IMPACT

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

Our rating for this key question remains requires improvement. The risks associated with people’s care had not been consistently assessed and managed. Staff had not always been provided with the clear information and guidance required to mitigate risks and keep people safe. There was no record of any safeguarding concerns, accidents, incidents or near-misses and so we were unable to assess the effectiveness of learning when things went wrong. Systems and procedures in relation to people’s medicines required improvement. Some staff lacked understanding in relation to safeguarding and whistleblowing. However, people felt safe receiving care and confirmed their care calls were generally punctual and reliable. Staff were satisfied management informed them about risks and changes in these.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives did not raise any concerns with us about the safety of the care provided, or how staff helped them to manage risks. However, we received mixed feedback from people and their relatives on whether they knew who to contact with any concerns or complaints. For example, 1 relative told us they would speak to care staff or management about any concerns, adding, “Yeah, I have got their numbers.” However, another person said, “I wouldn’t know who to speak to [about concerns].”

Staff told us the management team informed them about people’s risks and changes in these. One staff member said, “If anything changes, [nominated individual] would tell us.” Staff said they could approach management with any concerns about people’s safety and had confidence they would act on these. One staff member said, “Yes, I can talk to them [management] about any concerns.” The registered manager explained that they encouraged staff to inform them of any changes in people’s needs and prompted staff to read and sign any updated care plans. However, most staff we spoke with lacked understanding of whistleblowing as the action to take to report wrongdoing at work. On the subject of whistleblowing, a staff member told us, “I wouldn’t know where to go.”

Not all identified risks to people had been assessed or managed. Staff still had not always been provided with clear information and guidance on the support people needed to manage risks, including risks associated with people’s long-term health conditions, such as epilepsy and dysphagia. The information recorded on people’s risk assessments was often confusing or incomplete. The provider had no record of any safeguarding concerns, accidents or incidents or near-misses having been reported since our previous inspection in 2019. The registered manager told us there had been no events of this nature. However, this may indicate these events were not being correctly or consistently identified and reported by staff. Therefore, we were unable to assess the effectiveness of any systems in place to ensure lessons were learned from safeguarding concerns, accidents, incidents or near-misses to improve people’s care. Staff had not always been provided the necessary training and competency checks to safely meet people’s health needs. This included a lack of evidence of epilepsy and diabetes awareness training.

People and their relatives did not raise any concerns in relation to how staff and management worked with external professionals, teams and agencies to ensure continuity of care.

The nominated individual spoke about how they liaised with occupational therapists with regard to people’s care equipment and any related concerns they may have. The registered manager explained some circumstances in which they might contact people’s GPs, pharmacists or social workers. Staff did not raise any concerns in relation to people’s safety when they were accessing or moving between different services.

We did not speak with external health or social care professionals involved in people’s care as part of this assessment.

There was very limited information recorded in people’s care records regarding the external health and social care teams and professionals involved in their care or how staff worked with them. There was no evidence of how routine communication with external professionals and teams was recorded. People had ‘hospital passports’, designed to help healthcare professionals understand their needs in the event they accessed healthcare or were admitted to hospital. However, the information recorded on these documents was limited and incomplete.

People and their relatives told us they felt safe receiving care and support from staff, who treated them well. One person said, “I feel happy and safe.” However, we received mixed feedback from people and their relatives on whether they knew who to speak to regarding any concerns about their care.

Staff did not have any current concerns about people’s safety. However, some staff we spoke with lacked understanding about safeguarding and the action to take if they had any abuse concerns. For example, 1 staff member told us they could not recall what safeguarding meant. Another staff member said that, in response to abuse or neglect, their responsibility was to ‘report to someone senior or call the police or something’. This did not reflect a clear understanding of their individual safeguarding responsibilities.

Although staff had received safeguarding training, and safeguarding was discussed at group supervisions, our discussions with staff indicated they had not received effective support to understand their individual safeguarding responsibilities. The provider had no record of any safeguarding concerns having been reported or investigated, and so we were unable to assess the effectiveness of their safeguarding processes. The registered manager informed us there had been no concerns of this nature to date.

People and their relatives did not raise any concerns about staff’s understanding of their individual risks or the support they had from staff to manage these. One person spoke about the support staff gave them to cook their meals safely, if they were ever unsure what to do.

Staff told us they were informed about risks to people and any changes in risks. They also said they would record and report any changes in people’s care needs to the management team. Staff were able to provide us with basic information on people’s individual risks.

