Crestar Healthcare

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

Systems to assess, monitor and mitigate risks to people, including risks associated with people and staffs risk management were not always robust. Staff had not always been provided with clear guidance on how to safely meet people's individual needs and manage risks. Medicine procedures required improvement on how administration of medicines was recorded. Health management plans were generic and needed to be more person centred.People told us they felt safe with the care provided

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were aware of how to report any concerns. People told us they were involved in learning for the future and where things had needed improvement, people raised their concerns and were satisfied actions that followed were preventable and improved the care they received.

The registered manager promoted a positive culture and throughout the inspection was transparent. However, we did find concerns where the leadership had not identified all safety risks with 1 persons care package. Once we raised the concern of safety the registered manager took on board our feedback and sourced further information on the care package, this assured us that the registered manager was willing to respond to concerns. The registered manager was able to evidence how they investigate and report safeguarding events.

The provider had a process in place to report and record incidents and had in place learning for the future, staff and the registered manager were aware of the process and knew the appropriate ways to report concerns. The registered manager held regular team meetings where they would discuss learning and actions to improve the care provided to people. The registered manager we evidenced during team meetings promoted the values of the service and that all staff worked in a transparent way, having the chance to be open and honest.

The registered manager told us how they assessed people referred to the service. For example, where a care package was submitted for the provider to undertake a review, a pre assessment was completed with the person before they started delivering care. Guidelines on how to care for the person were created and put into place prior to staff providing care. Staff told us they had never gone to provide care to people without guidance being in place and if they were unsure about anything they would call the office.

Partners who worked alongside the provider raised no concerns with the assessment process completed by the care provider. Partners told us the provider engaged with them and were responsive to providing feedback.

Systems and processes were in place to complete assessments prior to people using the service. This was a formal pre assessment process for when care packages came through as referrals. This process meant the provider completed a home visit to meet people and their relatives. As part of this visit a document was completed which Identified needs and learned about people’s characteristics. Following this process, the provider reviewed staff skill mix to ensure they could meet the care needs required. We found during the inspection where 1 person’s pre assessment did not contain full information on a risk that meant the persons care package required specialist measures. Where a care package would be no longer required by the service, we saw that the provider had in place a process where they would handover essential information for the person, this was to ensure the transfer of the care package was completed safely and, in the persons, best interest.

People and their relatives understood how to raise any abuse concerns they may have. People and relatives, we spoke with told us they felt safe being supported by staff and did not have concerns about their safety. One person told us, ‘I always have the same staff, they make me feel safe’. People we spoke with told us how the staff got to know them well and provided the appropriate support for their needs.

Staff were aware of people’s capacity and how to support people in the correct way. Staff told us they knew how to raise a concern if they felt a person’s capacity was changing or didn’t match what was in their care plan. The management team told us how they assessed people’s capacity and who they would involve when completing best interest decisions. Staff were aware how they identified a safeguarding concern and the process they would complete to ensure the person was safe.

The provider had a process in place where the registered manager reviewed safeguarding concerns along with incidents and accidents. We found the registered manager understood their responsibility to report and investigate safeguarding concerns. Staff had completed safeguarding and mental capacity training. This was refreshed yearly, and staff told us they found the training informative. Staff and managers were aware of the safeguarding policy in place and understood the process to follow in line with the policy. Where restrictive practice was identified, we saw a process was in place to ensure best interest meetings were completed.

Most people told us they felt involved in the management of risk in their care. However, a couple of people told us how they couldn’t recall a review on their care package taking place. People told us they felt staff understood the care they required and met their care needs. People felt that staff had read and understood their care plan and would relate to it whilst providing care needs. People felt staff knew how to support them to manage their risks.

Staff were not always aware of the full history and risks to people and what their role was in monitoring and managing these. Risks identified for people who had a criminal previous history were not safely risk assessed. Not enough information was obtained to protect and mitigate risks to people and staff. This left the potential to cause harm. Staff felt that care plans and risk assessments had enough detail in to safely care for people meeting their needs. The provider had a system in place to update and review care plans and risk assessments to ensure information was up to date and present.

