Oasis Private Care Limited

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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

We looked at 5 quality statements in the safe key question and identified five breaches of the legal regulation. System and processes in place did not ensure staff understood how to report concerns externally or consistently protect people from abuse and to mitigate the risk to people’s health safety and welfare. The provider did not always identify allegations of abuse or make referrals to relevant professionals. The provider did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. People did not always have sufficient care plans to guide safe practice. Not all staff were trained to provide safe care and did not have the relevant employment checks in place. Medicines were not managed safely. There were enough staff to ensure people’s safety and meet their needs. However, we were not assured that staffing records were accurate or that staff had the necessary training to provide safe care.

This service scored 44 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We received mixed responses from people and their relatives about how concerns raised were dealt with. Some people felt if they had any concerns or complaints they would be listened to [by care staff]. People also told us that where concerns around care had been raised with staff, these concerns had not been addressed by the provider. One person said, “I’ve got a number for them [Service] if I needed to contact them.” In addition, people told us they did not know who to approach if they had concerns that were not addressed, as they did not know who the Registered Manager was.

Staff who had raised concerns felt they were not always listened to, supported or their issues fully investigated. The Registered Manager told us concerns were logged, analysed and learning was discussed with staff at team meetings. However, there was no evidence learning was shared with staff. Staff were aware of the reporting procedures for accident and incidents but did not feel they received feedback from the provider. There had not always been openness and transparency from the provider. We identified incidents which should have been reported to the local authority safeguarding team. There was a fundamental lack of understanding and learning around the Registered Manager’s regulatory requirements as well as a failure to ensure risks were not ignored and dealt with appropriately to ensure people's safety.

Processes were not robust to ensure continuous learning. Incidents and accidents were not all appropriately recorded or investigated to reduce the risk of recurrence. For example, for one person there had been 10 assaults on staff or other people using the service within a 5-month period. These had not been recorded on the monitoring log and there was no learning documented to support the person or staff to prevent people coming to harm. Quality assurance processes such as care plans and medicine audits did not highlight shortfalls in people's care records which meant staff and management were unable to learn from findings to improve the quality and accuracy.

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.

Whilst people told us they generally felt safe, evidence found during this assessed demonstrated that systems and processes in place were not effective in ensuring risks to people were mitigated and people were kept safe from abuse.

Staff and management did not have the knowledge, skills, or competence to keep people safe and protect them from unavoidable harm. Despite staff and management telling us about signs of abuse and requirements to report this, records showed not all safeguarding concerns had been appropriately escalated to keep people safe. Staff were aware of safeguarding risks associated with people’s care. However, not all staff were able to demonstrate how they would keep people safe and were not able to give examples of safeguarding. Staff were not always able to identify or escalate safeguarding concerns due to having limited guidance from management and documentation in place. Staff we spoke to were not always clear on the process for escalating concerns and had been told to report any safeguarding issues to the manager first before notifying anyone else.

Systems and processes in place in relation to safeguarding were ineffective. People were not protected from harm, the Registered Manager did not identify or respond to risk, and there were limited risk assessments and guidance in place. Where staff had identified risk and called the office, the service provided limited guidance which did not ensure peoples safety. Safeguarding processes and policies were not always followed. Investigations did not always take place, there was no action plan to implement the outcome and recommendations from safeguarding outcomes. The Registered Manager did not have oversight of safeguarding concerns and had not analysed concerns to identify trends and patterns. The provider had not always contacted the safeguarding team or taken appropriate action following allegations of abuse. We found CQC were not always notified by the service where referrals had been made. We were not assured that capacity assessments had been completed for people using the service, or, that people’s capacity had been taken into consideration at assessment. The Registered Manager was not aware of their responsibilities in this area, and told us people who required mental capacity assessments [MCA] had these in place, however we did not see any evidence of MCA assessments or best interests’ decisions documents. The Registered Manager had employed a consultancy at the beginning of year to assess the quality of the service. They identified that care records must record people’s abilities to make decisions and to evidence the MCA as well as LPA, this had not been implemented.

People told us they were not always involved in planning their care and support. One person said “I’ve never seen a written one [care plan], my needs seem to be passed on one carer to the next” and “No, never seen it, can’t remember.” We did not see evidence that people were involved in the management of their care or risks. Care records did not reflect people's individual needs. As people had not always been involved in their care planning staff could not be certain they fully understood the individual risks associated with their care and support needs. For example, we found people who were at risk of pressure damage to their skin, diabetes, falls, choking, seizures, nutrition and hydration, did not have accurate risk assessments in place for staff to follow.

