Creative Care and Support Limited

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 the management of safe care and treatment.

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 service did not always have a proactive and positive culture of safety. Risks to people were not always used to learn and improve. For example, some incidents within the service were not recorded and reviewed at service level. Therefore, the provider could not effectively mitigate risk or monitor for themes and trends. We found the management team were open and transparent and wanted to drive improvement at the service. They were confident the revised management structure alongside the new electronic system once embedded would provide greater oversight and monitoring of the service.

People’s care records did not always accurately reflect their needs or provide sufficient guidance to staff to allow them to support people safely or provide accurate or up to date information if shared with other parties. Some staff also told us since the introduction of the new system that they did not always have information for new people at the time of support starting. The process for the collation and sharing of information following visits by health professionals also required improvement to ensure records could be updated and allow good continuity of care. Concerns identified during our assessment were all actioned immediately.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. However, people’s care records did not accurately reflect their needs or detail how the service was working within the principles of the mental capacity act. We received mixed feedback from people and relatives with concerns raised about changes to call times and the impact this had on them. However, overall they were positive about support provided. One relative told us, “They look after [person] very well.” Effective systems to provide robust oversight of accidents and incidents including safeguarding’s were not in place. Records showed safeguarding concerns were reported promptly to the local authority, but notifications were not always submitted to CQC. Staff had completed safeguarding training and the provider’s safeguarding policy guided staff about different types of abuse and how to raise a concern to ensure people were protected. Staff told us they would like more training around restraint and positive behaviour support to support people who may show behaviours of distress.

The provider did not always work well with people to understand and manage risks. Effective systems to provide complete oversight of risk including accidents and incidents were not in place. Not all incidents were being recorded and reviewed at service level or follow up completed. For example, one person experienced a choking episode and although this was recorded in care notes no incident form was completed or follow up action taken. Care records on the new system lacked detail and up to date information to allow staff to have the guidance to support people appropriately and mitigate risks. For example, some people needed support with catheter care, but there was no reference to this in their care plan. The care plan for another person hadn’t been updated to reflect changes around pressure area care. Some staff told us that since the new system was introduced, they didn’t always have information at the start of supporting a new person. One staff commented, “It just says their name, address and key safe but when we look on care plans there’s nothing on it, so we don’t know what we are doing.” The provider advised that initial information was on the system whilst the care plan was being completed due to the short turnaround time for commencing support for some people. They agreed to take prompt action to address this and communicate to staff where this information could be found as well as ensuring all essential information was provided in each care plan.

The provider did not always detect and control potential risks in the environment. For example, we noted some concerns around fire safety that had not been picked up by the provider’s audits. The provider agreed to review audits completed to ensure all risks were evaluated and to provide more in-depth audits in supported living environments where people were being supported 24/7 to ensure people and staff were kept safe.

The provider did not always make sure staff received effective support, supervision and development. They did not always work well together well to provide safe care that met people’s individual needs. We received mixed feedback from staff at the service with a number of staff raising concerns about poor communication, last-minute changes to their rota and staff morale. Some staff told us they felt unsupported and were reluctant to contact staff in the office. One staff commented, “Very rarely do we receive 1:1 or supervisions. When we do, it’s very brief and I feel like it’s a box ticking exercise. I don’t feel listened to or feel supported when I have an issue.” Staff were receiving supervision in line with the provider policy. However, we asked the provider to review the frequency and type of support to ensure staff felt fully supported and had the opportunity to speak on a 1:1 basis and discuss issues confidentially. Staff working with adults with a learning disability or autistic people had completed training in learning disability and autism. Staff were positive about face-to-face training but told us that the training booklets used did not always fully equip them with the skills for some elements of care. For example, to know how to support people with a catheter or convene. The provider told us they were in the process of reviewing the training provided, as well as utilising health professionals for specific training including catheter care. Recruitment procedures were in place, so people were cared for by suitably qualified staff who had been assessed as safe to work with people. However, it was noted that on some occasions staff had commenced on shift prior to a suitable Disclosure and Barring Service Check (DBS) being in place. We received immediate reassurance from the provider that these staff had not worked unsupervised and revised systems were now in place to prevent this occurring in the future.

The provider assessed and managed the risk of infection. Policies and procedures were in place and staff received training in infection control. No concerns were raised by staff about the availability of personal protective equipment (PPE). However, some people and relatives raised that gloves were not always disposed of appropriately and aprons not always worn when carrying out personal care.

Staff were trained in medicines administration, and their competency had been assessed. People were supported by staff who followed systems and processes to administer, record and store medicines safely. People’s Medicines Administration Records (MARs) confirmed they received their medicines as prescribed. However, protocols to support people who required medicines on an ‘as and when’ basis were not always in place for some medicines, or required further guidance to ensure people received their medicines when they needed them. In supported living settings care plans needed to be more person centred and evidence medicines being reviewed by prescribers in line with the principles of STOMP (stopping over-medication of people with a learning disability, autism or both).