Sure Care Chester

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 that people were protected from abuse and avoidable harm. At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The provider was in breach of legal regulation in relation to staffing and safeguarding. The provider did not ensure there was enough staff to meet people’s care and support needs. People were not adequately protected from the risk of harm and neglect.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Policies were in place to help ensure people’s safety, such as a whistleblowing and safeguarding policy. These were up to date and contained guidance for staff to follow.

However, we could not be assured that policies were as effective as they could be, as we noted recurrent issues, such as missed care calls, meaning safety concerns were not addressed in a timely enough way. Necessary and longer-term improvements were not always made when things went wrong.

Despite the shortfalls we identified, we found the management team were keen to make improvements at the service and learn from events that had gone wrong.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care.

We were not assured the provider worked with people to ensure safety was managed and monitored. Some people had failed to receive the care they required. Some people told us they did not experience continuity of care.

However, processes were in place to help ensure people received care from external agencies if required, this included working with people to ensure appropriate referrals were made as needed. The manager explained, “We would, and we have made a referral if a person needed it, such as a dietician.”

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People’s right to live in safety was not always upheld. Processes were not always effective to help people receive care in a safe way and to help keep people free from the risk of abuse and harm. People had experienced missed calls which left some people feeling unsafe, vulnerable and distressed. One person told us, “Sometimes for missed calls they [staff] have not rung and let me know - the first I have known about it is when they have not turned up.”

Relatives also confirmed people’s feedback, comments included, “Sometimes they [staff] have arrived so late after they should have, I have had to send them away as [Name] has gone to bed. Recently there were 3 missed calls and not all of them were communicated” and “I have had to assist [Name] when staff didn’t turn up, but I don’t want to do that again as equipment is involved and I am worried about our safety.”

Safeguarding and whistle-blowing policies were in place which helped protect people from the risk of abuse and harm. However, we were not always assured people were protected from the risk of harm, some people had experienced missed care calls which left people vulnerable to harm.

This meant people were not always adequately protected from the risk of harm and/or neglect. This was a breach of Regulation 13, safeguarding service users from abuse and improper treatment..

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Processes were not always effective enough to help ensure there was a balanced approach to risk in line with people’s choices and ability. Although people’s care plans recorded what risks had been identified, for one person, who was not able to mobilise without assistance, their risk when moving had been scored as low. For other people, risks had been listed in their care plan with no evidence of a proper assessment of the risk. This meant some risk assessments did not always offer clear and accurate guidance for staff to follow.

For example, risks were not always scored making it difficult to establish if the risk was a high or low risk to people’s safety and well-being. People were unnecessarily placed at risk of harm and neglect by missed, late and cancelled calls.

People told us although the more regular members of staff knew about their risks and their routines, on occasion newer staff did not. One person told us, “If I get new staff, they are not introduced beforehand and they just turn up.”

On speaking with staff, we were assured they knew how to manage risks to people appropriately.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Processes, such as health and safety checks, were in place to help ensure the safety of any equipment used by people, such as mobility equipment. A risk assessment was carried out on people’s homes to help ensure the environment was as safe as possible.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

Not all staff had completed their mandatory training. We saw instances of staff administering topical medicines (medicines such as creams and pain-relieving gels) to people without having been trained or their competency having been assessed.

We were not always assured staff were properly supported. Some staff supervisions and appraisals were out of date and didn’t always evidence proper staff participation. One member of staff told us, “I had a supervision in the summer, prior to that it was 2 years ago.”

Some staff fed back there was not enough staff to meet people’s needs. One member of staff told us, “There isn’t enough staff – they are not replacing staff who leave quickly enough, we are in and out to people’s houses sometimes and I can’t give the care I want to give, because there just isn’t enough time.”

Some staff told us there was not enough time given to travel between care calls. One member of staff told us, “There is not enough travel time. I run late and overlap my calls most days. I am running in and out of people’s houses and that’s not right.”

The provider did not always ensure there were enough staff to meet people’s care and treatment needs. The provider did not always ensure staff received the appropriate support. This was a breach of Regulation 18, staffing.

During our assessment the provider recruited 3 new care staff. They told us recruitment of staff was an ongoing process and would be treated as a high priority.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Processes were in place to ensure staff were trained and had a good awareness of infection, prevention and control. One person who required staff to wear PPE due to their health condition told us, “Yes, staff always wear PPE as they should.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Processes and policies were in place to ensure medicines were given in line with best practice guidance and appropriate arrangements were in place for the safe management, use and oversight of medicines.

However, we could not be assured this worked in practice as the manager did not have any overall audits to evidence this.

Some staff told us how information about people’s medicines on their care plan was outdated, so medicines they were no longer prescribed had not been removed from people’s plans.

Individual audits in relation to people’s medicines were neither accurate nor effective. For example, we saw how for several people, the audit tool was ticked to confirm instructions warfarin (a blood thinning medicine) and PRN (as and when required medicines) were in place. We looked to see if these people were prescribed such medicines, and they were not.