Care at Home Group Cheshire West and Wirral

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

We assessed 8 quality statements under this key question. Our rating for this key question has improved to good. Overall, we found the service was keeping people safe. However, feedback was mixed about staffing arrangements. Some people felt they were supported to manage risks and to keep safe. Others felt that calls time were not always as expected, and changes in staff impacted on how effective the support was. Feedback indicated some staff had not always followed guidance for the use of PPE. There were systems in place to ensure concerns relating to abuse were reported. The provider and new registered manager were focused on learning lessons from any incidents and sharing lessons to make improvements. Systems were being embedded to ensure there were enough suitably qualified, skilled, and experienced staff and they were recruited safely. Managers were working with partners to provide safe pathways for people. The provider had made improvements in relation to the safe management of medicines.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall people told us they felt safe with the care provided. We received mixed feedback about how the service had previously listened and addressed concerns. However, people were positive about the registered manager and told us she had been responsive, having started to make improvements where necessary.

Managers were open about previous gaps in governance systems. They had learnt lessons and were taking action to address this. The new manager was focused on continuous improvement and sharing lessons learnt with staff to support learning. Staff understood how to report any incidents or accidents. Further training had been developed to better support staff, because of lessons learnt from complaints, such as in relation to catheter care or meal preparation.

The provider had systems in place and was embedding these to ensure staff followed procedures in relation to reporting issues. They had a focus on analysing and learning from these to try to prevent future occurrences.

People’s needs were assessed before their care began with the service and their care plans were discussed with them. They were given information about the service and contact details.

Managers were working with partners to provide safe pathways for people. They used information from and liaised with other agencies to help plan safe care for people.

The local authority told us the provider had worked with them over the past few months and had made improvements to the service. The new manager had been responsive and helpful to ensure systems were safe.

People’s care and support needs were assessed at the start of the service, with the support of local authority assessments. These were used to develop individual care plans. These were reviewed and amended as people’s needs changed. Staff were devising a new document to help support a smoother transfer of information for people who needed to go to hospital.

People's feedback indicated they felt safe with the way staff supported them. They commented, “I think they [staff] are all kind and treat him well” ; “They’re respectful and kind” and “Yes it’s all safe and I’ve no problems.”

Staff understood their duty to report any concerns of a safeguarding nature. They felt managers would act on any concerns. They told us, “Anything negative or bad I would ring the office or raise a concern on the app” and “Yes, I know how to raise a concern.”

Systems were in place to ensure people were protected. Any safeguarding concerns were dealt with. Staff had received safeguarding training and understood their duty to report any concerns. Managers ensured safeguarding concerns were appropriately reported, with any further actions required and outcomes being recorded.

We received mixed feedback from people and relatives about managing risks. Some felt they were supported to manage risks and to keep safe. Others felt that calls time were sometimes late or not when expected, and changes in staff impacted on how effective the support was. Some relatives felt the care provided was not always meeting their relatives needs as safely as possible, due to differences in staff skills and approach. Comments included, “They’re all lovely and have a bit of banter, but if they come too early, he won’t communicate” ; “Sometimes they come too early so she’s not able to feel she knows when to expect them" and "They log in on the phone, they have details on the phone. They know how to help."

Overall, staff felt they had information about people’s needs and how to mitigate any identified risks. They had access to an app, which provided information about the support people needed and how to keep them safe. Since the previous inspection the provider had completed an action plan to review and update care plans for everyone who used the service. Some feedback suggested information could be clearer and more specific in relation to care tasks. Staff said, “We have an app we use; it has all the information you need. If you go on there you can see any risks and everything” and “I would read their notes on the Birdie app, I would check previous notes.”

Processes were in place to assess potential risks to people. Staff undertook assessments and risk assessments, which included actions to mitigate risk. These contained detailed and person-centred information about people’s needs and any risks were assessed and rated.

