Global House Facilities (UK) Ltd

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

During our assessment of this key question, we identified five breaches of the regulations. The provider failed to provide safe effective leadership, governance and to have and maintain robust oversight of the service and its delivery. The provider failed to act in accordance with the requirements of the Mental Capacity Act 2005. The provider failed to ensure people were protected from the risk of abuse. failed to ensure medicines were managed in a safe manner and risks to people were not always identified, assessed and recorded and staff did not always have access to risk management information to ensure the support they provided to people was safe and appropriate to meet their needs. the provider failed to ensure there were systems in place which provided safe and effective staffing. Notwithstanding the above, people and their relatives told us the provider ensured the continuity of their care. People and their relatives felt safe when receiving care from staff. Some staff understood what abuse was, the types of abuse, and the signs to look for. Some staff told us, they knew how to respond to people’s risks and to meet their needs. People and their relatives were satisfied with staff team for the care and support they received. Staff training records showed they completed training required including refresher courses to carry out their roles. Staff told us the training programmes enabled them to deliver the care and support people needed. Staff told us they had regular supervision either face to face or virtually in a group and felt supported by the registered manager.

This service scored 38 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

Some of the people and relative's we spoke to said the provider ensured the continuity of their care. For example, a relative told us, “My relative had a full assessment via a social worker upon leaving hospital and as a relative, I’m satisfied the formal assessment went well”. “The company share enough information with me that’s important to me as relative”.

We drew this omission to the registered managers attention who informed us that they would implement appropriate systems. We will check on the implementation of this at our next assessment of the service.

The provider failed to work effectively with commissioning partners and to implement a safe and effective handover and transfer process to ensure continuity in people's care. Systems in place and staff we spoke with showed that the provider was not proactive in seeking ways to participate and communicate with commissioning bodies and with health and social care professionals. There were very limited processes in place for reviewing and improving communication internally and with external health and social care partners. There was little evidence of inter agency and partnership working, and the provider failed to become involved in practice forums, system meetings, provider support, commissioner quality assurance or communication with other parts of the local system with which the service has links. However, the provider’s current commissioner in their feedback have raised no concerns with the care packages, staff and about the provider.

There were no systems in place to actively seek the views of a wide range of stakeholders, including people using the service, staff, professionals, professional bodies, commissioners, local groups, members of the public and other bodies, about their experience of, and the quality of care and treatment delivered by the service. There were no systems in place to analyse and respond to information and feedback gathered, including taking action to address issues where they were raised, and to use the information to make improvements and demonstrate that the provider had taken appropriate actions and to learn from them. This placed people using the service and staff at risk of potential harm.

Some people and their relatives felt safe when receiving care from staff. For example, one person told us, “I feel safe with the staff that look after me”. One relative said, “My relative loves the staff and we are both happy. [My loved one] is kept very safe in their hands”. Another relative commented, “We have no safety issues with my relatives care”.

We drew these omissions to the registered managers attention who confirmed that MCA’s had not been completed. We discussed with him about the MCA and advised the provider should seek up to date further training for staff and to also consider the implementation of this as part of their transfer of care when people are discharged from hospital or transferred from other services. Staff were not knowledgeable about them, how to respond to concerns raised or knowledgeable about safeguarding and best practice. We discussed these concerns with the registered manager. Their knowledge of safeguarding processes and best practice was limited, and we advised the provider to seek up to date further training for staff. Some staff understood what abuse was, the types of abuse, and the signs to look for. This included staff being aware of the action to take if they suspected someone had been abused and reporting their concerns to the registered manager and the local authority safeguarding team. Staff completed safeguarding training including an annual refresher course. They knew the procedure for whistle blowing and said they would use it if they needed to.

The provider was not working within the principles of the MCA. Mental capacity assessments had not been completed in line with legal requirements, guidance, and best practice. When people had been assessed by health and social care professionals as lacking capacity or had fluctuating capacity to make decisions about their care, MCA's and best interest decisions were not completed, discussed, and recorded by staff as legally required. Care plans did not document people's capacity to consent and to make decisions. For example, one care plan documented that the person was living with dementia and required support from staff to safely manage and administer their medicines. We spoke with staff who lacked knowledge about the differences between the administration and prompting of medicines and saw that no MCA or best interest assessment had been completed. Another care plan documented that a person was living with dementia and Alzheimer’s and read only that "[person] is not regularly on alert]” failing to explain what this meant and the support the person required. No MCA’s or best interest assessments had been completed in line with best practice guidance and the law. Staff had received MCA training, however, training records showed that most staff had overdue or expired training required from February 2023 which included MCA, safeguarding and medicines management. Staff we spoke with lacked understanding and knowledge of the MCA codes of practice and legislation. Safeguarding and whistleblowing policies and procedures were in place. However, there were no effective systems, processes and practices in place to ensure people were protected from the risk of abuse and neglect. There were no safeguarding files and records in place and no monitoring and auditing tools and systems in place to oversee and learn from safeguarding enquiries and concerns. This placed people at risk of abuse and neglect.

