CARE 24/7 SOLUTIONS 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 inadequate. At this assessment the rating has changed to requires improvement.

Although some improvements had been achieved since our last inspection, there was still some aspects of the service which were not always safe and there was limited assurance about safety. There was still a risk that people could be harmed. The service remained in breach of legal regulations in relation to safe care and treatment and fit and proper persons employed.

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 still did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were still not always learnt to continually identify and embed good practice. For example, there were gaps in recording on the daily notes about an incident in relation to a service user where paramedics were called. Daily notes were not written for the lunchtime call, and the morning notes did not indicate any concerns when staff left. The incident report was completed and contained information that had not been recorded in the daily notes. Therefore, it was difficult to establish exactly what happened and when and if the incident had been appropriately recorded, reported and actions and learning taken to prevent reoccurrence. This was also not identified through audits completed by the provider.

However, we found lessons learnt around the reporting of safeguarding’s incidents and notifying external stakeholders of other incidents had improved.

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. For example, one person told us about their experience of returning home from a hospital setting and how the service supported them, along with other providers to rehabilitate and become independent. They told us, “We were referred to the agency via the Paramedic and District Nurse, the referral for the service worked well. We have finished with the service from today as we no longer need the help. [Staff member] used to go above and beyond, with care and commitment.” A staff member told us, “The managers do an assessment and then pass the information over to us, we get told about it verbally and also it’s in the care application system, it tells us what is needed, what needs the person has and what timings are involved.”

The provider now 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. The provider shared concerns quickly and appropriately in line with their policy. One person told us, “Certainly, no safeguarding concerns, no abuse ever, if so, I would go to the manager.” The provider had added a safeguarding quiz to the recruitment process and safeguarding was discussed regularly during supervisions and team meetings to strengthen the team approach to safeguarding. Concerns raised at the last inspection about recording and reporting safeguarding incidents had now been resolved.

The provider still did not always work well with people to understand and manage risks. For example, we identified a person who was being cared for in bed who was at risk of pressure wounds and needed regular repositioning. Staff were able to tell us what they did to ensure the person was repositioned and the person’s relative assured us the person was being repositioned during every visit. However, no repositioning charts or documentation was available to record how and when the person was repositioned which placed the person at risk of skin breakdown. In addition, people’s fire risk assessments did not always highlight risks associated with the administered cream and ointments. Care plans still did not always contain sufficient information, and we found some gaps in people's care plans around person-centred information. For example, lack of information about people's religion, nutrition and individual preferences. The information available did not assure us that plans were in place to mitigate risks and manage the safety of some people although no harm to service users had been found due to staff knowing the service users well and were aware of their preferences through working with them. The provider’s own audits had also not identified the concerns we found.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. For example, people told us they had access to the equipment they needed to stay safe and independent. Staff told us about the checks they completed for equipment and what they would do if they had any concerns. Leaders explained the process of the checks they expected staff to complete during visits.

We found new staff still lacked appropriate recruitment checks in line with legislation. For example, the employment references for 2 new staff members, and a Disclosure Barring Service (DBS) check for 1 new staff member had not been checked by the provider before they started in their role. This was against the provider’s own recruitment policy and national legislation to ensure safe recruitment. We also identified a staff member who had not received an appraisal since joining the service in 2023, in line with the provider’s own policy and the provider did not supply evidence to us that it had taken place. The provider had adapted their application forms since the last inspection; however, we found people’s previous employment history was still not recorded fully. Therefore, the new system in place was not effective in identifying gaps in employment as it was not clear when people started or finished in their previous role.

However, staff had the required training and qualifications and worked well to provide safe care that met people’s individual needs. Staff told us they receive regular supervision and support. The nominated individual was also scheduled to attend additional recruitment training in March 2025 to improve the provider’s recruitment practices.

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. Concerns found at the last inspection in relation to infection prevention and control had been rectified. People told us staff regularly used personal protective equipment (PPE) and was aware of hygiene and infection control. Staff had a good understanding of infection prevention and control and knew when to use PPE and how to dispose of it appropriately. Policies had now been updated to reflect good working practices.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. At the previous inspection concerns were identified that the medicines records did not reflect the current medicines, and the effectiveness of the medicines audit process. Whilst the audit tool had been updated, concerns about the effectiveness of the medicines audit process remained. During this inspection, although improvements since our last inspection had been made, we now found people’s fire risk assessments did not always highlight the risks associated with the administered creams and ointments which were paraffin-based products. In addition, further information about variable doses was not available and information to support staff to administer “when required” medicines was not person-centred. Therefore, we were not assured that “when required” and or “variable dose” medicines would be administered consistently by staff.

However, people and their families supported by the service told us they were happy with the way staff supported them with their medicines. Staff described and showed us the processes from initial assessment, creating the medicines administration record, through to administering and recording the medicines. Staff were able to explain the risk when people, who were prescribed oral anticoagulants, had falls and the need to dial 999. We reviewed 3 services users care plans including medicines administration records and when required protocols. These care plans included people’s allergies and body maps to support the administration of creams when delivering personal care.