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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

The service was not always safe and has been rated requires improvement. We found a breach of regulation relating to records. Risk assessments did not always reflect known risks or working practices, although we found no evidence that people were harmed, there was potential risk due to the lack of clear guidance. Records relating to recruitment, training and staff support were incomplete and did not always follow good practice. These needed to improve. We had mixed responses from staff about the support they received. People told us they felt safe and trusted the staff who supported them. Accidents and incidents were reviewed, and lessons learnt shared with staff. Staff had safeguarding training and knew how to recognise abuse. Staff understood the requirements of the Mental Capacity Act 2005 (MCA).

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.

People told us they felt the service responded to and learnt from any issues that occurred. Staff asked for people’s feedback and responded to this. People found staff were competent, caring and treated people in a dignified manner. Most people told us they found staff open and willing to discuss their care and any changes needed. A relative told us they could review the care records via a telephone app and said, "I can ask anything, and they will tell me.”

Staff had mixed views about how well the service listened to and learnt from their feedback. One staff member told us, “Yes, we can talk openly and freely to all our managers, senior and head of services.” However, other staff told us they did not feel their comments were acted on by management. For example, a staff member told us, “I am able to communicate any issues but know they are not listened to and, no, I never get feedback.” Management told us they acted on information shared with them and used this to improve the service.

Processes were in place to support a learning culture. Accidents and incidents were reviewed for trends and learning was shared with staff. The registered manager was open to feedback and there were various ways people and staff could comment on the service.

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.

Everyone we spoke with said they felt safe using the service and with staff. People felt able to raise concerns about safety and had confidence staff would respond. One person said, "I feel very safe because they [staff] explain everything they are doing and if I know, I feel safe.”

Staff told us they had safeguarding training and a good understanding of what to do to make sure people were protected from harm or abuse. Staff were able to tell us actions they would take should a concern be raised with them. One staff told us, “We all have a responsibility to safeguard our service users through supporting and prompting wellbeing and health. Protecting from harm, neglect and abuse.”

There were systems and processes in place to support safeguarding practices. Staff had training and policies to support their understanding of safeguarding and the Mental Capacity Act 2005. Where concerns had been raised action had been taken.

People told us they felt involved in managing risk and felt safe with the care provided. One person told us, “I feel pretty safe, they [staff] are very careful. They take very good care of me.” However, we could not be assured people were fully aware of all the risks involved with their care, and the action being taken, as care records were not accurate.

We received mixed feedback from staff about the management of risks. A staff member told us, “Everyone is entitled to take risks if they have the mental capacity to think about the outcome. I would discuss with the customer to assess if the risk would be positive for them.” Another staff member told us about a change in a person’s needs and presenting risks, that had not been recognised in the person’s care records. They had raised this with senior staff but told us records had not been changed. Another staff member also told us records were not always up to date or available. The registered manager told us they tried to ensure consistency of staff so that they built relationships of trust with people and knew their presenting risks.

Risk assessments were incomplete. This resulted in a breach of good governance around record keeping. We found risk in people’s care and visit records that were not transferred to risk assessments. Staff did not always have enough guidance to support people safely. For example, some people did not have risk assessments for the use of bedrails, specialist equipment or personal risks. Audits and checks did not identify the issues we found with risk assessments. Where we highlighted issues with risk assessments the registered manager told us they were taking immediate action to update these.

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 told us they felt staffing was safe and care was delivered on time. They felt they had consistent staff with the skills and knowledge to carry out their role effectively. One person told us, “I have the same carer come in nearly every morning. [Name] is wonderful, they come at the same time, but I can press my buzzer if I need them earlier, which is great.” Another said, “They [staff] don’t tend to be late they stick to structure.” Although people raised no concerns about staffing, we identified a breach of good governance in relation to staffing records. We also received mixed feedback from staff about the support they received.

There were enough staff to ensure people received care as planned. However, staff told us they did not feel there were enough staff, and some told us they had worked a lot of additional hours to provide cover. One staff member told us, “It feels like we are always understaffed. When someone calls in sick, or is on holiday, it is not well managed.” A further staff member said, “We are currently undergoing a large staff recruitment so staffing is low at present, but I am confident we will be adequately staffed soon.” The registered manager told us there were enough staff for the hours being delivered and recruitment was ongoing. Although some staff were well supported, other staff told us they did not always feel well supported in their roles. Some told us they felt training needed to improve and some shared concerns about the e-learning training on offer. A staff member said, “Training currently is not good. I understand the need to go digital, but we all need to learn differently. Some are not confident using technology. I don’t feel supported.” The registered manager told us additional support had been offered for staff to help them with e-learning and they could do this with a trainer present. Some training, such as moving and handling, would remain face to face. Some staff also told us they felt formal support was not always effective or consistent. For some staff supervisions and appraisals had not happened as regularly as planned. The registered manager told us staff were appropriately trained and supported to progress, “We have staff matched on the rota and have all been trained, and I support them through a career escalator.” Management acknowledged, due to unplanned leader absences, some supervisions had fallen behind schedule. They told us they would review the support offered to staff considering the mixed feedback gathered during this assessment.

Processes were in place around safe staffing and recruitment, but records were not always accurate or up to date. Records needed to improve to reflect good practice and the policies in place. Some recruitment records were incomplete. For example, full employment histories, or exploration of any gaps, were not always documented. We were advised by the registered manager that further discussions happened with staff around this at interview. Although most staff received relevant training, overview records for this were not complete or up to date. The training matrix did not include dates of when training had been undertaken. Where training was not completed, or failed, it was unclear what action had been taken. Although supervision and appraisal processes were in place, we could not be assured all staff were being supported in-line with the provider’s policy. Processes were in place to ensure there were enough staff and care visits were delivered as scheduled. The provider was currently recruiting for more staff, which would help safe staffing level to be maintained. The registered manager was open to our feedback and advised they would remedy the concerns raised straight away.

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.

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