Overall feedback indicated that people were supported to feel safe in their home environment. Comments included, “I stand on a turner, and they [carers] put me from my chair to bed. They know, I always ask if they know how to use it and they know. Yes, I feel safe” and “She’s [relative]never said she feels unsafe.”

Feedback from staff indicated they had information about keeping people safe whilst supporting people. They were able to access relevant information via the app, which included any environmental risks. They said they had training on how to use any equipment or could ask for support if necessary.

The provider had processes in place to ensure any risks in the office location were safely managed. Staff were given training to support them to use equipment safely. Staff undertook risk assessments taking account of any potential risks within people’s home environments.

People’s feedback was mixed about staffing. We heard concerns about the number of staff changes and the skills of some staff. We received some negative feedback in relation to some staff communication, due to language barriers and skills in areas such as cooking, which impacted on people. Other people were positive about the support they received from a regular care team. Relatives told us, “The regular ones [carers] know me. Sometimes the odd new one comes, we get to know one another” and “[Manager] is trying to put in regulars rather than all different [carers]. But the times are all to pot”. People told us, “I can’t always understand what they [carers] are saying, but they are all so lovely”; and “They are pretty regular. They’ve not been late so far and not missed any calls.”

Managers told us there had been a period of recruitment. Staff views varied about rotas and schedules. Some said they didn’t always have enough travelling time between calls, which could cause them to be late. Comments included. “Rotas can change quite often. We're given travel time, sometimes it’s not enough.” Overall staff were positive about the training and support they received. They told us there had been a number of management changes which had impacted on consistency. However, they were positive about the current manager and actions they were now taking. They said, “She is fair and will listen.”

There were sufficient staff who had been recruited safely. The provider had an electronic recording and monitoring system for care calls. Staff logged in and out of calls. However, there were sometimes phone signal issues, and the provider was exploring ways to address this. They had recruited to roles in the office-based team and were now able to monitor and respond to alerts from the system more robustly, to ensure care calls were provided as expected. This was an area for ongoing monitoring. There was a training and quality team who had oversight of induction, eLearning and refresher training. Specific training had been recently rolled out especially to support international staff to become familiar with cultural differences for examples local cooking styles and preferences. Some refresher training was overdue. There was a policy for staff supervision and appraisal. Staff supervision meetings and appraisals had fallen behind. However, the management team were addressing this, and meetings were in progress and planned.

Overall, people told us staff were aware of infection control measures and wore PPE when providing support. However, feedback suggested that some staff had not always worn aprons in line with guidance. One relative told us “[Manager] has got them uniforms, but they are not wearing aprons.”

Staff told us they had access to PPE and had received training. They indicated that they used PPE in line with current guidance.

The provider had an infection control policy and staff received training as part of their induction. Managers monitored the use of PPE through spot checks and surveys with people using the service. However, feedback suggested staff had not always fully followed guidance. The provider had already taken some steps to improve this, but agreed to address this further with relevant staff.

Overall, people received their medicines safely and as required. Some feedback indicated there had been previous issues in relation to staff not always following procedures to administer medicines safely. However, this was now being addressed by managers.

Since our previous inspection, the provider had been focused on staff training and support in relation to medication administration. Staff told us they had been trained and their competency was assessed. Staff knew how to report any medication errors. One said, “I have done training in medication, I did a competency. When in a call, they will just pop in from office and see how we're administering.”

Processes were in place and had been tightened to ensure medicines were administer safely. The provider had a medication policy in place. The policy and procedure had been reviewed since our previous inspection. Staff undertook medication training and competency assessments had also been completed for all staff. Staff kept electronic medication administration records, which provided alerts for any issues with administration. Managers were monitoring to ensure such alerts were checked and responded to in a timely way. They also carried out regular audits. Information about the support people needed with medicines was included in their care plans. Medication risk assessments and detailed protocols were in place for medications taken “as required.” We found some minor recording issues relating to medicines which the registered manager addressed straight away.