Care Gems

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

We identified 2 breaches of the legal regulations. Information that was needed had not always been recorded or obtained. Risk assessments did not always contain guidance so staff did not have clear information on how to manage people’s needs. Medicines were not always managed safely. Safeguarding incidents had not always been reported to the CQC, as required. However, people were happy with the care they received. Staff had completed training, knew people well, and were able to describe how to meet their needs.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives said they felt they could talk to care workers if they had any safety concerns and that they would be listened to. People gave us positive feedback. However, the provider's processes were not robust which could affect people's experience.

The provider told us they had not had any written complaints. They told us where concerns had been raised verbally, these had been recorded and taken action to resolve them.

The provider listened to concerns. However, as incidents and discussions were not always documented, there was no formal system in place to ensure oversight or that lessons that could be learned were identified or embedded as good practice.

People told us their care needs had been discussed with them. They gave us examples of how other health and social care professionals had been involved in their care. People gave us positive feedback. However, the provider's processes were not robust which could affect people's experience.

Staff told us how they had worked with other professionals to ensure a joined-up approach for people’s care. The provider told us they carried out assessments to ensure they could meet people’s needs before they started to receive care.

Although we did not receive any feedback from health and social care professionals, we saw evidence that professionals had been involved in people’s care.

Records showed people’s needs were assessed before they started to use the service. People’s needs were communicated to staff before they visited them. However, care plans did not always contain all of the information staff needed.

People told us they felt safe using the service. Comments included, “We feel safe with them” and “I feel ever so safe with carers.” People gave us positive feedback. However, the provider's processes were not robust which could place people at risk.

Staff had completed safeguarding training. They knew how to protect people from harm and abuse and how to raise concerns. We discussed safeguarding with the provider. They told us about the actions they had taken.

Safeguarding procedures had not always been followed when safeguarding incidents occurred. Where allegations of abuse had been made, the service had contact with the local authority safeguarding team. However, the provider had not informed CQC of the incidents; statutory notifications had not been sent to CQC, without delay, as required. Incident reports contained limited information. In relation to one allegation against a staff member, the provider told us there was a written risk assessment in place but when we asked to see this on our site visit, it was not available.

Where relatives had lasting power of attorney (LPA) in place to make decisions on behalf of a person, we asked to see evidence of this. We did not receive copies of the LPAs that had been validated by the Office of the Public Guardian.

People told us how staff supported them to reduce risks. Some people told us how staff sought medical assistance if they had concerns about them. People gave us positive feedback. However, the provider's processes were not robust which could affect people's experience.

Staff had completed safeguarding training. They knew how to protect people from harm and abuse and how to raise concerns. We discussed safeguarding with the provider. They told us about the actions they had taken.

Although most care plans contained a good level of detail, where potential risks had been identified in relation to some people’s medical conditions and safety, these had not always been fully assessed and recorded so staff knew how to manage and mitigate risks. None of the care plans included a photo of the person for identification purposes. The service’s care plan audit had not identified this. The provider told us they will ensure the additional information is added. Care plans did not include people’s end of life wishes. We discussed this with the provider who said they wanted to add this information; they said care plans would be audited and most changes made by the end of January 2025.

People felt staff respected their home environment.

The provider told us environmental risks were assessed within people’s homes prior to care being delivered.

Information was included in people’s care plans about any actions staff should take to keep themselves and people safe.

People told us they were happy with the staff who visited them and knew them well. Comments included, “Staff know my needs and look after everything. They are trained and competent” and “Staff are very good all of them.” People told us staff always arrived for their visits and were usually on time. People said visits could sometimes be a few minutes late but understood this may be due to another visit taking longer or an emergency. People gave us positive feedback. However, the provider's processes were not robust which could place people at risk.

Staff told us they had completed training, so they knew how to carry out their role effectively. Comments included, “We do training and there is a lot of it” and “The training the staff are given on any of the equipment is good.”

Staff told us they felt well supported in their role. One staff member said, “(Name of provider) is very relaxed and very willing to help in any way she can, and she has been very supportive.”

The service did not have a robust staff recruitment system in place. Records were not easily accessible or clear. Evidence of completed DBS checks and some staff references were not available to us during our site visit. Following the visit, we received copies of DBS checks and some staff references. Some staff did not have 2 references in place. Supervisions and spot checks were carried out to ensure staff were competent in their role. We discussed more robust checking of recruitment processes with the provider.

People told us staff wore personal protective equipment (PPE) such as gloves and aprons.

The provider told us there were checks on the system to prompt staff to wear the correct PPE. Staff told us they had completed infection control training.

The provider had a policy for infection control. PPE was available for staff to collect from the office. The provider had undertaken spot checks on staff working in people’s homes.

People told us they were happy with the support they received from staff with their medicines. People gave us positive feedback. However, the provider's processes were not robust which could place people at risk.

Staff told us they had completed medicines training.

The provider had a medicines management policy in place. Information relating to people’s medicines was contained in their care plans and staff completed medication administration records. However, we found one person’s medicines administration was not clearly recorded in their care plan. At times, staff were administering medicines that a relative had removed from its original packaging and placed in a dosset box. This meant staff did not have clear guidance and could not be sure what the medicines were. The service had not identified this during their medicines audit; the provider told us they had taken action to prevent this from happening in the future.