180 Surrey Street

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

The provider was unable to demonstrate call scheduling was always effectively planned. Staff did not always stay for the full duration of their scheduled care visits. Staff did not always report all accidents and incidents through the providers reporting processes. The providers systems did not always provide enough detail to manage risks to people and to protect them from the risk of harm. The provider had systems and processes in place to safeguard people from the risk of abuse. Staff received training and understood their responsibilities to safeguard people. Staff were recruited safely and received ongoing training and support within their roles. Staff managed medicines and treatments safely and met people’s needs.

This service scored 59 (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 feedback from people and their relatives about the culture of learning within the service. One person told us, "The regular carers seem well trained but the new ones don’t really know what they are doing, they try to resolve this by job shadowing." A relative told us that updates to care records were made when their loved ones health condition changed saying, "Everything is recorded and updated."

Although there had been improvements to oversight and response to incidents and accidents, staff did not demonstrate an awareness of distressed behaviour as incidents and did not report occurrences through internal processes. This presented a risk that incidents of distressed behaviours were not effectively analysed or responded to reduce the level of distress for people. We raised this with the provider who told us they would address this with staff. One member of staff told us the management team verbally communicated lessons learned. Although they were unable to provide any examples of learning that had been communicated.

The provider had recognised improvements were needed around staff understanding and reporting of accidents and incidents. The provider had developed an action plan to make improvements. They had met with staff to raise their awareness and had introduced a new process of analysis to ensure a robust review and response to accidents and incidents. However, action areas did not evidence how the provider would ensure improvements were embedded in staff working practices. Further work was needed to ensure staff fully understood incident reporting and responses; particularly around distressed behaviours.

People and their relatives told us they were happy with the continuity of care staff attending their care calls. They told us there was a consistent staff base, one person said, “It’s like a routine with the carers I get from the morning to a different set in the evening. I’m happy with the continuity”.

The registered manager told us they worked closely with commissioners and hospital discharge teams to provide care and support for people leaving hospital and for people who required longer-term care through supported living or if people were moving between services. Staff told us they received detailed information from the registered manager during people's transition to the service. The provider carried out assessments with other healthcare professionals and shared information to help ensure safe transition between services.

Prior to our assessment, the commissioning authority had identified concerns around assessments and care planning, including assessment of risk. Commissioners had taken action in response to their concerns and were working with the provider to support them to make required improvements under their contractual responsibilities. At the time of our assessment, commissioners told us there had been some progress towards making the required improvements.

The provider had recognised systems and processes to assess, establish and monitor safe systems of care for people required further development. For example, people’s risk assessments were not always sufficiently detailed or comprehensive to support staff to provide safe care. Interim assessments and strategies to enable staff to provide consistency in responses to acute distressed behaviours were not in place. The provider was in the process of making improvements at the time of our assessment, though this had not yet been embedded in to practice.

People told us they felt safe with the care provided by staff at the service. One person said, "“I really do feel safe with the carers I get.” The relatives we spoke to were positive that their loved ones received safe care and treatment. A relative told us, “My relative definitely feels safe with the carers being there.”

The registered manager told us they ensured all staff completed safeguarding training and understood that safeguarding was everyone's responsibility. They discussed safeguarding scenarios and lessons learnt in staff meetings. The registered manager told us they completed assessments of people's needs and identified risks prior to people using the service. They shared this information with staff through care planning and guidance. Staff understood safeguarding and told us they felt people were safe. One staff member told us, “If I was concerned about anyone I would report it. We have our own lines of reporting which minimize the risk of abuse. We also have access to whistleblowing if we need to raise concerns.”

Processes were in place to ensure people were protected from harm and abuse. The registered manager worked with external agencies to ensure timely action was taken to keep people safe.

People and their relatives told us they were aware of care plans being in place, but they had not been fully involved in developing the content of such documents. One person said, "I believe there is a care plan, but I haven’t had much involvement in it."

Staff felt they had received sufficient training around mitigating people's risks and health and safety to provide safe care. A staff member told us, "Risks for people are assessed before they start to use the service and managers identify ways to minimise risks as far as possible. People are safe because we follow the guidance in people's care plans which is comprehensive." Staff told us they were able to raise concerns if they felt people were at risk or changes needed to be made and action was taken by managers.

The provider had assessed risks to people's safety and wellbeing. The assessments included plans about how they could support people and reduce risks, however, these were not always sufficiently detailed or personalised. For example, risk assessments relating to people’s health conditions did not always include the guidance staff needed to understand and respond to these. People’s daily care records showed staff were not fully responsive or effective in monitoring emerging risks associated with people’s health and wellbeing. Daily care entries were not always sufficiently detailed or appropriate use of terminology.

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

Some people we spoke to raised concerns around the punctuality of staff and felt that care calls were often rushed. They said, "They are telling me regular that they have to leave for their next visit which can be annoying at times.” Some relatives also noted that care staff did not always stay for the full allocated time. One relative said, "They seem reliable, but they don’t always stay as long as they should stay with [relative]." Another relative we spoke to provided positive feedback and said, "Reliability for arriving on time is very consistent, I think they stay for the correct allotted time."

Staff told us they thought there was enough of them to meet people's needs. They described how they worked well as a team and supported one another. Staff explained they undertook training which helped equip them for their work. The provider told us they had developed rotas to help make sure people were usually cared for by the same group of familiar staff. The provider did not use agency staff and was able to meet their assessed staffing needs with their own employees. Feedback from some people and relatives was that staff did not always stay the agreed length of time and people sometimes felt rushed, with staff informing people they had to leave early as they did not have time to get to the next visit. We raised this with the provider who told us they would investigate and take action to remedy this. The provider told us some people asked staff to leave early if all support had been completed and this was their choice. However, staff had not recorded this within daily care notes and therefore there was no evidence to support this agreement.

The provider offered a range of training for staff. Staff had recently undertaken training about people with a learning disability and autism. The provider arranged for staff to undertake specialist training with external professionals when a person had a specific need, for example using a new piece of equipment or a health condition. There were safe systems for recruiting and selecting staff. These included checks on their eligibility to work in the United Kingdom, suitability, and experience. New staff completed inductions, which including shadowing experienced workers and a range of training. The provider used an electronic call monitoring system (ECM) to schedule care calls and plan staff rotas. Records showed that staff were not always provided with adequate travel time between care calls. A further review of the providers ECM records demonstrated that staff did not always log calls correctly, sometimes marking themselves as attending a call when they were not physically at the persons property. The systems and processes in place for monitoring calls were not effective in identifying issues with ineffective call scheduling. The result of which was some people felt their care was rushed or that staff were leaving for their next call without staying for the fully allocated call time.

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 and their family members expressed satisfaction with the support provided medicine administration. One family member. A relative said, “My relative takes medication and that’s handled very professionally with good thorough communication."

Staff had undertaken training about the safe handling of medicines. The registered manager gave us examples about positive support they had given people with their medicines, including working with people, their families and health professionals to make sure people received the right medicines, that these were reviewed, and that administration was personalised. Care records included information about people's medicines and any risks associated with these. Staff kept records to show when they had administered medicines. The management team audited these and to check staff were following procedures. Audits and checks showed the management team addressed areas of improvement directly with staff and monitored to ensure these were actioned.

Care records included information about people's medicines and any risks associated with these. Staff kept records to show when they had administered medicines. The management team audited these and to check staff were following procedures. Audit and checks showed the management team addressed areas of improvement directly with staff and monitored to ensure these were actioned.