CCS Home Care Services (Hillingdon)

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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 identified one breach of the legal regulations. There were systems to record and investigate incidents and accidents, safeguarding and complaints but people’s care plans and risk assessments were not always updated with the identified actions. Risk assessments were not always developed for identified risks. The provider did not have a robust system to ensure visits always started and ended as planned. We have asked the provider for an action plan in response to the concerns found at this assessment. The provider supported people to have a safe transition when they started to received care in their home. There was a process for the prevention and management of infection. People received their medicines as prescribed and safely. Care workers completed a range of training courses to meet people’s support needs. The provider had a recruitment and supervision process which enabled them to assess the competency and suitability of care workers.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives confirmed they knew how to raise any concerns or complaints about the care provided but at the time of the assessment they had no concerns. A relative told us they had raised a concern about their family member’s care which was acknowledged and resolved. While the people we spoke to expressed that they knew how to raise a concern, our assessment found the process for identifying actions to reduce risks did not meet the expected standards.

The registered manager explained learning from incidents and accidents, safeguarding and complaints were discussed with staff, and this was confirmed by care workers. The registered manager had a good understanding of the role of the duty of candour when providing care. They said, “If there is any concern that has been raised it is my duty as registered manager or as a care service that we acknowledge the concern and respond to it and we are open and transparent about any concern and if there is a mistake we need to raise our hands and take responsibility and deal with it.”

The provider had a process for the recording and investigation of incidents and accidents, safeguarding and complaints but people’s care plans and risk assessments had not been updated to reflect the outcome of the investigation and any actions identified. The incident record for one person indicated they had experienced a fall, but the risk assessment had not been updated to include the fall and the actions identified from the investigation. This meant the provider could not always ensure care workers were provided with up to date information on the appropriate action which was identified following the investigation of the fall.

We did not receive feedback from people receiving support and relatives of people who received care about this aspect of the service.

The registered manager told us the majority of care packages they provided were funded by the local authority and they worked closely with them to ensure people received they support they needed.

The provider worked with a range of external teams and organisations when providing people’s support. We did not receive any direct feedback from partners as part of this assessment, but we saw the local authority had identified in an audit that the provider had carried out assessments of people’s needs before their care package started.

The registered manager confirmed they used information from the local authority and healthcare professionals when developing people’s care plans when they started to receive support in their own home.

People stated they felt safe when they received care in their own home. Relatives confirmed they felt their family member was safe when they were supported.

Care workers demonstrated an understanding of safeguarding in relation to providing support. The staff described how they would escalate any concerns to the office. They also confirmed they had completed training on safeguarding adults which was confirmed by the training records.

The provider had a procedure for the reporting and investigation of safeguarding concerns. If an issue was identified it was reported to the local authority, an investigation was carried out, any actions to reduce the risk of recurrence recorded. However, the care plans and risk assessments were not always updated.

People felt safe when they received support from care workers. While the people we spoke to expressed that they felt safe when they received their care, our assessment found elements of care did not meet the expected standards.

Care workers confirmed they could access people’s care plans and risk assessments using the electronic care planning system on a handset.

The provider had a system in place to assess and mitigate risk, but risk assessments had not always been updated when a possible risk had been identified. For example, a person had a fall and the care plan did not provide guidance for staff on how to mitigate any further risks from their health condition. Risk assessments had not always been developed for when people were supported with outreach activities in the community. People’s care plans indicated that care workers supported them with undertaking activities they enjoy but risk assessments had not been developed to identify how care workers could mitigate possible risks due to known health conditions.

CQC does not assess people’s home environments for this type of service. However, the provider had completed risk assessments in relation to the internal and external environments of each person’s home.

We did not receive feedback from care workers about this aspect of the service.

The provider had provided staff with additional information in relation possible risks related to the internal and external environment of the person’s home.

People receiving support and relatives gave a range of feedback in relation to the care visits. Some people and relatives told us that the care workers did not always arrive at the agreed time and they were not always contacted when the care worker was running late for a care visit. However, other people said the care workers arrived on time. People also said they felt care workers did not always stay for the full time of the visit. Their comments included, “The lunchtime call is so late that it is nearly time for the evening call and mum still has not had her lunch. Mum does not like to say anything to upset them”, “They are regular and they come on time. I had to sort it out with them direct” and “It is more consistent and much better lately. There were times when it wasn’t so good.”

Care workers confirmed that rotas did not always include a space between each visit for travel time. They told us this meant that some visits ran into each other. The staff who created the rotas, for care workers who walked or used public transport, tried to group local visits together. The registered manager stated that the electronic call monitoring system (ECM) did not permit care workers from being logged in as present at 2 different locations at the same time. The records indicated this was possible and the registered manager confirmed this would be looked into. Following the assessment the provider submitted an action plan indicating how they were planning to make improvements in relation to the ECM.

The provider had an ECM which care workers used to record when they arrived and left visits. The visit records showed that the provider did not always allocate care workers with travel time between each visit. The start time of one visit was the same as the end time of the previous visit. This meant care workers did not always have enough time to travel to the next visit. The visit records for some care workers also indicated that they had registered for the next planned call but had not logged out the previous visit. The meant the records showed the care worker was in 2 different locations at the same time and the provider could not ensure visits started at the indicated time and were for the agreed length. The provider had robust recruitment processes which included obtaining both character and previous employer references, disclosure and baring service check for criminal records and the applicant’s right to work in the UK. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. Care workers completed a range of training including moving and handling and basic life support. Care workers attended regular group and 1 to 1 supervision meetings and spot checks were carried out 4 times a year.

People told us care workers used personal protective equipment (PPE) such as gloves and apron when they provided support with personal care.

Care workers had a good understanding in the importance of infection prevention and control and confirmed they had completed training. A care worker told us, “We do the infection control training to understand how to prevent infection and cross contamination. We also learn how to dispose of our aprons, gloves, sharps and incontinence aids safely.”

Training records showed care workers had completed training on infection prevention and control. The registered manager confirmed that care workers were provided with PPE and there were processes to ensure they could obtain additional supplies when required and they followed best practice when using PPE.

People receiving care and relatives confirmed care workers provided support with medicines if required.

Care workers told us they had completed administration of medication training each year. Care workers told us they were confident when administering people’s medicines and they knew what to do if an issue occurred with the medicines. The registered manager confirmed that care workers completed a competency assessment in relation to the administration of medicines and there was a medication officer who provided support and guidance for care workers.

The provider had a procedure for the administration of medicines and used an electronic medicines administration record (EMAR) which was completed by the care workers. The EMAR included information on the dosage, frequency of administration and, if a cream was prescribed, where it should be applied. Where a person had been prescribed a medicine to be administered as and when required (PRN), staff were provided with guidance on when the medicine should be administered.