Everycare West Kent

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 Inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to the way people’s medicines were managed, safeguarding service users from abuse and safe care and treatment.

This service scored 34 (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 have a positive culture of investigating or learning from incidents and accidents. Although there was a summary of incidents each month, there was no analysis carried out to look for themes or trends. We reviewed recent incidents. We read one person’s fall had resulted in a broken leg, another person was found unresponsive and a third person’s leg had been hurt by a staff member pushing their wheelchair.

Although care staff had recorded details of what had happened, people’s care plans were not updated to reflect these incidents or additional guidance put in place for staff to help reduce the likelihood of a similar incident occurring.

Staff said they were not always able to access support when an incident occurred. A staff member told us, “There is an on-call, but we are told this is only for an emergency. But office staff leave the office at 15:00.”

The lack of oversight and analysis of accidents and incidents meant the provider and manager may not be able to identify whether, for example, they needed to refresh staff training.

Assessments were carried out prior to a new care package commencing. The manager told us, “I would go out and do the assessment. If they are at hospital, I would go and assess and then assess the house before we go there.” Some people also had their funding authorities assessment in place which contained relevant information.

However, despite this, people’s care plans were not robust which meant there was a risk staff may not have sufficient information about a person in order to ensure continuity of care. For example, one person had attempted to harm themselves, but there was no information for staff on potential signs to look out for should they do this again. A second person had a serious allergy. Although they had emergency medicine for this, it was unclear from their care plan whether they were able to administer this themselves, or if staff needed to administer it. Training records did not indicate if staff had been trained to recognise signs and symptoms or instructed on how to use the emergency medicine.

Care staff did not always know people’s needs. Staff told us one person had no allergies, when they did and they, “Thought” a second person was diabetic when it was clear from their care plan that they were. They were also unable to identify one person’s risk of falls could be due to their high blood pressure as they were unaware they had this condition. Staff also told us important information about people that was not in their care plan. For example, around one person’s cultural needs and another’s medical condition. This meant new staff may not be able to provide care in line with a person’s specific needs.

The provider did not always ensure potential safeguarding concerns were shared quickly and appropriately. Despite the manager telling us they would report any concerns to the local authority safeguarding team, we found body maps in one person’s care documentation which showed a number of bruises which had not been reported. The manager told us the doctor had reported one of the person’s medicines would cause them to bruise more easily. However, the bruises were unexplained and should have been reported. Further potential safeguarding concerns were identified by us as there had been two incidents when one person did not receive a care call. It also meant that without a safeguarding concern being considered or the incident investigated, the provider could not be assured people were not being harmed intentionally.

Care staff did not always know how to recognise potential abuse and raise it appropriately. One staff member said, “If I found bruises on someone, I would document it and do a body map. I would not consider it a safeguarding unless there were a few bruises. If they were unexplained, I would expect the manager to contact the GP.” Although one care staff member was able to tell us, “If suspected abuse it would be important to protect the clients confidentiality. I would need to make it clear that it’s my duty to report to the local authority, the office has the details of the local authority.”

The provider had failed to understand and manage risks. One person said they had a pressure cushion to sit on, but often had to remind staff to put this underneath them, as staff could, “Forget.” This person’s care plan had no information or guidance for staff to help ensure they supported this person with this equipment

Care staff were not always given sufficient information to they could provide appropriate care to people that was safe and supportive as people’s care plans were not robust.

There was a lack of risk assessments related to people’s health conditions. One person had experienced weight loss but staff were simply instructed to support the person with ‘feeding’. There was no guidance in place to help support this person to maintain a healthy weight. They also required equipment for their safety, but this was not included in a moving and handling risk assessment. A second person had a skin wound but no associated skin integrity risk assessment.

There was a lack of information available for staff associated with people’s needs. Some people were diabetic but staff had no information on the risks this presented, e.g. high or low blood sugars and what to do should this occur. Two people suffered with poor mental health with one person at risk of harming themselves, but there were no separate care plans in place relating to these. Other people had poor eyesight and high blood pressure, yet staff had not been provided with information on how this may affect them on a day-to-day basis. The manager told us, “I know the care plans are not person-centred. They need more information.”

