Care Direct Salford

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 remained the same. This meant people were safe and protected from avoidable harm. There was an open and transparent culture. Staff supported people to safely transfer between services. There were systems and processes in place to ensure people were safeguarded from abuse. Staff effectively managed risks and people were involved in planning their care. Environmental risk assessments were in place. There were enough staff to meet people’s needs. People and relatives confirmed staff wore personal protective equipment (PPE) as necessary. There were some areas of concern regarding medicines management; we discussed this with the registered manager who took immediate action to rectify these issues.

This service scored 75 (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 had a culture of safety and learning which was based on openness, transparency and learning from events. Staff told us at their induction, they were introduced to the importance of reporting incidents and the investigation process. They were assured there was a no blame culture with an emphasis on learning from incidents to improve the quality of care. The provider had an incident/accident log file which contained 6 accident forms in 2024, all of which were falls. Incidents documented within the file had been appropriately reported and investigated. Not all falls which were documented in people’s care plans were included within this file. We raised this with the registered manager who had already taken action to address this. Staff were encouraged to raise concerns and reported incidents to the senior staff in line with the services policy. Staff felt incidents/accidents were reviewed appropriately by the senior team. Staff told us and we saw evidence that incidents and accidents were discussed with staff at team meetings, during supervision meetings and via the annual newsletter. The provider completed an annual safeguarding analysis report which was shared with staff. We reviewed the incident analysis for 2023 which identified key themes.

The provider ensured there was a collaborative, joined up approach with other services to ensure continuity of care when a person using the service was referred, admitted or discharged. The provider completed their assessment of a new service user within 48 hours of being informed of the referral. The registered manager provided an example in which a care worker supported a person using the service by attending meetings with the incoming provider which ensures a seamless transfer. There was a strong awareness of the risks to people across their care journeys. For example, all 8 peoples files which were reviewed contained detailed hospital support plans; they contained key information about the person including contacts, allergies, current medical conditions to help support the admission. Care and support were provided in a timely manner for those accessing the service. The provider provided data from their electronic call monitoring system which we completed analysis on. We found between 16 September 2024 and 15 December 2024 that 84% of calls were delivered within 15 minutes of the planned start time. Staff told us the senior team made them aware of new people being added to their case load and provided necessary information and a detailed care plan prior to their first contact with them. Staff effectively shared information about the person to ensure their needs were met. For example, 1 relative described how the person being supported had required hospital admission on several occasions and staff had been pro-active in contacting social services, and the ‘rapid response team’ to ensure the correct package of care was being provided. People and relatives told us they were involved in assessments of people’s needs.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. Safeguarding systems, processes and practices meant peoples human rights were upheld and protected from discrimination. People who used the service and their relatives told us they felt appropriately supported and safe. Staff understood their responsibilities for safeguarding. Staff knew to raise concerns to the senior team who reported safeguarding concerns to the local authority. We saw evidence of the provider completing their own internal safeguarding investigations which were detailed. All staff understood the Deprivation of Liberty Safeguards (DoLS), and most staff had knowledge of the key triggers and signs which would indicate a safeguarding concern; however, a refresher session would have been beneficial for some.

People had care records which included assessments of specific risks posed to them, such as risks arising from mobility, nutrition, skin integrity, moving and handling and falls. All care plans reviewed identified risks for people. These were person centred, proportionate and regularly reviewed with the person and their relative. Staff told us care plans were detailed and kept up to date. We observed this was the case apart from the care plans for medicines which were sometimes outdated. Staff understood how they would respond in a clinical emergency, for example a staff member said, “Dependent on the severity of the situation I would either call the office staff or contact the emergency services immediately.” Staff told us they had annual training to support people who presented with different behavioural needs. The registered manager told us positive risk-taking approaches were taken which focused on empowering people. Examples included staff supporting people to go in to the community to complete their preferred activities including shopping and exercise. The provider had policies and procedures in place to help keep people safe. For example, they had a ‘no access, no reply policy’ which guided staff, dependent on the person being supported and the individual situation to respond in the best interests of the person if they were not responding to their scheduled call. People were overwhelmingly positive about the quality of their care. They felt safe and were fully involved in planning their care and understood their rights.

People using the service were cared for in their own homes. The provider completed detailed environmental risk assessments for each person being supported which helped to keep them and staff safe. Staff said they would report any environmental concerns they had regarding a persons’ home to the office who would follow this up with the relevant agency. Staff told us they had the appropriate equipment, including technological devices to support the delivery of safe care. The provider completed a monthly health, safety and environmental audit which reviewed whether fire risk assessments, electrical testing and gas safety certificates had been checked and updated for the office on an annual basis.

There were safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. We reviewed 4 staff files and found evidence of application forms being completed, interviews taking place, suitable references being reviewed and identification being sought. There was evidence staff had disclosure and barring service (DBS) certificates, but we did not see copies of the certificates. We spoke with the registered manager who told us they had reviewed all the DBS certificates and had no concerns. We asked the registered manager to ensure copies of certificates are obtained and added to staff files in the future. Staff completed online training and in house training with the nominated individual before starting a period of shadowing qualified staff. Senior staff completed reviews of newly qualified staff during their probation. All staff told us the recruitment process and induction stage were appropriate, and this helped them to feel competent in their role. We reviewed staffing rotas and found staffing levels were appropriate. Staff and people who used the service told us there were enough staff. Staff received the support they needed to deliver safe care. We saw evidence of, and staff told us there were regular supervisions, spot checks, shadowing opportunities, probationary reviews and annual appraisals. Staff received training appropriate and relevant to their role. The overall compliance rate for mandatory training for staff who worked for the service was over 99%. The registered manager told us there were no current vacancies and staff sickness and turnover was low, which was corroborated by staff.

Staff said they had enough PPE; however, we found that most of the hand gel and hand wash they were using was out of date which compromised its effectiveness, potentially putting people who used the service at harm. The registered manager removed these items during the assessment. The provider had policies and procedures in place to ensure infection, prevention and control (IPC) was managed well. There were clear roles and responsibilities around IPC. Staff had completed mandatory training on IPC. Staff provided us with examples of how they washed their hands when entering, exiting and helping to prepare food for people; they told us they felt adequately trained to raise concerns with people or their families if they had hygiene concerns. They were aware of raising such concerns with senior staff.

People were supported by staff who followed systems and processes to prescribe, administer, record and store medicines safely. Staff who administered medicines had been trained to do so and the registered manager completed regular competency checks to ensure procedures were followed. A new electronic Medicines Administration Record (eMAR) system had been introduced 2 months before the inspection. This had not been fully established and was having a negative impact on the recording of medicines administration. Paper records were reintroduced during the inspection until these issues could be resolved. There were other shortfalls. These were responded to and resolved quickly during the inspection. These included updating 3 care plans to ensure staff had the right guidance to support 2 people with diabetes and 1 person who was prescribed a high-risk medicine. People with medicines with a, ‘when required’ dose (PRN), also had their PRN protocols updated to ensure staff had clearer guidance.