Some people and their relatives were satisfied with staff team for the care and support they received. For example, one person told us, “The staff are very respectful to me and keep my dignity intact”. They take any disability into account”. A relative told us, “My relative has Parkinson’s and the staff understand their needs well”. “I can’t fault the service I get from them”. Another relative said, “My relative loves the staff and we are both happy that’s [my loved one] is kept very safe in their hands”. A third relative commented, “I am confident in the staff handling him with mobility equipment”.

Some staff told us, they knew how to respond to people’s risks and to meet their needs. For example, in relation to falls prevention, hoisting, prevention of pressure sores and ulcers. They said, they worked with external professionals such as a district nurse and a stoma nurses. However, some staff we spoke with had limited knowledge regarding the safe management and administration of medicines and in particular the differences between the administration of medicines and the prompting of medicines. This placed people were at risk of potential harm as systems and processes were not in place to ensure that medicines were safely and appropriately administered and managed.

Risks to people were not always identified, assessed, recorded and managed in a safe manner. The provider continued to fail to identify, assess, monitor and mitigate risks to the health, safety and welfare of people using the service. For example, three people’s records showed that they all had mobility needs, had a history of falls and were all at risk of falls. However, there were no risk assessments in place to provide detailed information and guidance to staff on their history of falls, physical conditions which may impact mobility and increase risks, equipment and the use of or support required to safely mobilise and the actions to take to mitigate and or minimise the risk of falls. These risks were not safely and appropriately identified, assessed and mitigated placing people at risk. A person using the service was at high risk of developing pressure areas and wounds and had a graded category pressure wound upon discharge from hospital. There were no skin integrity or pressure area risk assessments in place despite this risk. Two people using the service had a history of falls and required the use of equipment to aid safe mobility and transfers. There were no mobility and moving and handling risk assessments in place to provided staff with details of how people could best be safely supported using their equipment and no guidance for staff on the equipment required and how to safely use the equipment. The systems and processes in place for managing and administering people's medicines was not safe. We saw that minor improvements had been made since our last inspection as the provider had implemented medicines administration records (MAR) for people who required support to safely manage their medicines. However, there continued to be failings in that there were no medicines care plans and risk assessments in place for people where required and medicines audits that were completed had failed to identify the lack of medicines care plans and risk assessments.

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 didn’t always receive the visits on time, to meet their assessed needs in a timely manner. For example, one relative told us, “Punctuality is something that needs to improve a bit”. “The times can vary drastically of up to 2 hours difference”. “As relative I also wish they could stay longer”. Another, relative said, “The timing is the problem”. “My relative would like someone at 8.00 am and she often doesn’t get the visit until 9.30 am and that annoys her”. Notwithstanding the above, the provider trained staff to support people and meet their needs. One person told us, “I’m very confident that they are well trained and skilled for me to benefit from their support”. “They keep clean and keep me clean and wear protective clothing”. A relative said, “They are well trained and well capable to carry out the required care duties on my relative”.

We spoke with the registered manager who told us that health care professionals sometimes visit the service to advise and train the staffing team on specific conditions and care topics. However, they advised that they do not keep records of the content, who attended or what good practice guidance or national standards are referred to. The registered manager told us that ‘informal conversations’ with staff were conducted but these were not recorded, and no formal supervisions were conducted. Staff told us they had regular supervision either face to face or virtually in a group. Staff told us the training programmes enabled them to deliver the care and support people needed. They said, they felt supported and could approach the registered manager at any time. Staff told us, “I do both single and double call. We are always going together in a comp-any car.” Another member of staff said, “I do double up care. We both go together in the same car and reach same time. When there is traffic, I get late and will let know service user that I will be late and inform office as well.” Another member of staff commented, “The office had introduced electronic call monitoring (ECM) 2 weeks ago; and have not perfected about login and log out timings at all, the office is working on it with the ECM service provider.”

Systems in place for oversight of staff recruitment, training, supervision and appraisal and staff competencies were not fully embedded placing people using the service at risk of receiving unsafe care and support. Staff recruitment processes did not follow safe recruitment practices and several staff were employed without prior care work experience or skills. There were no interview records kept within staff recruitment files. There were no systems in place to provide staff with appropriate ongoing supervision, appraisal, and support within their roles to confirm their competence within their roles was maintained. Notwithstanding the above, we found staff completed training required including refresher courses to carry out their roles. The training covered areas such as basic food hygiene, health and safety, moving and handling, infection prevention and control, promoting privacy and dignity, administration of medicine, mental capacity act, and falls prevention. Some of these were done with the help of external professionals. For example, about catheter care The service maintained an electronic call monitoring (ECM) system to monitor staff attendance and punctuality. We found of 338 calls; 148 calls were more than 15 minutes late (44%) including 73 which were more than 45 minutes late (22%). There were 146 short calls (43%). A short call is when less than half the planned time is delivered. We found there were 20 double handed calls, of these 12 calls (60%) 2 staff spent less than 15 minutes together on call. Although, we did not find any evidence of harm to people, but this issue required improvement. We found some calls were scheduled for staff to be in 2 places at the same time. For example, there were 91.5 pairs of calls where staff were logged in at two locations simultaneously. There were no travel time allotted between two calls. For example, out of 338 calls, 88 had no travel time. (26.0%), which impacted on staff ability to arrive promptly.

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.