All Care (GB) Limited - Lion Oak Court

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 service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 62 (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 listened to concerns around safety and had taken steps to identify lessons learnt from incidents that had occurred. However, actions taken in response to incidents were not always fully embedded and more work was needed to ensure all staff understood how to apply learning. For example, the provider had worked collaboratively with stakeholders to improve fire safety at the service. However, some staff told us they were unsure about fire evacuation procedures for different scenarios that may arise. They said they would benefit from additional learning opportunities to reaffirm their knowledge. The registered manager told us they would organise learning sessions, to help ensure staff were secure in their understanding.

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. The registered manager worked with stakeholders to identify whether prospective admissions were suitable for the model of care at the service. They worked pro-actively with people and stakeholders to review and adjust the levels of care people received. This included work with commissioners around the care hours delivered and work with a local hospice, to help people remain in their own homes towards the end of their life.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve it. The provider shared concerns quickly and appropriately. People told us they felt safe receiving care from the provider. There were effective policies and procedures in place around safeguarding. Records demonstrated senior staff understood their responsibilities in reporting and investigating concerns in partnership with professionals. Staff had a good understanding of safeguarding procedures and minimising restrictive practices. The provider was pro-active in helping people keep safe in their own homes. This included promoting people’s home security and protecting people’s personal information.

People told us they felt safe receiving care from staff. They told us that staff understood their needs and how to reduce risks related to their care. This included reducing risks around mobilising around their home through the use of equipment and mobility aids, such as hoists or stand aids. Staff understood how to keep people safe in relation to their medical conditions. For example, where one person had epilepsy, staff were able to tell us about the action they would take to keep the person safe in the event they experienced a seizure. However, care planning documentation needed improvement to ensure the actions staff needed to take in the event of a seizure were clearly documented. Although the risk to the person was minimal due to infrequent seizures, clearly documented seizure protocol would help to improve safety. In a further example, one person’s care plans and risk assessments contained contradictory information about the number of falls they had experienced and how ongoing risks were to be managed. The registered manager had recognised the need to improve people’s care records to ensure they contained accurate information. They were implementing a plan to ensure this was completed, with senior staff prioritising reviewing people’s care plans who had the most complex needs and were most at risk. This was in progress at the time of our assessment. There were effective systems in place to monitor care and reduce risks related to missed care calls or care tasks not being completed. This included the use of an alert system on their electronic care planning system, which notified senior staff when planned tasks were not carried out by staff. This helped the provider monitor care pro-actively and identify and address any issues promptly.

The provider detected and controlled potential risks in the care environment. They made sure equipment, and technology supported the delivery of safe care. The provider completed environmental risk assessments of people’s homes to identify and reduce risks related to the delivery of care. They assessed care related equipment, to ensure it was in good working order and there was guidance for staff around its safe use. For example, they had improved fire safety by advising people about the safe storage of electric mobility vehicles. The provider used technology to support the safe and effective delivery of care. This included systems to monitor care delivery and securely store people’s personal information.

We received positive feedback from people around the consistency of staff and their competency in their role. People told us staff arrived at planned times and stayed the duration of their allotted care calls. However, the provider needed to make improvements to ensure all staff had received training in line with people’s needs and health conditions. The provider also needed to strengthen their recruitment practices, specifically when using agency staff. The provider had obtained evidence of agency staff’s training records and checks made with the Disclosure and Barring Service. However, they did not always verify documentation in relation to agency staffs’ right to work in the UK. In mitigation, the provider’s use of agency staff was low and there were systems to ensure they only worked alongside experienced permanent staff. This helped to reduce the risks around agency staff lone working or not being familiar with people’s needs. Staff had a high compliance with completing provider’s mandatory training. However, available training was not fully reflective of the breadth of people’s health conditions. For example, staff had not received epilepsy training. Although this related to one person, who did not suffer frequent seizures, the registered manager acknowledged this shortfall and arranged for staff to receive this training. Staff told us they felt supported in their role by senior staff. This included monthly monitoring and support activities, such as supervisions and spot checks.

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 told us staff used appropriate personal protective equipment (PPE) and followed good hygiene practices when delivering care. The provider had infection prevention and control policies in place. Staff confirmed there were sufficient supplies of PPE available for their use.

Staff supported some people to take their medicines and medicine administration records showed people had received their medicines as prescribed. Staff had received medicine training and had been assessed as competent to administer people’s medicines. Staff could describe the action they would take when people refused or missed their medicine in accordance with the provider’s medicine policy. However; escalation guidance was not always available if people missed the application of their topical creams for the treatment of pressure ulcers. Some medicines guidance required more detailed instructions to help ensure they reflected how medicines should be administered. For example, one person was prescribed a medicine that needed be taken before eating. Their care plan did not provide specific enough instruction around this requirement. However, the registered manager and staff were able to explain how they ensured this medicine was administered as prescribed. The vast majority of people had private arrangements around the supply of their medicines. The registered manager had completed positive engagement with an external supplier over recent issues with the supply and availability of some medicines. However, they did not always document the actions taken to keep people safe if issues with supply resulted in missed administration. Therefore, record keeping around medicines management needed to be more thorough.