Supreme Care Services Limited

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• 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 inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm. People received a safe service, were protected from abuse or neglect and had their human rights promoted. Staff and managers understood the reporting procedure for any safeguarding concern or allegation. Risks to people were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Accidents and incidents were monitored and analysed, so lessons could be learned and recurrences could be avoided. The service followed robust recruitment procedures and there were enough suitably trained staff employed to meet people’s needs and keep them safe. Staff supported people to manage their medicines safely where required. Regular medicines audits were completed, staff were trained and their competency was checked at regular intervals.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People we spoke with told us they felt safe and protected from abuse or harm when receiving care and support from the care workers. One person told us, “Yes, I do feel safe”. A person’s relative told us, “Yes, my [relative] is very vocal and they would tell me if anything was wrong. And, if I suspected anything, they [the care staff] wouldn’t be going there anymore.”

The management team and staff understood how to recognise abuse and neglect and explained how they protected people from its different types. They told us they reported any concerns appropriately to the local safeguarding teams and notified CQC. The management team confirmed that any restrictions on people’s freedom were only used when they were in the best interests of the person. They also had a clear understanding of the processes to follow, via the Court of Protection, if people needed any restrictions for their safety. All the staff we spoke with confirmed they had completed safeguarding training and would report any concerns without hesitation. One member of staff said, “Safeguarding means the well-being of the person I work with. If a staff member was rough, I would always report it.” Another member of staff said, “If I noticed an unexplained bruise, I would report it to the manager”.

We saw the provider's safeguarding policy, procedures, and processes were in line with current and relevant legislation. The systems we looked at showed that any safety concerns were reported to the registered manager, recorded and raised with relevant professionals such as the safeguarding team. There was evidence to show that, where appropriate, people using the service and those important to them were involved in this process and kept informed about what action would be taken to help make sure people remained safe.

People told us the staff helped them to recognise risks in their daily lives and take action to reduce these as much as possible. People we spoke with confirmed they knew about their care plans and risk assessments and had been involved in compiling these. One relative told us that staff were very good at identifying areas of risk as taking appropriate and prompt action. This person told us, “[Carer] saw something on my [relative] which needed an urgent appointment. [Carer] sees things we may not notice.”

The management team told us that risk assessments were completed with people who used the service, to help them understand and manage the various risks they faced in their daily lives. They told us these assessments were regularly reviewed and updated as needed and included aspects such as people’s health, daily living and social activities. The management team told us they also completed risk assessments for equipment used to support people and any other risks identified for staff working in people’s own homes.

We saw the provider had effective systems and processes in place to assess and minimise risks that had been identified for people using the service. Risk assessments were person centred and covered areas such as people’s mobility, daily living and personal care requirements. People’s care plans included up to date information and guidance for staff about the action they should take to manage these risks and keep people safe. We saw there were clear processes for staff to follow when they needed to report concerns, incidents and accidents. These processes helped enable the provider to have oversight of risks and ensure they were mitigated as much as possible. The management team completed regular audits and care plans were updated as soon as there were any changes or new risks were identified.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Most people we spoke with told us they felt the service employed enough staff. They said that staff were usually on time and completed all the tasks they were required to do in their allocated time. One person told us their carer was, “Wonderful, efficient, kind and thorough”. They said they were virtually always on time but always let them know if they were running late for any reason. This person also said, “When [staff] has had time off, I have had two substitutes who were as kind and good as [staff name] but, [staff name] is the best of them all.” A person’s relative told us, “Speaking on behalf of [relative], I know they are very happy with the care they receive. The carers are always very punctual and attentive, showing care and sensitivity”. Most people said they had the same carers on a regular basis and understood the need for different carers to cover when they were on leave or days off. One person commented that their relative had experienced late or missed calls but said they had followed this up with the office staff and things had improved. A few people said the care staff didn’t always stay for the full amount of time, but everyone said the staff always completed the tasks they were required to do.

The management team and other staff told us there were enough staff employed to meet people’s needs and this was reflected in the staff rotas. The management team also told us that staff were deployed using a ‘patch postcode’ system, which helped cut down travel time between visits. Staff said they always tried their best to be on time for their visits, but occasionally there were delays. One member of staff told us, “Sometimes I arrive late due to traffic or if there was an emergency at my previous client.” All the staff we spoke with said they usually stayed for the length of time required and had enough time to do everything they needed to. Some staff said they occasionally left early, but only when everything was finished and if the client told them to go. One member of staff told us, “In cases that the time is not enough, I report to my coordinator.” Another staff member said, “Sometimes, if there is not enough time to do tasks, they [manager] will ask social services for more time.” All the staff we spoke with confirmed they had completed an induction, received regular support and supervision, appropriate training and spot checks of their work.

We saw the provider had a thorough staff recruitment process and records demonstrated this was followed. Staff disciplinary and capability processes were fair and regularly reviewed. This helped ensure staff were not disadvantaged because of any protected equality characteristics they may have. Staff completed comprehensive training that was appropriate and relevant to their role. They were also supported to deliver safe care by receiving regular supervisions, appraisals and development support and by being encouraged to be actively involved in improving the service.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The people who received support with their medicines told us they were happy with the way the service and care staff managed these. One person told us, “Yes, I am happy they take an interest in that [medicines].”

The management team told us care staff were required to manage and administer some people’s medicines. They said that regular monitoring and audits were completed by way of checking people’s medication administration records (MAR), spot checks by the field co-ordinators, telephone calls to people using the service and welfare monitoring visits. All the staff we spoke to confirmed they had completed training for medicines management and administration and were confident with this area of responsibility. Staff also understood their responsibility for reporting problems or errors with people’s medicines. One member of staff told us, “I report to the office and sometimes call the pharmacy. I also report it to the client’s relatives.” Another person said, “I report it to the manager and fill in the MAR chart and accident book.”

The service had effective systems and processes in place to ensure people’s medicines were managed and administered in a safe way. People received their medication safely and as prescribed. The service’s medicines management processes reflected current and relevant best practice and professional guidance. The systems used for auditing medicines were reliable and robust.