff members' safeguarding training was close to expiring and the registered manager's safeguarding training had expired. This increased the risk that staff and leaders may not have access to the most up-to-date safeguarding guidance and practice.

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

Whilst relatives told us they, "met [with the service] often to make sure everything's ok," records did not demonstrate that people, or where appropriate, their relatives, had been involved in the assessment and review of risks. This meant the service could not evidence that people's views, preferences and experiences had been considered when identifying and managing risks.

Risk assessments were not always comprehensive and did not consider all known risks relevant to people's individual circumstances. This meant that some risks may not have been fully identified or managed appropriately, increasing the potential for inconsistent approaches to risk management. Leaders could not demonstrate that risk assessments were routinely reviewed to ensure they remained accurate, up to date and reflective of people's current needs.

As a result, the service could not be assured that people and their representatives were consistently involved in decisions about how risks were assessed and managed, or that all risks had been adequately considered to support people's safety and wellbeing.

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

People were supported in safe environments where risks to their health and wellbeing had been appropriately considered. We saw evidence that environmental safety assessments had been completed, including assessments relating to fire safety and the management of asbestos risks. These helped to ensure potential hazards were identified and addressed.

People's homes were clean, tidy and well maintained, with no obvious environmental hazards observed during the inspection. This reduced the risk of avoidable harm and supported people to remain safe within their home environment.

Staff told us they had access to the equipment they needed to provide care safely and effectively. This helped them to meet people's needs while reducing risks to both people using the service and staff. Overall, systems were in place to help ensure environments remained safe and suitable for the delivery of 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.

Recruitment processes were safe. We saw evidence that appropriate pre-employment checks had been completed before staff commenced work. During the assessment we became aware that one staff member had started work before their full Disclosure and Barring Service (DBS) check had been received. We saw evidence that the provider had obtained an Adult First check and completed a risk assessment to help mitigate potential risks. The manager explained that there were exceptional circumstances which necessitated this decision to maintain safe staffing levels and continuity of care for people using the service.

Staff had access to training to support them in their roles; however, records identified some gaps in training compliance. This included the manager's training being out of date. These omissions reduced the provider's assurance that all staff, including leaders, were maintaining up-to-date knowledge and skills required to perform their roles effectively.

We found evidence that staff supervision sessions and team meetings were taking place. Staff and leaders spoke positively about these arrangements and described how they supported communication, development and oversight.

Despite the gaps in training, we did not find evidence that people had experienced harm as a result. One relative told us, “I think, like all of us, [person] has their favourite (staff). The staff keep a close eye on them. They love going out and having cups of tea and ‘chilling out’ with staff.” Staff understood people's needs and were able to describe how they provided safe care and support. However, the gaps identified in recruitment oversight, training records, and the documentation of staff support arrangements meant the provider could not fully demonstrate that systems and processes were consistently effective in ensuring safe and effective staffing.

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 were protected from the risk of infection through effective infection prevention and control practices. We saw that people were supported to maintain the cleanliness of their homes, helping to reduce the risk of infection and promote a safe living environment.

Staff had access to appropriate personal protective equipment (PPE), including gloves and aprons, and understood when and how to use it. We observed that PPE was used appropriately when staff were supporting people with personal care. Relatives also confirmed that staff use PPE available to them. Staff demonstrated an awareness of infection prevention and control procedures and how these helped to protect both people receiving care and themselves from the spread of infection.

Overall, suitable arrangements were in place to support good standards of hygiene and infection prevention and control within the service.

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

Systems and processes for the management of medicines required improvement. Staff responsible for administering medicines had received appropriate training and competency assessments had been completed to help ensure they could administer medicines safely.

People had prescribed pro re nata (PRN) medicines. This means they were only to be taken ‘as required’ and not regularly. The provider had PRN protocols in place, however, these were not always sufficiently detailed to guide staff on when medicines should be administered. For example, one person's PRN protocol for pain relief did not include information about the signs, symptoms or indicators staff should look for to determine when the medicine was needed. This increased the risk of inconsistent decision-making and could result in people not receiving their medicines appropriately.

Where staff carried out delegated healthcare tasks, records showed they had received the relevant training. However, there was no evidence that competency assessments had been completed to confirm staff were able to perform these tasks safely and effectively in practice. This was not in line with expectations set out in the Skills for Care guidance for providers on delegated healthcare tasks. This states that providers should be assured staff are competent to undertake delegated healthcare activities and that the delegating health professional is responsible for confirming the competence of staff.

We did not identify evidence that people had been harmed as a result of the issues found during the assessment. However, the gaps in PRN protocols and the lack of documented competency checks for delegated healthcare tasks meant the provider could not demonstrate that medicines and delegated healthcare activities were always being managed in a safe and consistent manner.