Care Solutions Direct Head Office

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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

We assessed all 8 quality statements within the safe key question which has been rated Good. This meant people were safe. Preservice assessments, risk assessments and care plans were in place. Where we identified additional detail was required the service manager agreed to add this to care plans. Care staff received appropriate recruitment, training, support and supervision. Medicines and infection prevention measures were well managed. There was a learning culture whereby any accidents or incidents were fully investigated and measures taken to reduce the likelihood of repeat events.

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.

Family members told us they were kept informed about any accidents or incidents and were confident that any concerns raised would be listened to and acted upon.

Staff were aware of the process to follow should they have any concerns about a person’s safety. They understood how to report accidents and incidents and were able to contribute their views about what happened and what they could do to reduce risks. The management team encouraged a culture of openness and honesty. The service manager described how they always ensured that any learning was shared with all staff via emails to help reduce the likelihood of any repeat incidents. Information was also shared with CQC and relevant health and social care agencies with advice and support sought if required.

Systems were in place to support prompt reporting and investigation of safety concerns should these arise. This ensured all accidents or incidents were individually reviewed and, if required, prompt action could be taken to reduce the likelihood of similar events.

Family members did not raise any concerns about the transition between care staff and felt there was good continuity of care.

Staff described the systems in place to ensure essential information was shared which helped support continuity of care. The management team and staff told us they had good working relationships with health and social care professionals and sought advice and support when needed.

We requested information from partners however, we received no relevant information for this quality statement.

There was a comprehensive preservice assessment process which helped capture relevant information about people, their care needs and risks to their safety. This helped ensure that the service would only be provided for people whose needs could be safely met by the care staff. Assessments evidenced that this included contact with the person, family members and external professionals involved in the person’s care. There was an extended documented handover between live in care staff to help ensure continuity of care between care staff.

Family members told us they felt people were safe when receiving care from staff. One family member said, “Yes I feel he is safe; they are very good carers; he has 24-hour care, his views are taken into consideration and he feels happy with the care he receives.” Another family member told us, “No sign of any form of abuse, the complete opposite in fact.”

Staff told us they had received safeguarding training and knew how to prevent, identify and report allegations of abuse. One staff member described the actions they would take and said, “I have done safeguarding training, we learnt how to support the client emotionally, about harm and abuse and who we should report this to. I would report neglect and harm to our line manager. I believe they would deal with it. I would also report any concerns out of the service to but that hasn’t happened.” The management team understood the actions they should take if they had a safeguarding concern. The service manager described these which included ensuring the person was safe, notifying relevant authorities and undertaking an investigation as directed by external authorities.

Appropriate systems were in place and followed, to help people, family members and staff to identify and report safeguarding concerns. Where concerns had been raised they had been reported to the relevant authorities and appropriate action taken to ensure the safety of people.

Risks were managed in a way to ensure people were able to be as independent as possible and could enjoy activities they liked doing. For example, one family member told us, “[Family member] has a sweet tooth and constantly asks for biscuits, limiting them can be a challenge but the carers are very patient with them.”

Discussions with staff and the service manager showed they understood people’s individual risks and worked with people to mitigate these as far as possible. A staff member said, “We have a client who is at risk of falls. The clients all have care plans, we have an app to access these. The manager updates the risk assessments. If I noticed it needs updating I would let my manager know.”

We identified some additional risk assessments were required such as for people receiving blood thinning medication and further individual detail was needed where people had a diagnosis of diabetes. The service manager agreed to put these in place. The comprehensive half day handover between live in care staff meant staff were aware of individual peoples risks and how to support people safely. Other risks had been assessed and recorded, along with action staff needed to mitigate the risk. For example, risk assessments were in place for people at risk of falling, medicines management, skin integrity, nutrition, dehydration and mobility.

Family members confirmed equipment their relative required was available and that staff used this when needed.

Staff confirmed they had received relevant training to use equipment safely and that any necessary equipment, such as for supporting people to move safely, was available to them. Staff had received health and safety training.

The management team had arrangements in place to assess safety risks to people in their own homes and had put plans in place for staff to manage these risks when providing people with care and support. We identified environment risk assessments such as in relation to fire evacuation and monitoring of smoke detectors for one person were not in place. The service manager agreed to put these in place.

Family members told us they were happy with the care provided by care staff who they felt were well trained and able to meet their relative’s needs.

Staff told us they felt supported in their roles and received one to one supervision and regular training. For example, one staff member said, “Yes I had an induction. I was taught the rules and regulations, what to do at a client’s homes. We went through policies and care plans. We were taught we need to respect the client and did all training before we went to the clients house.” There were enough staff available. The management team were clear they would only accept new care referrals if they had enough suitable staff available to meet people's needs. They explained that they aimed to match care staff to the individual person to help ensure a positive experience for both people and staff.

Appropriate pre-employment checks were undertaken to ensure staff were suitable to work with vulnerable people. We identified that the provider had not ensured they were fully aware of any restrictions on overseas staff working hours. Immediate action was taken by the provider when we informed them of this. Training was available for all staff and this was further strengthened by specific supervision meetings to monitor and assess their knowledge. Records showed staff were up to date with training and systems were in place to monitor this and remind staff when further training was due.

Family members told us staff kept the home clean and wore personal protective equipment (PPE) when needed. One family member said, “Always clean and tidy, carers wear gloves.”

Staff demonstrated they understood their responsibilities in relation to infection, prevention and control. They confirmed they had undertaken relevant training and had access to all necessary PPE. One staff member told us, “I have done Infection prevention and control training. We have gloves and aprons. Our supervisor orders these.” Discussions with the service manager showed they understood their responsibilities for the prevention and control of infections and undertook unannounced visits to monitor staff performance.

There were policies and procedures in place which reflected national guidance to aid staff to understand the risks around infection control and what action they needed to take. Training records confirmed that all staff had completed relevant infection prevention and control training, including food hygiene training.

People were supported safely with their medicines which they received as prescribed. A family member said, “Carers have alerts on their phones for administering her medication, I order them and check expiry dates. Staff administer the medication very accurately, and also put cream on her legs to keep her skin integrity intact.”

Staff confirmed they had received training in safely managing and administering medicines. They understood the actions they should take if they had any medicines concerns. The service manager described how they monitored medicines monthly, when unannounced spot checks occurred and during staff handovers. They described appropriate actions they would take if they found any discrepancies indicating medicines may not have been administered as prescribed.

There were appropriate policies and procedures in place to support the safe management of medicines. Training records confirmed staff had received medicines management training and their competency was assessed by a senior care staff member. Medicines records confirmed people received the medicines prescribed to them.