The provider had processes in place designed to enable them to identify and mitigate risks to people; however, these were not effective. Not all identified risks to people had been assessed. Where risk assessments had been completed, the information and guidance provided to staff on risks to people, and their role in helping the person manage these, was not sufficiently clear. For example, 1 person’s risk assessment did not provide staff with clear guidance on how to minimise the risk of them choking. Another person’s risk assessments provided incomplete information on their epilepsy. In addition, there was no record of how people and, where appropriate, their relatives had been involved in assessing and reviewing risks.

People and their relatives felt safe receiving care and support from staff at home. They did not raise any concerns about their care equipment or the ability of staff to provide safe care in their home environment.

Staff did not raise any concerns about the availability or maintenance of suitable care equipment or any potential risks in the home environments in which they delivered people’s care. They told us they would report any new risks to the management team.

The provider had processes in place to assess, record and manage any risks in people’s homes and their surrounding neighbourhood, in order to keep people and staff safe.

People and their relatives did not have any concerns about the reliability or punctuality of their care. They told us they were supported by familiar staff who were normally on time. One relative told us, “There is consistency of [staff] so we have the same [staff] that [person] is familiar with … a rapport [has] built up.” People and their relatives felt staff had received the training they needed to meet their needs.

Staff felt the provider employed enough staff to meet people’s care needs. They confirmed they had received an induction, including opportunities to work alongside more experienced staff, at the start of their employment. Although some staff could not remember when they had attended particular training, staff did not raise any concerns regarding the training they had been given to perform their roles. Staff told us they attended supervision meetings with the management team, but, again, were sometimes unclear about the frequency of these.

Staff were supported to complete the Care Certificate during their induction. The Care Certificate is an identified set of standards that people who work in health and social are expected to adhere to in their daily working life. However, the provider had not always maintained records to demonstrate the broader, company-specific induction which staff received to understand and settle into their new roles. Staff supervision records indicated that staff had not received consistent 3-monthly one-to-one supervisions in line with the provider’s policy. For example, records indicated that at least 3 members of staff had not attended any one-to-one supervision meeting so far in 2024. Staff recruitment processes were not always robust. The provider had not requested a full employment history from 3 members of staff. Although the provider had identified 16 mandatory staff training courses, staff training provision and competency checks did not fully reflect people’s individual care needs. For example, although staff supported a person with epilepsy and another person with diabetes, they had not received awareness training on either medical condition. At least 1 member of staff supported a person to take their medicines via their percutaneous endoscopic gastrostomy (PEG). Although staff had been trained by a nutrition nurse specialist in 2019 to safely use this person’s PEG, we saw no evidence of any refresher training or associated competency checks. Our analysis of staff rotas indicated staff did not always have travel time between calls. However, people, their relatives and staff did not raise any significant concerns regarding staff punctuality.

People and their relatives did not express any concerns around the provider’s infection prevention and control practices. They confirmed staff wore appropriate personal protective equipment (PPE) when delivering their personal care.

Staff explained how they protected people from the risk of infection through good hand hygiene, use of PPE and safe disposal of waste. They confirmed they were supplied with correct PPE by the provider.

The provider had processes in place to ensure staff were supplied with the necessary PPE to reduce the risk of infection. They conducted observations on staff’s infection prevention and control (IPC) practices and discussed the importance of IPC during group supervisions.

Most of the people and their relatives we spoke with any did not require any support from staff to manage and take their medicines, as part of their care. One person told us staff helped them by putting out their medicines ready for them to take. A relative explained how 1 member of staff had been trained to help their family member take their medication via their percutaneous endoscopic gastrostomy (PEG) feeding tube.

It was not always clear from our conversations with staff and management which people they currently supported with their medicines and the level of support they provided. Staff provided contradictory information in some cases. One member of staff explained how they administered 1 person’s medication via their PEG feeding tube. Another staff member confirmed they applied 1 person’s topical medicine. However, the nominated individual told us staff did not apply people’s topical medicines, which was contradicted by what we saw in people’s care records and what a staff member told us. The registered manager confirmed staff did apply topical medicines. Staff did not raise any concerns in relation to the handling and administration of people’s medicines.

People’s care plans and risk assessments did not always provide clear, accurate and up-to-date information and guidance for staff on the support they needed with their medicines. For example, 1 person’s care plan stated their medication was administered by their family via their PEG feeding tube. However, a member of staff described how they sometimes administered this person’s medication via their PEG and a family member of the person confirmed a staff member had been trained to do this. Staff had not received any associated training in the administration of medicines via PEG since 2019, and we saw no evidence of associated competency checks. This person’s initial assessment directed staff to ‘cream [person’s] lower body’ and their care plan also confirmed they required ‘creams applied several times a day to maintain skin integrity’. However, there was no information or guidance for staff in this person’s care records on how and when to apply their topical medicines.