Despite this people said they felt safe with staff and staff knew them well. One person confirmed 2 staff were always provided to ensure they could be transferred safely. Another said they were happy with the way staff undertook their care and how they supported with their skin integrity.

Although environmental risk assessments were completed for people we found this were very generic and 1 staff member had told us they were not always informed of environmental risks prior to delivering care. Good environmental risk assessments are important as they identify and mitigate potential hazards in people’s homes, ensuring a safer and more comfortable environment for both the person and the care staff, whilst also promoting independence.

Some people did have fire and rescue checks undertaken of their premises which were more detailed. Reports were shared with the agency.

While people provided positive feedback regarding care calls time and duration of visits, we identified shortcomings in these areas.

Our analysis of 1 person’s February care calls revealed staff left at least 15 minutes early on 65 occasions and did not stay the full time a further 26 times. Another person, who received 4 calls a day (including mealtime support) had inconsistent call timings. Often the gap between the morning and lunch call was very short and it was often noted the person had not eaten their lunch. Also, the time between their night and next morning was up to 14 hours meaning they went a long time without nutrition or continence care. The manager said, “I can’t be fully consistent with call times as some staff work around their school runs. Weekends are the worst. We have limited staff working.”

A survey of people highlighted concerns around scheduling. They commented, “It would be great if we were notified when carers' arrival times change” and “Rotas are not always correct and keep changing.” Some people reported frequent staff changes and others mentioned not being contacted if staff were running late. However, other people said staff arrived as expected allowing them to plan their day.

The provider did not always ensure staff received support, supervision or professional development. Some staff had completed shadowing shifts but started working independently without being formally assessed as competent. Some staff said training was not robust. One told us, “Every 6 months (senior staff) does a spot check and just watches you on the care call but not meds (medicines) competency.” There was no structured discussion around objectives, training or career development as formal one-to-one meetings with line managers were not conducted.

Staff were recruited through robust recruitment processes which required full employment history, references and evidence of the right to work in the UK. Staff underwent a Disclosure and Barring Service check.

People told us staff wore appropriate personal protective equipment (PPE). People said staff wore PPE when helping with personal care, with one telling us staff wore masks, gloves and aprons whilst supporting them in the shower. Management said staff either picked up new stock from the office, or they would drop supplies to care staff. Staff said, “We can go into the office and get that whenever we need” and, “We are going between people with a lot of conditions, we have a lot of contact with a lot of people. We have to make sure we don’t transmit things between people. Always wear with gloves and aprons to wear in clients houses.”

The provider did not consistently ensure medication practices were thorough. For people prescribed topical creams, while body maps were in place, there was no guidance on how often the cream should be applied. One person expressed concerns that staff did not properly rub in the creams. The manager informed us that specific training had been arranged to improve practice in this area.

Staff were recording an ‘A’ on people’s Medicine Administration Records (MARs), which, we were told, indicated staff had dispensed the medication and handed it to the person to take. Senior staff explained care staff would only sign a person’s MAR when they had directly administered the medication. As a result, it was unclear the level of support being provided or the level of support a person needed with their medicine. Although we were informed care staff always checked if the person had taken their medication, staff were not signing to confirm the person’s medicine had been given. As a result, senior staff could not be confident people’s MARs provided an accurate and reliable record of who had supported with medicine administration.

Staff were not competency assessed following medicines training to ensure they were following good practices. One staff member said, “The MAR is pretty self-explanatory and I think because I had been doing medicines for years, they were happy with me.” However safe medicine administration involves much more than filling out a MAR chart.

Feedback from people was that they had the medicines they required, although we did receive some comments about ‘as required’ (PRN) medicines. One person told us they had a PRN medicine but felt staff did not understand that they should only take this when they needed it. They told us, “Staff can get a bit ‘funny’ as they state it’s in my medication box therefore it should be taken.” Other people said staff were competent with medication practices and would go over and above to ensure they had their medicines.