Generations Care Ltd

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 requires improvement. At this assessment the rating has remained 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.

This service scored 62 (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. Lessons were not always learnt to continually identify and embed good practice. Some processes, designed to give the registered manager an overview of incidents across the service, required further development and embedding. Recorded incidents included errors in the recording and management of medicines. We found analysis of medicines audits needed to be further strengthened to demonstrate how those checks drove improvement. The registered manager assured us they would improve their systems to show what actions they had taken. People and relatives told us if they raised concerns, those concerns were listened to and acted upon. One person said, “I had raised concerns about some staff and improvements have been made.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People and relatives said the provider worked well with other health professionals such as doctors and district nurses. One relative told us, “A few weeks ago carer noticed [person] had a rash on their back. They advised us to have it checked by a GP.” A care coordinator told us how they worked with family members and the hospital to ensure safe transitions back home when people were discharged from hospital. One care coordinator said, “We liaise with family and the hospital and confirm the best time to send the person home. We complete a reassessment and update our records, so staff are aware of any changes.” External healthcare professionals told us the service supported transitions safely and effectively. One healthcare professional said, “Generations work closely with our therapy staff and are proactive in escalating concerns. I believe Generations strive to meet the service aim of carers assessing patients within two hours of discharge home.”

The provider worked with people to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People told us they felt safe and well cared for by staff. One person said, “The carers are always courteous and tell me what they’re doing.” Staff understood their responsibilities to report any concerns to ensure people were safeguarded. One staff member said, “Safeguarding is protecting people’s health and well-being and their rights, so they can live a life free from harm and neglect. If I suspected anything I would inform my manager.” The registered manager understood their responsibility to report any concerns to the local authority and to the Care Quality Commission (CQC), to ensure any allegations of abuse, or suspected abuse, were investigated. Systems were in place to report and refer any safeguarding concerns.

Processes to manage and monitor risks across the service required better management and oversight. People had monitoring charts where it was an identified need to manage risks to their health and wellbeing. This included repositioning people in bed to prevent skin damage and supporting people with modified diets because of their risk of choking. However, the registered manager had not always undertaken daily checks to ensure that important information had been recorded as required by staff. For example, one person’s urine output was not recorded, and the registered manager had not identified this issue. One person told us, “The care is very good. The carers are always checking my skin. If they’re concerned, they tell the nurse.” Another person said, “I never feel rushed. Once they’ve done what I need them to do they always ask if there’s anything else.” Staff told us they understood how to manage people’s care in a safe way. One staff member said, “[Person] has good and bad days, on some days [person] can walk with assistance from us and when in bed we ensure they are sat upright.”

The provider managed risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People and relatives felt staff respected their home environment. People told us they felt safe. One person said, “I feel safe in the hoist because I keep an eye on where they’re putting the straps.” Staff explained the importance of ensuring people were safe by checking equipment before it was used. One staff member told us,” Before using any equipment such as the hoist we check it’s been serviced, and we make sure no cords are in the way. Any issues with equipment are raised with the office.” Environmental risks within people’s homes were identified during the person’s initial assessment process. Information was included in people’s care records about any actions staff should take to keep themselves and people safe. Care records provided staff with instructions on how to use equipment safely and how to report any faults.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. People and relatives told us they were pleased with the consistency of care. One relative told us, “Normally we get the same staff on a 2-week run, that’s what I like about it. This means we have the same staff throughout the day.” Staff confirmed they supported the same people. One staff member told us, “I support the same client from their morning to bed calls, it’s a good thing.” Both registered managers told us they reviewed staff capacity and staffing levels which they matched to people’s level of need and gender where requested. Calls were grouped geographically to ensure consistency in staff delivering individual care packages and staff did not have to travel excessive distances between calls. Office staff monitored care calls ‘live’ on the electronic system so they could intervene if calls were running later than planned. The provider operated safe recruitment processes. Safe recruitment checks Included undertaking checks such as references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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. People and relatives told us staff attending their calls wore personal protective equipment (PPE). Staff confirmed they had enough PPE and understood when to wear PPE and the importance of changing it between different care tasks. Observed practice was completed to ensure staff used PPE when required and followed good infection control practices.

Medicines management was ineffective, meaning it was not always safe. At our last inspection we identified medicines management required improvements. At this assessment we identified similar issues. Processes to support safe medicines practice included staff training; however, we were not provided with evidence staff had their competency to give medicines assessed in accordance with national medicines guidance. Monthly checks of medicine records were completed; however, these were ineffective. We found some people did not have PRN (as and when medicines) guidelines to inform staff when they should give the medicines. This meant people were at risk of having too much or not enough of those medicines. One person was prescribed thickener [thickener is an additive to fluids to support effective swallowing] in their drinks as they were at high risk of choking. Records did not evidence this was being given consistently with people’s fluids. The provider’s audits failed to have sufficient detail, for example they did not include checks to ensure PRN medicines had protocols in place. Regular checks had not identified the issues we found during our assessment. Some people told us they managed their own medication. Where people had staff support with their medicines, relatives raised no concerns. One relative said, “Usually, I collect [person’s] medication from the chemist and sometimes I get a reminder from staff to tell me it’s going to run out at the end of the week.”