Care at Home (Midlands) 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 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.

This service scored 59 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Some lessons had been learnt in mitigating specific risks such as safely using lap belts. However, a review of the provider’s systems and processes identified further improvements were required in the oversight and auditing procedures of care call monitoring, incidents, safeguarding issues and complaints. The management team agreed and took immediate actions. New and improved practice required time to fully embed and be sustained.

People confirmed they knew how to raise any issues or concerns and felt confident the management team would be responsive. Where issues had been raised, the management team were reported to have worked hard to remedy the situation to reduce re occurrence.

Staff were able to explain how they would report accidents or incidents. They confirmed there was a procedure in place and outcomes of investigations were shared. Another staff member explained their role was to ensure relevant agencies had been informed of any accidents or incidents when reviewing the audits.

The provider had improved how they worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

They ensured people received continuity of care by providing regular care staff as far as they reasonably could do so. Processes had been developed to share important information with others, such as ambulance and hospital staff to support people to receive consistent care.

The provider had a pre-assessment process that included a face to face and an electronic assessment procedure. The management team told us they only accepted new care packages if they had capacity to do so. A senior care worker or field care supervisor completed all initial new care calls to further assess the person’s needs and develop care plan and risk assessment guidance for staff.

People confirmed they were involved in their pre-assessment and how staff overall, shadowed experienced staff before working independently. People confirmed overall they received care and support from a core group of consistent care staff that knew them well.

The provider worked with people and healthcare partners 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.

A review of the provider’s systems and processes found where safeguarding concerns and allegations had been reported, action had been taken to investigate and reduce the risk. However, the provider had not consistently reported safeguarding concerns quickly and appropriately with external agencies as required to do so. This was discussed with the provider who agreed actions were required to make improvements and an action plan was developed.

People told us they had no concerns about safeguarding. Staff wore a uniform and badge to identify themselves. Staff provided safe care and when people had experienced any safeguarding issues this had been reported to the provider, and action taken to make improvements.

Staff were able to explain how they would protect people from harm, and they could recognise abuse. One staff member told us, “Safeguarding means protecting vulnerable individuals from abuse, harm, or neglect. As a care worker, it is my responsibility to ensure the well-being of those in my care by being vigilant, identifying signs of abuse or neglect, and reporting concerns to my manager or the safeguarding lead promptly.”

The provider ensured staff received safeguarding refresher training and had access to the provider’s safeguarding policy and procedure.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk management included guidance for staff on how to manage and mitigate risks in relation to people’s physical health conditions, mental health and emotional needs. Whilst guidance included the measures required to keep the person safe, information was often generic and not personalised. Whilst this had not had a negative impact on people, it did raise the potential risk of harm. However, feedback from people was overall positive in how risks were managed.

Staff also demonstrated a good understanding of people’s individual care and support needs, suggesting this was a recording issue.

The provider detected and controlled potential risks in relation to the environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risk assessments were in place to ensure the environment was safe for people and staff. This included

information on smoke alarms and how to switch off the water and gas supply in an emergency.

Staff felt safe working in the community. They told us they were trained to safely use moving and handling equipment, in people’s homes. The provider had a loan working policy and an out of office procedure staff could use to contact for support or advise.

The overview and systems and processes that managed people's visits was not consistently managed safely. We received mixed feedback from people and relatives about visit calls. Some people told us overall calls were provided as expected. Comments included, “Always on time if delayed I get a call, and they always stay the full time if not longer.” Five out of 24 people and or relatives told us they had experienced late care calls and call duration having been shorter than expected. A sample review of care records also identified examples of late calls, and call duration shorter than expected. However, the provider had recently implemented a new electronic care / scheduling system and staff were still getting use to the new ways of working.

Staff had also altered call times to suit people, but had not informed the management team, impacting on the data reviewed. Whilst records confirmed staff travel time was factored into scheduling, some staff raised concerns that travel times were not long enough impacting on calls becoming late. We discussed this with the management team who assured us measures were being taken to address these issues.

Staff had been recruited safely and received a robust induction which included shadowing opportunities before supporting people independently. Staff told us they had received regular training opportunities and were positive regarding the training received. Comments included, “[Name of trainer] is amazing.”

Staff received ongoing opportunities to meet with their line manager to discuss their work, training and development needs. However, records confirmed this had not been completed at the frequency the provider expected. It was difficult to ascertain clearly the shortfall as a new electronic system had been introduced and data had not all pulled through. Some staff told us they felt more face to face meetings would be beneficial. The management team did acknowledge there were shortfalls and took action to make improvements.

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. Staff training records confirmed staff had completed infection prevention and control training. Staff told us they had access to personal protective equipment (PPE).

Staff spot check records included observations and discussion with staff about infection prevention and control practice. A staff member said, “PPE is worn as soon as you enter the client's house and you take it off after giving personal care, you dispose it in a bag and put a clean one for another task. You dispose it off in the correct bins outside the house.”

People told us they had no concerns about infection, prevention and control practice. Comments included, “They [staff] put a plastic apron on, and they have got gloves on. They are very good like that.”

The service involved people in planning the support they required to take their medicines. However, staff did not always follow systems and processes to ensure that administration records were accurate.

People were involved in planning for the level of medicines support they required, with a medicines assessment carried out and reviewed regularly. People were supported to self-administer their medicines where appropriate.

The service had a comprehensive medicines training programme in place and carers received regular training and competency assessments.

Electronic medicines administration records (eMAR) were in place for people who required support from staff to take their medicines. The service had access to GP records and processes were in place for staff to communicate with the management team if medicines for people had changed so that records could be updated. However, these processes were not consistently followed, leading to inaccuracies in the medicines documented on the eMARs compared with what people were taking. For example, we observed discrepancies in dosages, medicines and antibiotics not listed on the eMAR. We highlighted this to the service immediately and received assurances that people had received the correct medicines.

In one instance, staff did not adhere to the recommended time interval for an analgesic, which posed a risk of harm. After the inspection, the service communicated with all staff to reinforce the importance of following the interval guidelines. Additionally, some eMARs lacked specific instructions, such as whether medicines should be taken with or without food, potentially affecting their effectiveness.

Staff confirmed they had completed regular medicine training, including a competency assessment.

Where people received support from staff with their medicines they raised no concerns.