Rings Homecare Greater Manchester Also known as RHS GREATER MANCHESTER

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

Staff provided safe care. Staff knew the procedure for reporting accidents or incidents. The registered manager explained how they learned from incidents and followed the duty of candour when things had gone wrong. The provider had up to date policy and procedures in place for the management of accidents and incidents. The local authority told us the registered manager was open and transparent and was helping drive improvements. People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. Completed safeguarding forms were detailed and included information on who was involved, what happened, and the action taken to protect the person(s) and outcomes. The service worked with other agencies to meet people's needs. The provider had safe systems in place for appropriate and safe handling of medicines and medicines were given as prescribed. Staffing levels were safe, staff were recruited safely, and people were supported by familiar staff. People were supported by staff who had received relevant training. People had personalised care and support plans which reflected their needs. Staff assisted people to attend health care appointments. The registered manager provided examples of how the provider had worked with people to manage risks and make improvements within their lives. Environmental risk assessments were completed prior to staff providing any care and support to people. People and relatives confirmed staff wore personal protective equipment as required when supporting people.

This service scored 75 (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 family members knew how to complain but had not needed to. Comments included, “I have never had to complain but when I do call they [staff] will always listen and act on what I’ve said,” and, “Any issues are responded to very quickly and though I’ve not needed to complain, I know that they [staff] would listen and respond appropriately.” A file had been set up to store completed accident and incident forms, however, no accidents or incidents had occurred since we last visited the service. Where necessary, the provider or registered manager had written to people to apologise and explain what actions had been taken to address any concerns reported, in line with the Duty of Candour. The registered manager told us about 2 recent issues where people did not like the staff supporting them; in both cases, these staff were removed from providing care immediately and allocated elsewhere.

The provider had a complaints process in place. The registered manager said, "I am very big on being open, honest and transparent. It was difficult initially, as the culture here was different to this, but things have changed now. Complaints come through via phone and email and are documented and come straight to me. I tend to go out to visit the person, talk through the issues and try and sort them. If you get in at the start, you can stop things from escalating and turning into something bigger." Staff understood the process for documenting complaints, one staff member said, “We have to call the line manager to report these and there is also a form we have to fill in.” We asked staff if they received feedback or learning whenever an issue or incident had occurred. One staff member told us, “They [line-managers] provide an overall acknowledgement of the things we do and if anything went wrong they would tell us about this and how to improve.”

The provider had up to date policy and procedures in place for the management of accidents and incidents. Accident and incident forms were detailed, with sections for what happened, actions taken, what could be done to prevent a reoccurrence and whether any new risk assessments were required as a result of what happened. The provider had adhered to their complaints policy when dealing with any issues reported and used an electronic system for logging complaints received, action taken and outcomes. We discussed with the registered manager the need to consider including a lessons learned section, to help document any learning which could be taken forwards. The service was open and transparent and quick to respond to any concerns raised.

The registered manager told us about how they had adopted systems and strategies used by other professionals and organisations. For example, one person was non-verbal and used a specific communication tool when attending education; care staff had adopted this approach and also used this tool during their visits, to help them communicate with the person and vice versa. The registered manager told us they had formed links with the local hospital and their discharge team, to try and better support people being discharged back home following a stay in hospital. The registered manager said, “Hospital discharges are tricky, as timings are fluid. We may get told someone is being discharged within the hour but are still there two hours later. To help with this, we link in with hospital. Where possible we get the discharge staff to ring us directly, so can make sure staff are there when the person gets home.”

The provider worked closely with the local authority to support people when they transitioned into receiving homecare. The local authority told us the registered manager was open and transparent and was helping drive improvements and had been working hard and put a lot of improvements in place since they started in post. The local authority told us they had a good working relationship with the registered manager and had carried out a quality monitoring exercise in February 2024 which came out as Good.

Care files contained referral forms and local authority support plans where applicable. The provider worked closely with direct payment brokers and other professionals involved with people’s care and support to ensure this was safe and met their needs. The registered manager told us, "We often have a family member who is providing care, then the person is allocated a direct payment, so we would then go out and meet with them get them involved in the care planning process and take over the care and try to ensure this is seamless. The provider had a process in place for working with hospital staff, when people were discharged. The registered manager confirmed no person using the service had needed to move into a care home.

People and relatives told us safe care was provided by staff who knew people well. One relatives said, “Care is very good. Medication is given safely and they [staff] always leave the house secure. I have peace of mind [person] is truly cared for safely.” People and family members confirmed staff respected their wishes and offered choices. People were complimentary about the staff who supported them. One person told us, "I have no complaints at all. I have a carer every morning and it's usually the same people which is important to me. They [staff] stay for the full time and on the whole we get on very well. They [staff] leave the house secure, clean and tidy and always wear PPE. I self-medicate but they [staff] do apply my creams regularly." A relative told us, "One thing we particularly like is they [the provider] matched the carers ethnicity to [person] which we requested and this helps with [their] dementia to maintain communication and understanding; they [staff] really go out of their way to make sure this happens. Another thing is the staffs knowledge of dementia, which is very good as they have had training."

