Bkind 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

This key question has been rated good. We reviewed 4 quality statements for this key question. We found risks to people and medicines were not managed safely. Staff recruitment procedures were not robust and not all staff we spoke to said they had received the required training. People provided mixed views about how they were kept safe. Some people said staff were late to visits and they had not been contacted, whilst others said staff were helpful.

This service scored 53 (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 with from people and their relatives with some feeling there was a learning culture in place and others stating, “ the provider came out at the beginning and went through all mums care needs but my frustrations are they don’t seem to take any notice." Incidents were not always learnt from and the management team did not always ensure action was taken to improve practice.

Staff were aware of the reporting procedures for an accident or incident, however the procedure was to report this to the registered manager, who would then complete the paperwork. Staff told us that they do not see or complete these themselves. The management team told us, “We complete accident and incident form for all concerns.” However these were not all evidenced when asked to see completed accident and incident forms.

Processes were not in place to ensure continuous learning from incidents and accidents. We saw that incidents and accidents were not all appropriately recorded, investigated and learnt from to reduce the risk of recurrence.

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.

Mixed feedback was received from people who used the service and relatives, with some stating staff were lovely, helpful and kept them safe and others telling us they did not feel the support they received was always safe.

Staff told us they had a good understanding of safeguarding and how to recognise abuse and what action to take, however we found safeguarding training processes were not undertaken as required and did not give assurance that staff had received this training as required.

There were processes in place to report concerns to the relevant safeguarding authority when required. However, we identified an incident which had not been reported to the safeguarding authority as required. Leaders told us there was a safeguarding policy in place and this was available to staff on their app, however mixed feedback was received from staff with some staff members informing us this had been made available on the app following the assessment visit and was not available prior to this.

We received mixed feedback from people and relatives. Some said they received safe care and others said their calls were often late. Where this occurred, people did not receive any feedback about why their call was late. Relatives felt this placed people at risk. One relative informed us that no care plan or file had been available for staff, prior to the assessment visit for one person.

Staff were not always aware of risks associated with people’s care as risk assessments were not always detailed or completed. Staff told us care plans and risk assessments were on the app and within people’s homes. Upon checking we found staff did not have all the information required to keep people safe. One staff member said, “Sometimes these [risk assessments] are detailed but not always. I have never seen a care plan being reviewed or updated. I’ve never seen people involved.”

Risks to people were not managed safely. Risk assessments were not in place for people as required. We reviewed 4 risk assessments and found these were only available in the office. They were not available in people's homes for staff to refer to. There were no risk assessments in place for 33 of the 37 people supported with a regulated activity such as food and fluid, medication, person care and mobility. For example, one person required catheter care and there was no risk assessment or support plan in place to safely manage this need. This was a breach of regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

People told us staff did not always maintain a safe environment. One person said, “They leave my bedroom window open, when they leave, I ask them to close it but that does not happen, I then go out and my house is left unsecure.”  

We received mixed feedback from staff with some stating they supported people to maintain the safety of their environment and others stating that they did not have time to undertake management of the environment. The management team told us, “We go through an environment assessment and look at what is required when we start a new care package, however there was no evidence of these.

Processes were not in place to ensure people were supported using safe equipment and keep their home safe. No risk assessments were in place were required and care plans did not state what actions were required to keep peoples and staff safe within the homes visited.

People gave mixed feedback regarding staff who visited them. Some people stated the staff were caring and supported them well and others stated staff did not undertake the tasks asked, arrived late and did not speak with them. Comments include, “I have spoken with the registered manager because they [staff] are coming too late on a morning” and, “I'm not sure what training the staff get but I don’t think they have enough knowledge for example around nutrition they don't seem to give the correct foods, or they give the wrong meal at the wrong time.”

We received mixed feedback from staff with some staff stating that they had received appropriate training and others stating they had not received training since commencing employment with BKind Care Ltd. Some staff said they had received an induction and undertaken shadowing whilst others stated they had not. One staff member said, “I had no induction into the service and no shadowing.” We received mixed feedback regarding supervision with some staff stating they had not received a supervision and others stating they had.

Recruitment processes had not always been undertaken safely and not all staff had the required documentation in place to ensure they were fit and proper persons and had sufficient knowledge to support people as required. We did not find any evidence of supervisions to monitor staff practice. This was a breach of regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014.

People were not always protected as much as possible from the risk of infection. One relative told us “Staff should be doing personal care and and washing, dressing and medication, however these are not done as required, underwear is not always changed, and [Name] is lefty in the same clothes even when they are dirty.” Another person told us staff do not always wear PPE.

Staff were not always clear about their roles and responsibilities around infection prevention and control due to a lack of training being available. One staff member told us that PPE was not always available and that this was restricted for example a box of one hundred gloves a month.

We received mixed feedback from people and relatives in relation to support provided with medication. One person told us they were happy with the way the staff gave them their medicines. Family members of three other people told us staff always came but were sometimes significantly later than scheduled. Some people said the delay in receiving their morning medicines had an impact on their daily routine.

Staff told us they received medicines training. However, the manager said the record of staff’s medicines competencies was not easily available and therefore we had no access to this. One staff member told us the manager had never assessed their competency to give medicines in a person’s home. The service had a comprehensive medicine policy however, staff we met were unaware of the policy and had not read it.

Medicines were not always managed safely. We looked at Medication administration records (MARs) and found there were many unexplained gaps. Medication support plans, if in place did not show current medication. We found MAR charts with medication crossed out and no explanations regarding this. People’s medication care plans did not meet the standard required by the service’s own medicine policy. There were no PRN protocols in place for people who required medicines ‘as needed’. Where PRN medicines had been administered there was no record to show why the medicine had been given or the dose of medicine. Medicines were not checked by staff. For example, one person’s Dossett box (used for storing medicines) had 3 paracetamols in rather than the prescribed 2. This was in use but had not been verified as this would have been noted in the stock check. Instructions from the pharmacy were not always clear with descriptions of medication, although this is a pharmacy error this had not been picked up on medication checks prior to administration and actioned by either the staff member or escalated to the registered manager. We saw evidence that one person’s senna medication had been signed for as being administered by staff however this was not correct as the family had been administering these medicines on an evening. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.