Care & Grace

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

People told us they were very happy with the overall service provided. They had no concerns, told us staff turned up on time and that they felt safe when supported by staff. Despite this, we found the systems and processes in place to support staff to do their job safely were not robust. Risks to people were not adequately assessed. Care plans lacked detail about people’s needs and risk assessments were not in place to provide staff with information needed to mitigate the risks to people and keep them safe from harm. Opportunities to learn lessons were lost as the provider’s approach to reducing unwanted incidents was reactive, not proactive. Care records lacked sufficient information and guidance on people’s health care needs and how to support them to manage these. People told us they were involved in the planning of their care, but there was a lack of evidence to demonstrate this. Staff had received training in how to recognise abuse, but heavily relied on the provider to recognise and respond to any concerns. Recruitment practices in place were not robust and staff supervision and competency checks were inconsistent. Staff felt well trained, but systems were not in place that would assure the provider of the effectiveness of that training. There was currently no system in place to monitor the punctuality and duration of people’s care calls. Staff rotas seen indicated that, on occasion, some staff were expected to be in 3 places at once. Accidents and incidents involving people were not consistently investigated or reported appropriately. The provider had failed to follow their own accident and incident policy which meant opportunities to learn from these events and reduce the risks to people were lost. Systems were not in place to ensure medicines were administered accurately and in accordance with prescribers’ instructions. Medication audits had not been completed that would have identified some of the concerns found during the assessment.

This service scored 47 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us staff knew them well. Relatives and advocates reported they could raise any concerns they had with the provider in the knowledge they would be listened to and action would be promptly taken. One relative told us; “I feel [person] is totally safe with staff. [staff member’s name] is so patient.” Relatives and advocates told us they were kept informed of any changes in their loved one’s needs and knew they could speak directly to the provider regarding any concerns they may have with regard to their loved one’s safety and wellbeing.

Staff were aware of the need to report any accidents and incidents to the provider and were confident action would be taken in response to those events. However, there was a lack of evidence to demonstrate this. We saw an incident involving 1 person had not been recorded and the provider was not aware of it. Staff were not fully aware of the risks to people and had not been provided with sufficient information that would help them support people safely and in line with their care needs. Care records lacked detailed information about people’s individual needs and risk assessments which would identify potential risks to people and how to mitigate them, were missing. The provider’s approach to reducing unwanted events was reactive and not proactive.

There was a lack of evidence to demonstrate that accidents, incidents, complaints and safeguarding events were recorded and acted on, providing the opportunity to learn lessons and continually identify and embed good practice. The provider had failed to ensure risk assessments were in place for known risks to people, particularly in relation to their health care needs, such as diabetes, and being at risk of falls. The provider’s approach to these events was reactive, dealing with each incident on its own, but failing to look collectively at all the events for any patterns or trends. This meant opportunities to learn lessons from these events were lost, resulting in people being placed at potential risk of harm.

People told us they were supported to access a variety of health care services to meet their needs, and the provider assisted them in accessing additional equipment where required. People, relatives and advocates told us they were involved in their care planning, but there was a lack of evidence in their care files to demonstrate this.

Staff were not fully aware of all the risks to the people they supported and how to support them to manage those risks. For example, where people had specific healthcare needs, staff were not fully aware of the risks associated with those conditions and what actions to take to reduce the risks to people.

We received a mixed response from partners on the effectiveness of their communication with the service. One healthcare professional spoke positively of the service and their response to any concerns they may raise. Another professional raised concerns that information regarding the known risks to a person had not been transferred onto their care plan as previously agreed. This placed the person and staff at potential risk of harm.

The provider had systems in place to gather information from people and their loved ones prior them receiving support from the service. However, information held in people’s care records lacked person-centred detail. We also found information from people’s previous care providers was not consistently used to inform people’s care plans and share with staff to ensure safety and continuity of care.

On the whole, people told us they felt safe with the staff who supported them. However, one relative raised concerns regarding some staff’s lack of understanding regarding their loved one’s needs. They told us, “We have had some issues with staff but [provider’s name] sorts it all; they are wonderful.”

Staff told us they would report any safeguarding concerns they may have to the provider and were confident those concerns would be acted on appropriately. Staff had received training in how to identify potential abuse, but their knowledge was limited in this area and they heavily relied on the provider to respond to any concerns. Staff were not aware of local safeguarding procedures or who to report to in the absence of the provider or if the concerns related to the provider.

The provider had responded to a safeguarding concern but had failed to notify CQC of the incident. Staff were not fully aware of the different types of abuse people were at risk of and the provider had failed to put processes in place that would assure themselves that staff were adequately trained in this area.

Relatives informed us they were notified of any accidents or incidents involving their loved ones but had not been involved in any formal reviews of their care. One relative told us, “Staff are aware of the risks to [person] because they sit with them and when the GP comes out, they listen to them and write it in their notebooks.” People and their loved ones had no concerns about how staff managed the risks to them. However, the risks they told us about had not always been assessed by the provider or reflected in people’s care plans. For example, information was not shared with staff regarding the risks associated with one person’s medical diagnosis and the actions to take to protect the person from any potential harm.