Staff told us they received training in safeguarding and knew how to report any concerns. Staff were able to name the different types of abuse they should look out for, with all staff confirming any concerns would be reported to their line manager. One staff member told us, “Types of abuse include psychological, sexual, neglect. If I saw anything, I would clarify the details, make notes and then report to the senior or the office.” Staff were also aware of the potential need to involve the police in any concerns about abuse. The registered manager confirmed some people using the service had been assessed by the local authority as lacking capacity, but were able to make some decisions and live at home. The registered manager said, "All the carers are aware you must offer choice to people; care plans are specific about people being able to make choices (including unwise decisions). I have discussed with staff about positive risk taking, and people’s right to make unwise decisions where they have capacity to make that decision."

The service had an up to date safeguarding policy and the registered manager had followed the local authorities' reporting guidance. Completed safeguarding forms were detailed and included details of who was involved, what happened, the action taken to protect the person(s) concerned and the outcomes. Care files explained whether people had capacity and had consented to their care and treatment. Where people had appointed a lasting power of attorney (LPA), details of this and what decisions the LPA could make were also included. The providers training matrix provided a record of staff attendance at safeguarding training and also training on the Mental Capacity Act and Deprivation of Liberty safeguards.

People and relatives told us risks were managed effectively and they were kept up to date with any issues or changes. A relative told us, “They [staff] give [person] their medication safely and correctly and there is a medication supervisor who comes out to check on this regularly, any change in [person’s] condition is always reported immediately.” The registered manager gave us an example of staff supporting a person who had mental health needs, and limited support in place. The registered manager had worked alongside the local authority and had secured additional support for this person which had made a positive difference and had ensured the person was receiving all the benefits they were entitled to. Staff had liaised with the person's GP regarding medication which the person was not always previously compliant with, and there were now no issues. Staff also supported this person to attend important medical appointments.

The registered manager explained how risks were assessed and managed within the service; they told us the care coordinator completed the care plans and risk assessments, in close partnership with them. The registered manager had explained what needs to be done and how. The registered manager provided examples of how the service had worked with people to manage risks and make improvements within their lives; they confirmed nobody using the service was subject to any restrictive practices or being legally deprived of their liberty.

Care plans contained a number of risk assessments, which were specific to each person. These covered areas such as medical conditions, mobility, moving & handling, skin integrity, pets, falls, finances, eating & drinking. Risk assessments explained the risk and actions in place to manage the risk. A rating of the level of risk, based on successful application of the controls measures was also included on the assessment. It was evident from reviewing risk assessments, people had been actively involved in their completion, as information was specific and the assessments included questions for the person. These questions and answers helped to formulate the risk assessment. Each person’s home file contained a copy of their risk assessments, alongside their care plan and other relevant documents. Care plans reflected people’s needs accurately and guidance on how to manage any risks was clear.

People and family members told us their homes were kept safe and secure during and after visits from care staff. A relative told us, "The carers are excellent with [person] and are always on time. [Person] has two carers at each call and they are consistently people who know [person]. They [staff] leave the home immaculately clean and always secure. [Person's] medication is always given safely and if they are ever unwell they [staff] inform me and act appropriately. The staff seem very well trained and really caring and I have peace of mind [person] is truly cared for safely."

The registered manager explained how and when environmental risk assessments were completed; they told us, “Before the care package starts we go out to do an initial visit, to talk about the care and support the person would like. As part of this process, we walk around the home and start the risk assessment process. Where necessary, we escalate any concerns to other bodies, such as reporting fire safety concerns to the fire brigade. We also complete health and safety risk assessments where required. For example, some people use walking frames, but their homes are cluttered or have rugs on the floor which could be a trip hazard.” Staff told us they found the risk assessments useful, and these helped ensure their safety. One staff member told us, “I am happy with these [risk assessments], no concerns. Any risks are considered, and we have the information to stay safe.”

Risks in or around people’s homes had been assessed, to help keep both staff and people safe. Areas assessed included flooring, furniture, sockets, appliances, lighting, stairs, any adaptations and access to the property. Depending on level of perceived risk a second more specific risk assessment had been completed. Documentation was also in place which listed where the gas valve, fuse box and stop cock were located in case of emergency. Staff specific risk assessments were also completed; these included lone working risk assessments for staff who completed care calls on their own, and assessments when staff were pregnant. Meetings were held with pregnant staff to discuss any required changes to working practices. The provider had a contingency plan in place which detailed what actions would be taken to deal with any incidents, utility failures, staffing issues and other disruptions and these were regularly reviewed.

