Safe Choice Care received an overall rating of Requires Improvement at this September 2022 inspection, with breaches of Regulations 12, 17 and 19 identified relating to unsafe care and treatment, poor governance and unsafe recruitment practices. The service had failed to address shortfalls from its previous 2019 inspection, including incomplete employment histories, missing risk assessments for bed rails, ineffective governance audits and inconsistent PRN medicines protocols.
Concerns (7)
criticalGovernance: “The provider failed to improve the quality and safety of the service. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014.”
criticalCare planning: “Some people used bed rails to reduce the risk of falling out of bed. There were no risk assessments to guide staff on their safe use, for example to reduce the potential risk of entrapment.”
criticalRecord keeping: “Full employment histories had not been consistently obtained. Some application forms noted only years of employment and not months.”
moderateStaffing levels: “There were several entries in staff care calls when there was no travel time assigned. Time had not been allocated for staff to change their personal protective equipment and go to the next call.”
moderateMedication management: “Some people needed medicines on an 'as and when' (PRN) basis...These had not consistently been completed. This was an area for improvement.”
moderateInfection control: “The service had received a complaint regarding a person being given food, and on another occasion medication, whilst sat on a commode. This action was neither hygienic, nor dignified.”
moderateStaff competency: “Staff competency, to ensure they were safe moving people, had not been completed.”
Strengths
· People and relatives generally spoke positively about the quality of care received, describing staff as kind and supportive.
· Staff demonstrated good knowledge of the people they supported, including safe moving and handling practices.
· Safeguarding processes were in place; staff understood how to identify and report abuse and the registered manager liaised with the local authority safeguarding team.
· Accidents and incidents were recorded, monitored and analysed to prevent recurrence and prompt referrals to healthcare professionals.
· Staff felt valued and supported by the management team, with supervision, staff meetings and spot checks in place.
Safe Choice Care received an overall rating of Requires Improvement at its first CQC inspection, with breaches of Regulation 17 identified due to incomplete recruitment records, unsigned handwritten MAR sheets, and missing risk assessments. People using the service were positive about their care experience, and the service performed well in effective, caring and responsive domains.
Concerns (5)
criticalRecord keeping: “The provider had failed to improve the quality and safety of the services and ensure that they maintained complete and contemporaneous records. This is a breach of regulation 17”
criticalGovernance: “There were no records to demonstrate that the providers had checked staff's full employment history...application forms had been accidentally shredded.”
moderateMedication management: “Hand written MARs need to be checked by another person and double signed to ensure that these were accurate, and this had not been done.”
moderateMedication management: “Where people were taking as and when medicines (PRN's) such as pain relief there were no protocols in place to inform staff what the medicine was for.”
moderateCare planning: “Risk assessments were not always consistent in that some risk assessments were not in place. For example, one person used a feeding tube...and there was a lack of information.”
Strengths
· People and relatives were consistently positive about care quality; one person said 'I couldn't be more pleased'
· Sufficient staffing levels with reliable call coverage and good timekeeping reported by people using the service
· Staff received regular supervision, annual appraisals and a comprehensive induction including shadowing period
· Incidents and near misses were investigated, reviewed for trends and learning was shared with staff
· Person-centred care delivery with flexibility to accommodate unplanned calls and individual preferences
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to meet people's needs, preferences, interests and give them choice and controlGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careGood
well-led: Planning and promoting person-centred, high-quality care and support with opennessGood
well-led: Engaging and involving people using the service, the public and staffGood