The provider had failed to ensure the risks to people’s health, safety and welfare were assessed and staff provided with the information needed to support people to manage those risks. Staff were able to explain how they supported people with their particular needs but were not aware of some of the risks to them, particularly those associated with a number of healthcare conditions. This placed people and staff at potential risk of harm and meant people could receive inconsistent and potentially unsafe care. For example, there was no information available to staff regarding 1 person’s long-term health condition and the risks associated with it, placing the person at potential risk of harm.

Risks to people were not always assessed. We found only 1 risk assessment in place for 1 person at the service, which was for COVID-19. The provider had failed to ensure risk assessments were in place that would provide staff with the information required on how to manage and respond to the risks to the people they supported. There was a lack of evidence to demonstrate people had been given the opportunity to discuss the risks to them or be involved in reviews of their care. For example, there was no information for staff regarding 1 person’s long-term mental health condition and how staff could help the person manage this. For another person, their care record stated they were allergic to a particular food item, but there was no information available to staff regarding the risks to the person and actions staff should take if they experienced an allergic reaction. For another person, they were identified as being at risk of falls, but there was no information regarding how staff should help them to manage this risk on a daily basis.

People and relatives reported they felt safe in their own homes when supported by care staff. They reported the provider supported them, where appropriate, to access equipment required to support their daily living needs.

Staff were aware of the need to keep people’s living environment clutter free and report any concerns to the provider.

Environmental assessments in people’s care records had not been completed. The provider no longer had in place a system to monitor call delivery times. They advised they were looking into addressing this as soon as possible.

People reported staff turned up on time and often stayed longer than necessary. One relative told us, “[Person] has never had missed or late calls.” People’s relatives also reported some staff did not consistently respond to their loved ones’ needs; however, these concerns were reported to the provider who acted promptly on them.

Staff were unable to confirm their rostered hours and daily logs and timesheets held conflicting information, demonstrating on a number of occasions that staff were expected to be in two or three places at once. The provider confirmed they no longer had a call monitoring system in place that would provide them with assurances that staff were arriving on time for calls. Staff confirmed they had recently received a supervision meeting with the provider but were unable to confirm details of any other formal supervision meetings. From our conversations with staff, there was no doubt they felt fully supported by the provider and spoke highly of them. However, there was a lack of documented evidence to suggest these meetings took place on a regular basis. Staff told us they felt well trained, but the provider had no systems in place to assess the effectiveness of that training which would assure both them and staff that people were being supported safely and effectively. Staff had not been provided with all the necessary information regarding the risks to people which meant the provider could not be assured people were being supported safely and effectively and in line with their care needs.

Staff rotas and timesheets held conflicting information. There was no call monitoring in place which would provide the provider with assurances that staff arrived for calls on time and left at the correct time. Staff told us the provider observed their practice but there was a lack of documentation to evidence this. Recruitment practices in place were not robust and placed people at potential risk of harm; the provider had failed to follow their own recruitment policy. For example, gaps in employment were not routinely investigated and, in some cases, the provider had failed to ensure satisfactory references had been received prior to employing people. Information held on staff rotas and timesheets was limited and unclear and suggested travel time between calls was not always allocated. We also noted in some instances, staff were scheduled to be in 3 places at once. A training matrix was in place but the provider did not have systems in place that would assure them of the effectiveness of that training.

People reported no concerns regarding infection and prevention control issues when supported by care staff.

Staff confirmed they had access to supplies of personal protective equipment (PPE) and had received training in infection control.

The provider had infection control policies in place and ensured staff were provided with sufficient supplies of PPE.

People reported no concerns regarding their medicines management and told us they received their medication as prescribed. One relative advised, “They [care staff] are really on the ball with medicines.” A relative told us how the service responded to any changes in their loved one’s needs with regard to the timings of their medication.

Staff confirmed they had received training in administering medication. However, staff had not been provided with sufficient information with regard to people’s medication. Medication care plans, which would provide staff with information to ensure people received their medication as prescribed, were not in place. For example, there was no information regarding people’s preferences on how they wished to be supported with their with medication. For one person, who had been prescribed time specific medication, there was no written guidance available to staff to advise them of the times the medication was to be administered and the risks associated with failing to adhere to these times. Also missing, was information regarding administering ‘as required’ medication. For example, it was unclear from the medication administration record of 1 person, whether a particular medication should be administered 3 times a day or ‘as required’. As staff had not been provided with the correct information, this increased the risk of harm to the person as the provider could not be assured they were receiving their medication as prescribed. This placed people at potential risk of harm and meant people could receive inconsistent and potentially unsafe care.

Systems were not in place to assure the provider that medicines were administered in accordance with prescriber instructions. There were no medication care plans in place to provide staff with the sufficient information required regarding people’s medication and associated risks. There were no protocols in place for ‘as required’ medicines which place people at potential risk of harm due to inconsistent and potentially unsafe administration of medicines. Medication audits had not taken place which would identify these areas of concern or unexplained gaps in recording on medication administration records that were highlighted during the assessment.