People’s care visits were provided in line with their assessed needs and at the times stated within their care plan. Rotas viewed during the assessment confirmed staff travel time was provided and calls to people were spaced out appropriately. People and relatives spoke positively about the timeliness of care visits and the continuity of care and carers and told us their homes were kept safe and secure during and after visits from care staff. A relative told us, “The carers are excellent with [person] and are always on time. Another relative said, "We're really happy, they [staff] never rush and always stay for the full allotted time and give thorough, excellent care. We particularly like that it is the same carers who are known and liked by [person]; staff are reliable, on time and safe with [person's] care." A relative told us a staff member who was medication supervisor regularly visited the person being supported to check on medicines and any change in the person's condition was always reported immediately; they said staff respected the person's wishes whilst keeping the family informed.

Staff received enough training, supervision and support to carry out their roles safely and effectively. Staff new to care had to complete the Care Certificate which is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sector. The registered manager monitored training compliance to ensure all staff were up to date. Staff told us lots of training was provided and the induction process was very good and prepared staff for their roles and duties. Regarding staff supervision, one staff member told us, “We had supervision in January. I am happy with the process; we can chat in between meetings if we need to.” Staff told us their working rotas were manageable, with sufficient travel time included between calls. Another staff member said, “Travel time is provided; I am a walker but have enough time to get to each call.” We looked at how the provider determined how many staff were needed. The registered manager told us, "It’s very specific here, its person- centred. We have more than enough staff but not enough drivers. Even if we lose 5 carers, the office staff are all trained and can step in and they will do care visits before coming into the office. A lot of work is through direct payments and very specific. We have one person from [name of country] who only speaks [language]. We have 1 carer who speaks [language], so are advertising for another carer who speaks the language. Here is the first company I have been at where there are no issues with staffing levels."

Staff were recruited safely and pre-employment checks were completed; this included completing checks with the Disclosure and Barring Service (DBS) to ensure staff were of suitable character to work with vulnerable adults, seeking references from previous employers and ensuring the correct documentation was in place for any overseas workers. A new supervision process was implemented in January 2024, as the registered manager had identified when they commenced post in November 2023, this was not being provided correctly or consistently. All staff had completed a supervision meeting in ether January 2024 or February 2024, with the next meetings scheduled for May 2024. There was a clear staffing structure in place and people had clearly defined roles. There was a consistent staff team in place and systems were in place to induct and train staff and ensure staff received regular 1-1 support and regular spot checks to provide further management oversight. The provider used an electronic care planning system. When staff arrived at people's home they used an electronic tag to log in, so the office staff could monitor when they arrived. When staff logged in to this system, it identified a list of tasks, which explained what staff needed to do during the visit. Staff could input notes verbally onto the system.

People and relatives confirmed staff wore personal protective equipment (PPE) as required during care visits, and people's homes were left clean and tidy.

Staff told us they received training in infection prevention and control (IPC) and the safe use of PPE, as well as food hygiene. Staff accessed PPE from the office and there was always enough supply. One staff member told us some of the people they supported had agreed for PPE to be stored at their properties, to ensure there was always a fresh supply. The provider told us they had up to date IPC policies and procedures in place, which we saw. Staff told us they completed training in IPC during induction with annual refreshers completed, which we verified by looking at staff training records. Alongside training, staff’s understanding and adherence to IPC policy and procedures, as well as safe use of PPE was assessed during spot checks and via specific competency assessments.

We reviewed medicines records for 4 people, we spoke with 2 members of staff and visited 2 people’s properties to check how medicines were handled. People told us they were happy with the medicines support they received. People’s care plans were personalised and detailed their individual medicines needs. People were given their medicines safely and at the right time, including time-specific medicines. There was a robust medicines reconciliation process in place. People were supported to access health care services and appropriate monitoring relating to their medicines. People's allergies were listed. Staff assisted one person to access their GP and nurse appointments to ensure they received the required regular injections and to monitor the person's health conditions. People and relatives we spoke with had no concerns about how medicines were managed.

The manager told us staff had completed medicines training and had been assessed to ensure they gave medicines safely. We were shown evidence of training records to confirm this.

The provider had safe systems for the appropriate and safe handling of medicines and staff followed clear medicines policies and processes. A robust process was in place to accurately list people’s medicines. Medicines support provided was recorded accurately. Information to support staff to safely give ‘when required’ medicines was in place and was person centred. There was evidence of regular medicines audits and evidence of incident reports and lessons being learned. Medicines audits were completed regularly and actions taken following completion were recorded.