Top Option Healthcare 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 inspection we rated this key question requires improvement. At this assessment the rating for this key question has remained 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. During our assessment of this key question, we found concerns around safe and effective staffing. This was a breach of Regulation 18 [Staffing] of the Health and Social Care Act 2008 [Regulated Activities] Regulations 2014.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff knew how to record accidents and incidents however, the reports often lacked information and detail. Staff told us, “In an emergency the process is to call the office immediately then maybe ring the ambulance.” Another staff member told us, “If a person experiences a fall, I’m not supposed to pick them up without assessing how bad the fall is. I would then inform a senior person to me and complete accident report form.”

There were systems in place to record incidents and accidents which were reported by staff but these often-lacked information and detail. The registered manager reviewed incidents to identify where actions where needed but these had not always been completed. There was no formal record of lessons learnt however, the registered manager implemented a lessons learnt report following incidents and complaints, but these were often incomplete. The registered manager completed a monthly audit for accidents and incidents but these lacked detail and were not analysed for themes and trends.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were protected from the risk of abuse and said they felt safe. A relative told us, “I am just relieved to know that there is someone out there I can trust to call me if [relative] isn’t right. I know the carers are very fond of [relative] and it shows." Whilst most people and relatives we spoke to expressed that they were generally happy with their care, our assessment found safeguarding did not meet the expected standards.

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people including informing other agencies if they were concerned about action being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to”. Another staff member told us, “Safeguarding is protecting the person’s health and wellbeing and human rights and allowing them to live free from harm and abuse, neglect.”

The registered manager had been raising safeguarding alerts with the local authority however, there had been occasions whereby statutory notifications had not been sent to CQC as required. Providers must inform CQC of all incidents that affect the health, safety and welfare of people who use services. The failure to notify CQC of notifiable incidents is a breach of regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

A person told us they were involved in planning their care and managing risks. Care plan and risk assessments were person centred and aim to provide positive outcomes for people whilst maintaining their choice and independence. However, there was limited information in care plans to evidence people were involved in planning their care. A person told us, “I have always been included in care plan reviews and I know I can phone [manager’s name] to discuss any concern I might have.” A relative told us, “The staff and manager organised the District Nurses help after mum developed a pressure sure. I would never have seen that.”

Staff knew the risks to people well and told us they were kept up to date if there had been any changes to risk assessments. Staff told us they always read the care plan and checked the app to see if there had been any changes to their care package.

Risks to people had been assessed and risk assessments had been put in place to help mitigate risks as far as possible. These risks included areas such as supporting people with mobility equipment or with personal care. However, we found some risk assessments were generic and lacked detail. For example, there is no risk assessment or care plan in place for a person who has partial blindness. The registered manager told us they completed regular audits and action plans were put in place if any risks were identified. Some people’s care plans did not include end of life wishes. We recommend the provider seek and implement best practice guidance and training for staff on end-of-life care to ensure support plans are consistent, person-centred and respectful of people's wishes about end-of-life care.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s and relatives comments relating to staffing were variable. A relative told us, “[Relative] usually has a pretty regular carer, but there are about 3 or 4 that come unless they are training a new person (shadowing) then there are 2 people. I do not usually get told about any changes in advance (staff/timings) and I don’t get a copy of the rota or access to the App Notes.” Another relative told us, “[relative] has a particular health condition, so it is very important that [relative] has regular carers whose voices [relative] recognises. It took a while, but we got there in the end.” Another relative told us, “When [relative] had them (carers) for 7-8 months they came every morning to get [relative] up, washed and dressed. Times were not bad, but the thing that [relative] found hard to cope with was [relative] dementia, was the large team of different carers. [Relative] got a bit fed up with it and so did I to be honest as [relative] would keep asking who they (carers) were and what they were doing.”

Staff we spoke with told us there were enough staff. A staff member told us, “I normally only have 1 client per day, so you have all the time. We never run late because the manager doesn’t want us to run late.” Another staff member told us, “We are sent our rota a week in advance, so we know what we are doing. I usually only have 1 service user, so I have more than enough time.” However, some staff we spoke to told us they felt they did not have enough work. The registered manager told us, “When I can’t offer staff the hours, I send the overseas staff to work in care homes.”

The registered manager had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as incomplete application forms where forms had not been signed or dated and references received had not been verified or dated. Staff were subject to Disclosure and Barings checks. (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, the DBS checks seen on 1 staff file had been issued by a previous employer and the registered manager had not put risk assessments in place to ensure staff were safe to work. Following our visit, the registered manager used the update service to complete the DBS check. The registered manager had not completed the appropriate checks to ensure that staff were recruited safely into the service. This demonstrated a breach of Regulation 19 [Fit and proper persons employed] of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager told us, "Staff did not support people with medicines until they had completed the required training, and medicine competency assessments were completed." Medicine competency assessments were seen on staff files.

People had care plans and risk assessments in place which detailed what medicines they were prescribed and how they liked to be supported. The registered manager completed regular audits. There was a robust system in place to identify any shortfalls and to ensure people received their medicines safely.