Sowa

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• 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

During our assessment of this key question, we found medicines were not always well managed. Medications were not recorded safely and the systems in place did not allow for appropriate oversight. Risks to people were not always assessed and accurately recorded to inform staff on how to keep people safe. Incidents and accidents that occurred were not always known to the registered manager and there was a lack of evidence to show learning from incidents that had occurred. Relative’s said initial assessments were completed before people started to use the service to ensure their needs were fully met. However, we found some initial assessments had been completed by people not employed by the service which meant the registered manager did not have a good oversight these of care packages. People told us they felt safe, and staff supported them well. People told us the provider was approachable and felt their concerns were listened to. Staff told us they had enough time to travel between care visits and ensured all care tasks were completed. Relatives said staff were well trained and skilled in carrying out their role.

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.

Relatives did not provide any specific feedback on this quality statement but did tell us the provider was approachable and they felt assured they would act on any concerns raised.

Staff told us they were confident to raise any issues with the registered manager. Although the registered manager told us they analysed incidents and looked for patterns, in our review of records we found a lack of oversight in this area.

Systems in place to report and analyse incidents and accidents were not always effective. We found examples of accidents recorded in care notes, but these were not listed in the registered manager's accidents log and the registered manager was not aware of these. There was a lack of evidence to show how the provider encouraged staff to learn from incidents as these were not discussed during staff meetings or supervisions.

Relatives told us the manager carried out an assessment with them before they started to use the service to ensure their needs were fully met. One relative told us staff had supported them and their relative to a recent hospital appointment. The relative said, "I could not have managed without them."

The registered manager told us the process they followed when assessing a new care package. This included reviewing and gathering information about a person's needs, meeting with the person and relatives and completing risk assessments, care plans and mental capacity risk assessments, if required. However, during this inspection we found this process was not always happening. For example, the provider was caring for people living in Sheffield and initial assessments were completed by a person from an external agency that did not work for the provider. We found the registered manager did not have a good oversight of these care packages.

Partners told us the provider was available to assess people but also the service had started shadowing and working with people without developing their own care plans, but utilizing exclusively the documentation completed by the local authority who had assessed the person.

We found the providers admission policy and procedures were not always being followed. We found examples of people's initial assessments being completed by a person who was not a member of staff for Sowa. The registered manager told us this person worked in partnership with Sowa to source new care packages in Sheffield, but no evidence was provided of the specific roles and responsibilities of this partnership and how this ensured safe pathways and transitions. We found one example of a person who lived with dementia, required hoisting and had several risks linked to their care and they did not have a care plan in place. The registered manager put this in place after we raised these concerns.

Relatives told us their relatives were safe.

The registered manager was aware of their responsibilities under safeguarding. Staff told us they would not hesitate to raise any safeguarding concerns with their manager.

There were clear policies regarding safeguarding and records showed staff had completed safeguarding training. However, the systems in place to record and monitor accidents and incidents were not clear, there was also a lack of management oversight over accident and incidents. Quality checks were poor and did not identify any potential patterns or trends to address the incidents we found in peoples care records.

Relatives told us risks relating to people's care and support were managed safely. Where people needed help with their mobility staff supported safely. Relatives also told us, where people sometimes presented with behaviours, due to anxiety staff were skilled in offering reassurance and support which minimised the impact of this. One relative said, "They [the staff] are really good, not phased. They know their likes and dislikes. They are in tune with [name of relative]."

The registered manager told us a new electronic system was used to record people's risks and care plans, but we found examples of these not being detailed. The registered manager was able to tell us how to safely manage the risks linked to people's care, for example linked to health conditions such as epilepsy or agitated behaviour, however this was not always well documented. In our conversations with staff, most told us they provided care to the same people and were aware of how to manage people’s individual risks.

Risks were not always assessed or recorded to show how people would be supported safely. We found several examples of risk assessments in place lacking details about specific risks to people's care, such as risks linked to diabetes, epilepsy, moving and handling and fire safety. For example, one person had epilepsy; there was no detail of what staff should do to manage any triggers or how to act if they had an epileptic seizure. Another person was known to display behaviour considered challenging to others, including during being moved by staff with a hoist; there were no details of how these risks were being controlled and how staff should support the person safely. We raised our concerns with the registered manager and after our inspection they showed us the changes they had made to improve the quality of the risk assessments and plans.

Relatives told us staff supported them in ensuring the home environment was safe. Where care plans indicated support was needed in cleaning and household tasks relatives told us they maintained very high standards.

The registered manager told us staff had received training in infection and prevention control, and this was also checked during spot checks. Staff did not raise concerns in this area.

There were policies and procedures in place to control and prevent the spread of infections. These were being followed. Environmental risk assessments were mostly being completed to ensure any risks were identified and managed well.

Relatives told us there were enough staff to support their relative safely. They spoke positively about being supported by consistent staff and no concerns were raised about the timings of calls. There was positive feedback about the flexibility and reliability of the service provided. One relative said, "They often stay longer and never rush off. If there is a crisis they stay." Relatives said staff were well trained and skilled in carrying out their role. One relative said, "The staff are very knowledgeable, they are really well trained, you can see that." Relatives told us staff had a good knowledge of people with autism and dementia.

Staff told us they had enough time to travel between care visits and spend time with people to ensure all care tasks were completed. Their comments included, "They are close by I don’t have issues getting around" and "no issues getting there [person's home] on time." However, in our review of the rotas we found examples of some staff working several days without having a break. In the feedback we gathered from staff, they did not share concerns about this and told us the management team were receptive to any requests for breaks and rotas were planned around their preferences and availability. Their comments included, "I work 7-8 days then have a break for a day or 2. I prefer this, and the mangers give me what I want."

Staff were recruited safely. Recruitment files show all pre-employment checks had been made to ensure only staff who were suitable to work with people were employed, including the use of sponsorship for overseas workforce. Staff members completed an induction before they started their role and received support from regular staff. Staff had completed mandatory training, received regular supervisions and spot checks and had opportunities to attend team meetings.

Relatives told us staff followed safe infection, prevention and control practices. Staff were provided with personal protective equipment and used this when required.

Staff told us they had received appropriate training. In our review of the training matrix, we found this was being completed. No concerns were raised in this area.

There were policies and procedures in place covering infection and prevention control. These were being followed.

Where people received support with medication relatives did not raise any concerns. One relative said, "[name of person] has difficulty swallowing tablets, but the staff follow the ritual my wife has shown them and makes sure they take time and has plenty of water. She can be very slow, but they are patient. They are a great help to us as a family."

Staff told us they had received online training in medicines administration and been observed by a supervisor to administer medicines. In our conversations with the registered manager, they confirmed this process was followed. However, during this inspection we found concerns with how medicines were being recorded. We discussed these concerns with the registered manager, and they took action on the issues.

Medicines were not always safely managed. Medications were not recorded safely and the systems in place did not allow for appropriate oversight. There were 2 systems to record medication, and this did not create a safe system for the registered manager to keep appropriate oversight, check missed medication and take appropriate action. We raised our concerns, and the registered manager told us they would revert to using the paper Medication administration records provided by the pharmacy. One person was being supported to have their medication covertly in their food and drink. This had been assessed and planned with this person's GP however, there was no decision specific mental capacity assessment or evidence of this being reviewed. Another person was receiving medication that was time sensitive, but staff were not recording the time of administration, therefore it was not possible to confirm if the appropriate gaps were being maintained. We fed this back to the registered manager who told us they had taken action in relation to this.