WR Care Services

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 newly registered service. This key question has been rated Good: This meant people were safe and protected from avoidable harm.

This service scored 69 (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 reported safety events. Management listened to concerns about safety and investigated incidents.

Although lessons were learnt to identify and embed good practice these were not always documented.

The service was open and transparent and shared safety incidents with people and their relatives. People and staff told us they would raise safety concerns with the management team if they were worried about anything. Partners told us the service worked well with them to investigate safety events and took appropriate action. Staff told us, “I feel safe at my work.” This meant people were protected from the risk of repeated safety events.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Records of referrals to other health services were made in a timely manner. This meant people experienced safe continuity of care when moving between services.

The service made sure information was shared when people attended hospitals, by having emergency information sheets in people’s homes. These included details of people’s immediate support network and medications prescribed. However, these did not always contain information around communication or care and support needs. We gave feedback to the provider, and they took steps to rectify this.

Assessments of people’s health and needs were carried out when the service first visited people in their homes, however they were not always comprehensive. They lacked comprehensive detail regarding people’s medical conditions including signs and symptoms of good health, or deterioration. This meant staff did not have clear written guidance to help them recognise when a person’s health may be deteriorating.

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. Staff had all received appropriate training shared safeguarding concerns quickly and the provider worked well with local partners to resolve concerns when they arose.

People told us they felt safe. Comments included “Yes, I feel safe. Generally the carers are good.”

The provider had an in-date policy, and staff told us they could access it at any time. They felt confident in raising concerns. The service understood the basic requirements of the Mental Capacity Act 2005 (MCA), although records did not always clearly detail which decision had been considered or how best interest decisions were reached. Despite this, we saw no evidence that people were placed at risk of harm or that decisions made about their care were inappropriate. The Mental Capacity Act 2005 states that assessments should only take place where there is an impairment of the mind or brain, and whether the person is unable to make a specific decision due to this impairment. It also states that people should be assumed to have capacity to make a decision themselves unless stated otherwise. An assessment had been started for a person who did not have an impairment of the brain and there was no reason to believe otherwise. The person was deemed to have full capacity and so the assessment was abandoned. The provider was very responsive to our feedback and took action to seek clarification.

Although the provider worked with people to understand and manage risks processes to mitigate risk were not always effective or individualised. Risk assessments did not always document written strategies to mitigate risks of medical conditions, moving and handling or falls. As a result, staff did not always have the documented guidance they needed, creating the possibility of people being adversely affected.

Staff received training to support people to use their assistive equipment. However, their competency was not always assessed or documented, which meant there was a possibility that equipment might not be used as intended, potentially affecting people’s safety.”

A person’s relative told us staff knew how to use equipment to support a person. They said, “I've been warned not to use it on my own.”

Staff completed appropriate training specific to their roles to reduce risks to people, including falls, hydration and nutrition, dysphagia and choking, and dementia training. Staff told us they have time to read people’s risk assessments.

Partners told us that the service worked well with other health professionals “when reviewing care packages and moving and handling equipment to ensure that both the person and formal carers remain safe during transfers, bed management, and other essential daily tasks.”

This meant staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

The service was a home care service that supported people who lived in their own homes. The provider did not have responsibility for the safe maintenance of the property or the equipment used. However, the provider detected and shared potential risks in the home environment with people and their relatives.

Staff carried out risk assessments of people’s environments, and supported people to control risks within their home such as clear pathways to enable smooth transfers and mobilisation. Staff checked people’s personal equipment before use for any faults. Risk assessments and basic maintenance checks were in place for the main office used by the management team. These were effective and provided a safe environment for staff to access team meetings and individual supervisions.

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. Staff recruitment was managed appropriately, with evidence of interviews and enhanced disclosure and barring checks. Competency checks were carried out on induction, the provider had taken action to ensure the management team were trained to assess people’s competency in moving and handling, and medicine administration.

There was a stable, consistent team of staff to provide care to people. A person’s relative told us, “We see the same set of 6 carers”. We saw records that evidenced people were visited by their preferred carer where possible. This meant people were afforded good continuity of care.

We received mixed feedback from people and their relatives about staff arriving at planned times and staying for the agreed visit length. Feedback included, “Sometimes they [staff] stay for only 15 mins when they should be here for 45 minutes”, “I spoke to [the office] to have a word with them as they [staff] were late, and “[staff are good at] time keeping - they are very efficient in what they do.”

The provider acknowledged that staff had been late to some calls due to unavoidable circumstances and that they communicated with people affected if this occurred. Records did not demonstrate if staff had arrived at their call on time, however, unannounced spot checks showed staff had arrived promptly. Records and checks in place demonstrated that carers stayed for the duration of agreed call time. Other people and their relatives confirmed this. There were no audits in place to monitor this. We gave the provider feedback regarding this concern, and they told us they would take action to improve monitoring.

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. Staff told us they wore appropriate Personal Protective Equipment (PPE). On the day of inspection, we observed the management team ordering more PPE for their staff. People told us staff wore PPE including “blue gloves”. Staff told us they do not go to work if they are feeling unwell. All staff had completed up-to-date training in infection prevention and control. This meant people were protected from the risk of becoming unwell.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. Medicine Administration Records (MARs) were not always signed appropriately after medicine was administered, however, people’s daily records noted that medication was given. Medicine audits were undertaken but were not always effective. Staff were regularly reminded of their responsibilities to ensure MARs were complete in team meetings.

Where people were prescribed and administered thickener for fluids, these were not recorded on MAR charts. Specific medication prescribed to people was not always recorded in care plans, for example, medication that they self-administered such as Parkinson’s medication or iron supplements. This meant medicines information was not always presented clearly, potentially causing delays when sharing it with emergency services.

Topical Medicine Administration Records (TMARs) and body maps were not in place for people who used prescribed creams. The service could not demonstrate that topical medicines are being administered safely and consistently, and staff did not have clear instructions on where and how to apply prescribed creams. This meant people were at risk ineffective measures to protect their skin integrity. We saw no evidence that people had been harmed by this.
The service did not check stocks of people’s prescribed medicines held in people’s homes. This meant they could not be assured that medicines were being used as prescribed, stored safely, and were in date.

People with PRN (as required) medicines had protocols in place, however staff did not record the reason for administering PRN medicines and the outcomes, which meant the service could not be assured they were used safely or in line with people’s needs.

However, there were risk assessments for people who self-administered medication or were administered medication by their relatives.

We gave feedback to the provider, and they took immediate action to remedy the issues found on inspection. People told us, “They rubbed the creams on the prescribed area, and they keep a log of it” and “They did a body map recently for lotions and creams.” The service put in place an action plan to improve their medication audits.