Risks to people had not always been assessed with them or clear plans developed, with accompanying guidance for staff, for managing these. This included the failure to assess and manage risks associated with people’s specialised care packages. Some people's care plans lacked clear guidance for staff about their role in monitoring and helping people to manage risks associated to people. For example, one person’s care plan did not mention potentially serious safety concerns staff may encounter and protocols of response at these times. Guidance on how staff should monitor and provide support in an instance of potential risk was not clear in care plans and risk assessments. Management plans for people who had specific health needs were generic and not detailed in a person-centred way. For example, a management plan for managing Urinary tract infections (UTI) was generic and had the potential for staff to provide care that they were not trained to complete or appropriate to the person. Systems to ensure care was provided safely and appropriately were not always robust. This was a breach of regulation 17 (Good governance) of the Health and Social Care Act (Regulated Activities) Regulations 2014.

The provider had taken reasonable steps to control risks in the care environment. Furthermore, the provider used an electronic call logging and monitoring system to support staff to deliver safe and effective care. However, some staff relied on the use of public transport, this meant that regular delays in care call times were present. The electronic system also identified that staff were clocking into and out of calls at a distance and not whilst they were in the person’s home. The registered manager told us they would speak to staff and remind them about the correct procedure and importance of completing care call times meeting the agreed times set in peoples care plans.

People told us they were comfortable with staff who provide their care. People had consistent people who know them well. Some people told us they did experience lateness to care calls, however, people understood staff used public transport and that with this delays may become present. 1 person told us, 'The staff are very respectful and i feel they are well skilled'.

Staff confirmed they were given travel time between people’s care calls. Staff felt they received appropriate training to complete their role. The standard of training provided, we were told was of good standard and provided enough knowledge and information. The training was eLearning with some face-to-face courses. The registered manager told us how they had face to face meetings with the team, at times this would include going through online training they had completed. This helped staff engage in learning together and ask questions.

The provider’s staff training matrix indicated staff received regular training in a number of areas, this included specific training such as catheter and epilepsy awareness. Our analysis of the provider’s electronic call monitoring system showed sufficient numbers of staff were available to support people. New staff went through an induction which included training and opportunities to shadow experienced staff to help them learn the skills they needed. Records showed staff received regular supervision. The provider followed robust recruitment procedures to ensure staff were suitable to support people in their own homes.

People told us that staff always wore personal protective equipment (PPE) and had no concerns of how staff used PPE. People told us how the provider ensured that there was PPE in the homes, and they would regularly refill and monitor. People told us, the provider had asked them if they consented to PPE been stored in their homes prior to them storing it there. They told us they felt supported to remain safe from the risk of infections.

Staff received infection prevention control training. They also said they had access to plentiful supplies of the right PPE. The provider and staff were aware of current relevant national guidance. One staff member told us, “We always have enough PPE. We collect what we need, we have everything there.” Staff described the ways in which they disposed of used PPE in line with people’s individual preferences.

People receiving care from the service and their relatives told us they were happy with the support they received to take their medicines safely.

Staff we spoke with told us they received training to support people to take their medicines safely. Spot checks to ensure staff were in place and included checking medicines were being administered safely. Where a concern was found, an action plan was created for staff improvements. We saw, where actions were identified there was a plan created to ensure they were completed. The registered manager told us they ensured all staff received medicines training at induction as well as refresher training.

Systems and processes were not operated effectively. They had failed to identify and mitigate the risks to service users associated with the unsafe management of their topical medicines. For example, we saw 1 person had been prescribed topical creams and ointments did not have this recorded in their care plan. Staff were not signing after administering the topical creams or ointments and body maps were not found to be in place to identify where the creams and ointments had been applied. This meant there was no assurance that people were receiving their topical creams and ointments in line with the prescriber's and NICE instructions. Furthermore, we saw tablet medication was administered, staff signed the medication administration record (MAR). Peoples care plans had recorded the medicines they were prescribed and who was responsible in administering the medicine to people. Staff completed medicines training and were competency checked by either the registered manager or senior staff team before been signed off to administer medication when lone working.