A2Z Home Care Services 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 people were protected from abuse and avoidable harm. This is the first inspection for this newly registered service. This key question has been rated requires improvement. The registered manager had completed care plans and risk assessments which reflected people’s needs; we found some inconsistencies throughout the records and staff were not always able to describe how risks were managed. The registered manager had reported safeguarding concerns as required. Staff reported incidents. There was room for improvement in staff understanding of their responsibilities related to safeguarding. The service had not always followed their policy to ensure staff were recruited safely to the service. There were enough staff with appropriate training, however, competency assessments in moving and handling had not been completed. Staff administered people’s medicines as prescribed. Infection control was managed well.

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.

People’s relatives were informed if incidents occurred. A relative told us, “We are aware of issues; they have given feedback.” Another relative said, “The only thing was they sent our bill to another person by accident, but they told us straight away and they apologised.”

Staff reported incidents. They told us when an incident occurred, they documented it in the notes and informed the manager. They were able to tell us what they had learned from incidents they had been involved in. The registered manager told us there had not been many incidents and they had not identified any themes.

The service had a file for incident reports; there was no separate tracker. We reviewed the file and found only 1 incident which related to a person who was not supported with personal care and therefore outside of CQC remit. A data breach incident had been recorded as a complaint. Appropriate action had been taken, including issue of duty of candour letters and informing appropriate organisations. Other incidents such as falls had occurred but not when staff were present; these had not been recorded. The registered manager told us they would collate incidents for monitoring as the service grew.

People’s relatives we spoke with were not able to give examples of referrals to other services and in 1 case what they told us differed to information in the care plan.

The registered manager told us they had referred people to district nurses as required.

Another professional confirmed they were updated by the service. They said, “They are regularly in touch with me with regards to the citizens we have commissioned in their care.”

People’s records lacked detail about referrals to other services. We saw a person’s record stated they had been referred to the SALT team; this was not dated, and it was unclear whether the service or the family would contact the SALT team.

People’s relatives confirmed they felt their families were well looked after and safe. A relative said, “With the level of care, we have no concerns.”

Staff struggled to describe their responsibilities related to safeguarding or give examples of what they would report. We saw the registered manager had made safeguarding referrals on review of people’s daily logs; we did not see evidence staff had escalated the concern. Following the inspection, the registered manager told us they would discuss and confirm understanding with staff during supervision.

The service had a safeguarding policy. This included contact details for the local safeguarding team. However, there was a service user commissioned by a different local authority and those details were not in the policy. The service had 1 safeguarding concern open at the time of our visit. These were not collated separately but were visible via the online portal for referrals and the registered manager was aware of what happened in each case.

People’s relatives were happy with how risks to people were managed by the service. However, their level of involvement with ongoing reviews was not always clear. A family member said, “Everything has been fairly stable. There have been issues with my [relative]. [Registered manager] did come a couple of weeks ago, but I wasn’t part of the discussion.” Another relative told us, “[Registered manager] gives me a call once a month and we have a little catch up… [registered manager] goes to the house twice a week to talk to [person]. There is no full review of care records; we all feel what’s happening is working.”

Staff were not always able to describe how risks to people were managed. Not all staff knew what pressure sores were or when there were risks associated with eating. A staff member described how pressure sores were managed but they were not aware of anyone at risk of choking. However, we were told they were informed of any changes in people’s needs. A member of staff said, “Care plans are on the system. Whenever there is a change, we get told by the manager to check it.” Following the inspection, the registered manager told us they would address this during supervision and arrange additional training as required.

People’s risk assessments were not always dated, making it unclear which was the current version and information was not always consistent with other sections of the record. For example, 1 person’s record described them as immobile in some sections and able to weight bear elsewhere. Whilst their moving and handling risk assessment stated which equipment staff were to use to mobilise it lacked detail of specific tasks such as showering.

People’s personal data was kept securely. The registered manager’s computer was double password protected. There was a lockable cupboard in the office where paper records were stored. Staff had a mobile device application with people’s personal information on and they only had access to those people they supported with care.

Staff were not able to describe how they knew equipment was safe to use. This meant there was a risk they were not checking it before use.

Prior to our visit a data protection incident had occurred. Appropriate action had been taken which included further training. The registered manager had assessed people’s homes for risks in relation to the environment. We saw this included information about utilities, trip hazards and fire. However, while fire had been risk assessed to include smoking, overloaded sockets etc there was no guidance for staff related to fire evacuation. Following the inspection, the registered manager told us they would add fire evacuation information to the risk assessment.

People’s relatives said staff seemed to be well trained and confirmed they arrived on time and stayed for the full visit length. They were not aware of any occasion visits had been missed.

The registered manager was recruiting more staff. Agency staff were being used to cover hours at the time of our visit. The registered manager said, “I go out and do spot checks and meds competency checks with them.” Staff felt the service had enough staff with the appropriate training for their role. There was enough time to travel between visits and to meet people’s needs. They confirmed the registered manager had provided further training for additional needs people had. A staff member told us, “I believe I have all the necessary training and support to meet people's needs.” Staff supervisions were completed within the first week and month of employment and thereafter every 3 months.

The service had a recruitment policy. It stated at least 1 reference should be obtained from a professional, not a friend and a third to be sought if insufficient information received. We found this had not been followed. The registered manager did not document staff competency assessments in moving and handling. We were told this was included in staff spot checks, but the template we reviewed had no prompts related to this. Staff completed mandatory training. However, feedback from some staff suggested it had not been effective to ensure they understood people’s needs.

People’s relatives did not have any concerns about IPC. They confirmed staff washed their hands and wore Personal Protective Equipment (PPE) as appropriate. A relative said, “Theres a box of stuff here. There’s the gloves and they have plastic aprons.” Another relative told us, “Yes, they do, the gloves are there, and they always have their aprons on.”

Staff used the appropriate PPE when providing care. A staff member said, “We wear gloves and aprons.”

The service had an IPC policy. This included links to COVID guidance.

People’s relatives were happy with how their medicines were managed. A family member said, “No issues at all.”

Staff told us they administered medicines as directed in people’s care plans. They knew what to do if errors occurred or people refused to take their medicines. A staff member said, “I encourage them to take it most of the time, if not I will report to the manager.” However, they lacked understanding of PRN medicines, which are medicines to be taken as and when required.

People’s care records did not always include clear information related to their medicines We reviewed a record which had inconsistent information throughout and no medicines risk assessment. The person had behaviour-related medicine but there was no care plan related to this. Some sections stated their pain relief was PRN, but it had been prescribed for regular administration, according to the MAR chart.