The provider did not meet regulatory responsibilities for risk management, failing to ensure that all risks were properly considered and assessed to keep people safe while receiving care and support. Risks around people’s care were not always managed in a safe way. Although staff understood how to manage risk to people’s wellbeing by reading peoples assessments, assessments were not reflective of people’s needs. Staff told us about people and their risks, however these risks were not always included within people’s documentation. Documentation also evidenced clinical risks had been identified during visits and were not managed or mitigated, leaving people at risk of of deterioration due to a lack of appropriate care and treatment.

Robust processes were not in place to keep people safe and mitigate risks to people. People’s risks were not always assessed, and their care planning was not updated following changes to people’s needs. People did not always have care plans in place prior to the announcement of the assessment, and guidance was not always in place for staff to follow to meet people's needs and mitigate risk. For example, care records contained contradictory information about people’s needs and risks which meant staff did not have accurate information to deliver safe care. This included supporting people to manage their diabetes, information on how to safely support people to transfer, how to support people with wounds, and information to inform staff how to support people with a catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag). Incidents with catheter management and falls were seen during assessment, or what appropriate support was required to meet people needs and mitigate risks to people. These incidents had not been included within monitoring information; therefore, we were not assured that processes were in place to support people and their ongoing risks. Daily records completed by staff were of poor quality and did not always reflect the detail of care provided, for example, we found the same daily notes were repeated on multiple days. This meant there were incomplete records which did not reflect accurately people’s needs and people were at risk of receiving care that did not meet their needs or receiving inconsistent 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.

We encountered difficulties in gathering feedback from people using the service and their relatives due to inaccurate contact information. However, those we were able to reach said that communication regarding late visits was generally good. Additionally, some individuals raised concerns about not always receiving support from the correct number of staff assigned to their care.

The Registered Manager was unsure of how many staff were employed or where they were located. Staff we spoke to felt there were enough staff available to support the number of people using the service. However, staff were concerned they did not always have enough work from the service. Some staff we spoke to stated they received supervision and spot checks twice a week, however, were not able to expand on what this meant, others said they do not receive spot checks or supervision.

Not all staff were trained to carry out care. The services training matrix did not contain all the relevant training required to support people using the service. Documentation around staffing names was not consistent with the documentation in place regarding who worked for the service. We were unable to confirm the total number of staff employed. Supervision and spot checks were not carried out for all staff. The Registered Manager informed us that supervision was carried out every 3 months. Oversight of supervision did not reflect the staffing names or numbers employed by the service. Therefore, documentation to monitor spot checks was not effective, we were not assured training, spot checks and supervision were being carried out effectively. Recruitment procedures were not operated effectively to ensure persons employed met the fundamental standards. Staff files contained inconsistent information around start dates, CV information/application information did not match, and persons employed had not been evidenced as having the qualifications, competence, skills and experience for work to be performed by them. Required recruitment checks such as checking people’s DBS and references been made some time after employment. The provider had not identified these issues and had failed to undertake risk assessments to ensure people were supported safely. The Registered Manager told us they were not aware of their responsibility in relation to recruitment.

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.

People felt their medicines were managed well by the provider. However, some people shared information that was not accurately reflected in their care plans. While no direct concerns were raised with us, our assessment found that the provider had failed to implement appropriate guidance for ‘as and when’ (PRN) medication. Additionally medicine records were not consistently up to date or an accurately aligned with prescribed medicines, and medication administration records (MARs) were not always in place. This meant people were at risk of their medication not being administered safely.

Staff told us they felt confident administering and supporting people with their medicines and that they had received sufficient training for this responsibility. However, not all staff had received medication competency assessments to ensure they were safe and competent to administer medicines. Daily records indicated staff were applying creams, but there was no documentation specifying where these creams should be applied. Peoples notes lacked guidance, such as MAR charts or body maps to direct staff on application areas, the purpose of the creams, or the associated risks related to medication and pressure care. This lack of documentation posed a risk to safe and effective medication management.

Medicines were not always managed safely. Medication administration charts were not always available for people who were receiving medicines. Documentation regarding medicines contained conflicting information and did not reflect care planning documentation. For example, some aspects of care planning contained information staff were to administer medicines, whilst other sections detailed the person self-medicated. There was no MAR chart in place for this person and daily notes contained conflicting information about the support provided with their medicines. Medication auditing had been created after the announcement of the assessment. Therefore, we were not assured procedures were always followed or in place. People missed medicines and received medicines which were not listed within their documentation. Missed medication had not been identified by the service as there was not a robust process in place to monitor for missed medications. Audits created after the assessment, had not picked up the missed medications and contained incorrect information about people and their medicines. People were not always given medicine as prescribed. PRN medicines were ticked as given daily, however daily notes did not record why PRN medicine was required and there was no supporting documentation for these medicines. Peoples care plans gave direction for staff to apply creams, however there were no creams listed within documentation or medication charts or body maps available. This placed people at risk of not receiving their medicines or receiving them unsafely.