Eclectic Care Ltd

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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 found that the service Requires Improvement in relation to the Safe domain. We identified two breaches of the legal regulation in relation to safe care and treatment and fit and proper persons. People’s medicines had not always been managed safely. The service did not follow their own policies and procedures when administering medicines and inaccurately recorded information relating to medicines management. People's risks were assessed, and staff knew how to mitigate these. However, some risk assessments did not contain enough detailed guidance in all areas to inform staff of how best to keep people safe and meet their needs. Staff had not always been recruited safely; some staff did not have full previous employment history as required. However, there were enough skilled staff to support people for their scheduled care calls. People were safeguarded from potential abuse. The service had a learning culture which reflected on people’s experience including their safety and tried to improve it.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a positive culture of learning from incidents and making changes to people’s care when required. The registered manager told us about how they had resolved a complaint in relation to staff member’s personal attire. They said their company policy was, “the customer is always right, and any concerns addressed immediately.” The registered manager used meetings to discuss incidents with staff and make changes to prevent a re-occurrence. Complaints, concerns or accidents were logged, and action was taken when any patterns or trends were identified so that the service could learn and be better.

People were supported with their transition to receive domiciliary care. People and their loved ones told us they met with the registered manager to discuss their needs before the service began delivering their care. One professional gave positive feedback about the systems in place to support people to transition between services. They shared, ‘In some case, Eclectic Care Ltd has requested that I was present during the initial assessment to reassure the service user and to encourage full participation. Other times, they have requested the presence of family or other professionals that the service user is familiar with where it was established that the service user requires support to be able to participate in their care package assessment.” This helped to support people’s transition. People had been referred to external healthcare professionals when required. For example, the registered manager told us about people being referred to the GP, district nursing team and the falls clinic when any changes in people’s needs were identified.

People spoke highly of the support they received and said they felt safe with the staff supporting them. One person said when asked if they felt safe, “Yes, I need care, and I wouldn’t cope myself without them, they are very good.” Staff understood the potential signs of abuse and knew what action to take if they had any concerns. Staff followed the provider’s policy and procedure and had received appropriate training to keep people safe. Safeguarding referrals had been made to the local authority as required. Staff completed a safeguarding incident log when any concerns were identified, this information was then raised with the local authority and any actions were recorded.

People told us staff met their needs as required. Staff knew people well and understood any potential risks when meeting their needs. Staff followed guidance from health care professionals such as occupational therapists when supporting people to move using mobility equipment. Potential risks posed to people had been recorded in their care records and were reviewed on a regular basis. Risk assessments contained some details to support staff to identify and escalate concerns in relation to specific risks. However, this was an area for improvement. Some records lacked detail for example people at risk of skin breakdown risk assessments said monitor and report concerns without the signs to look out for. Some records contained inconsistent information about people’s needs or information that was out of date. For example, some records were not clear or conflicted on who was responsible for people’s needs whether this was staff or family members.

Systems were in place to ensure people’s safety was maintained in relation to their environment. Risk assessments, care plans and daily notes demonstrated environmental safety for example, staff used people’s key safes and returned keys and recorded they checked doors were closed properly when leaving the property.

People told us they had the same team of care staff who arrived on time and stayed for the entire length of their care call. Systems were in place in the event that staff were running late and people confirmed they were informed if there was going to be any changes to their care call.

Staff felt they had enough time between their allocated care calls and told us they followed procedure if they were going to be late. The registered manager told us they monitored people’s care calls daily to ensure people received their care as required. Staff told us they had been trained to meet people’s needs including their specialist needs such as, managing behaviours which may challenge and dementia care.

Staff recruitment files did not always contain a full employment history with any gaps in employment explained. This is necessary to ensure staff are suitable and safe to work with people. Other checks were in place and had been completed such as Disclosure and Barring Service checks. New staff worked alongside experienced staff to get to know people before working alone. Care call monitoring was in place to review whether people received their calls. Instances of reported late calls were investigated by the registered manager. As part of the service’s governance a report was run of care calls. However, the registered manager told us there were some variables which meant the data was not always accurate and there were limitations to how they could access their data. We were not fully assured the report provided clear, detailed information to demonstrate complete effective oversight of care call monitoring.

People told us and their relatives confirmed that staff wore personal protective equipment (PPE) such as gloves and aprons to reduce the risk of infection. Staff had been trained and followed the provider’s policy and procedure in relation to infection, prevention and control. Staff’s usage of PPE was observed and assessed during spot checks by a member of the management team. People told us that staff cleaned up after themselves and completed additional tasks such as, putting the washing on or hanging it out.

Feedback from a relative during our assessment highlighted that staff were secondary dispensing medicines to one service user at the request of their family. This is where medicines are removed from their original packaging and repackaged or left before being given at a later time. Although feedback received was positive about the medicines administration process, this practice leaves potential risk that people won’t receive their correct medicines as prescribed. However, no evidence of harm to this service user as a result was found during our assessment.

Staff we spoke to explained how they administered medicines for people. The process described was not in line with the service’s policy which prohibits secondary dispensing of medicines. Staff also told us they recorded medicines as administered at a later time than the actual time that it was administered. This is also against the service’s policy. Since this assessment, the provider provided evidence to demonstrate that paper administration records are now being used and these record the time of administration.

Records in relation to people’s medicine management such as medicines assessments, risk assessment and care plans were not always up to date, and some contained contradictory information. Although there was a medicine administration policy in place this was not being followed. For example, medicines administration records were not being completed at the time of administration, medicine administration records did not contain all relevant information such as dosages in line with the National Institute of Care Excellence guidelines. The medicines policy indicated a regime for medicines governance; however, we could not be assured that these had taken place. No evidence of harm was found during our assessment however people were placed at potential risk of harm from the medicine practices being carried out.