We Care Chorlton

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

People's visits were not always managed safely. Measures were being taken to address poor scheduling but needed more time to take effect. A high number of calls were more than 45 minutes late. People did not get their allocated time for visits. Medicines administration was not being managed safely. Care plans did not always have up to date information and records did not accurately record what medicines and creams had been administered and applied. Care plans and risk assessments were not always accurate and up to date. This increased the risk of poor care being provided. We could not be assured, people supported were being provided with the correct level of care to keep them safe. Staff were not recruited safely. Clear systems were also not in place to ensure staff had the correct skills and experience to support vulnerable people. Staff understood safeguarding and understood the importance of reporting any concerns to the office. Most people we spoke to told us they felt safe with the care provided. A small number of people expressed concern about issues related to medicines, understanding dementia and making sure the premises were secure after a visit. Staff felt supported to access support and to raise concerns if they needed to. Systems were in place to respond to complaints, safeguarding concerns, accidents and incidents. Staff were trained in infection, prevention and control. We did not receive any negative feedback about this issue during the inspection. Premises risk assessments were carried out in people’s homes to ensure it was a safe environment to provide care.

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.

Staff were clear about reporting any accidents or incidents. They told us reporting was encouraged to ensure the office staff could respond quickly.

An electronic system was in place to record and monitor any work related to complaints, safeguarding, accidents and incidents. Shortfalls were identified and actions taken to address them where required.

The service worked closely with the local council to accept new referrals and to establish a package of care within 48 hours.

We received feedback from a Performance & Quality Improvement Officer from Adult Social Care and 5 social workers about their experience of working with the service. There were no concerns shared about unsafe pathways or transitions.

Poor record keeping increased the risk of care pathways and transitions not being safe as the information being shared may not be legible or accurate. Medicines records were not always up to date and hospital transfer records were not always accurate.

The majority of people and family members we spoke to told us they felt safe, and they provided positive feedback. They told us, ‘Yes, my [relative] is safe with the carers’ and ‘Oh yes, I do think [relative] is safe.’ 5 out of 42 responses expressed concerns about safety issues related to medicines and staff not understanding dementia. Two other people reported safety concerns related to security where their front doors had not been locked when carers had left the property. They told us, ‘There have been Security issues. [Staff] left the key in the door and another time the key safe was left open with the key in it’ and ‘One little niggle, [Staff] don’t always check to see that the front door is closed and locked when they go, we know it happened at least once when the [Health professional] called and found the door open.’

Staff were supported through their induction and training to understand their safeguarding responsibilities. We discussed safeguarding with 10 staff and checked their learning in practice. They all understood the importance of reporting concerns and said they would call the office. Four were unable to give examples of the different types of abuse covered in their safeguarding training. They were all confident office staff would respond appropriately.

The safeguarding policy was recently reviewed and up to date. Processes were in place to ensure people consented to their care. A clear escalation policy was in place to ensure people who were at risk of self-neglect were referred to the local council. Systems were in place to ensure concerns were logged and investigated.

People and their families told us they felt involved in managing risks related to their care. They told us, ‘Oh yes, they use a hoist and are very careful’ and ‘Yes, they are helping me manage my risks.’

The provider responded to the feedback regarding the management of people’s risks and put plans in place to review and update the care plans.

We reviewed 10 care plans and risk assessments. They did not always capture the support people required to stay safe and well. People on modified diets, where there is a risk of choking, did not have accurate and up to date care plans in place. Risk assessments were not robust. Care records also lacked pertinent information on the support people required with repositioning, catheter care, food and nutrition. We could not be assured, people supported were being provided with the correct level of care to keep them safe.

Staff felt safe working in the community. They told us they were trained to use moving and handling equipment, in people’s homes, safely.

Risk assessments were in placed to ensure the environment was safe for people and staff. This included information on smoke alarms and how to switch of the water and gas supply in an emergency.

The organisation of people's visits was not managed safely. 9 out of 42 responses in telephone interviews with people and their families told us their visits were not on time or not for the full duration. Comments included, ‘They can be late for [relative] calls. They record in the book the time they stay for, but actually they don’t and cut the calls short…they will be in and out in ten minutes. It is all very rushed’ and ‘The arrival times agreed at the outset were 8.30 to 9.00 but consistently up to 11am which means its only 1 ½ hours till the next visit at 12.30…they rarely stay more than 20 mins.’

The provider acknowledged there were shortfalls in scheduling visits and safe recruitment. Measures were being taken to address scheduling but needed more time to take effect. Recruitment processes were reviewed by the provider during the inspection and further gaps were identified in staff records.

Staff were not recruited safely. The provider had not ensured they had sought satisfactory references for new applicants. The provider had not checked applicants’ employment history sufficiently to follow up on any unexplained gaps. The provider had not explored one staff members disclosure and barring service check when an undeclared conviction was identified. Clear systems were not in place to ensure employees had the correct skills and experience to support vulnerable people. Spot checks, supervisions and an annual appraisal were recorded for staff members, but the majority of these documents had not been signed or fully completed which meant we were not assured staff were receiving the correct observations and support to progress in their role. Visit schedules were not always managed safely. A high number of calls were more than 45 minutes late. People did not get their allocated time for visits. This put people at risk of not receiving safe care and treatment. A high number of calls were also scheduled with no travel time.

We received positive feedback from people and their relatives about infection, prevention and control.

Staff understood infection, prevention and control and could explain how they used their training in practice.

Staff received training in infection, prevention and control. Regular quality assurance questionnaires with people and their families and spot checks with staff helped to ensure good practice was followed.

Records showed regular medicines were given on time. Whilst staff demonstrated good knowledge of people’s medicines needs, care plans did not always have up to date, personalised information about how to support people with their medicines. Information to support staff to safely give ‘when required’ medicines was not always in place and did not adhere to the service’s medicines policy. This meant there was a risk people might not have got their medicines when they needed them.

Staff had completed medicines training and had their competency assessed. Medicines incidents were recorded, analysed and learnt from. Managers told us that at the time of our assessment, there were no robust arrangements for recording medicines should the electronic medicines recording system stop working. Medicines audits were not always effective in identifying medicines related issues occurring within the service.

The service had recently implemented a new electronic recording system for medicines. Initially, records were not always accurate and detailed. However significant improvements had been made in the last few weeks. People’s allergies were not always recorded on medicines records. Records to show when topical preparations such as creams were being applied were not always completed accurately, so we could not be assured they were being used safely. We found that one person had their medicines crushed because of their swallowing difficulties. Information to support staff to safely give medicines this way was not available at the time of assessment. This meant there was a risk that medicines might not be given in a consistent and safe way. However, following the assessment, the provider sent us evidence that this information was now in place.