AMG Care Services 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating remains requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. We identified a breach of the legal regulations. Risk assessments were incomplete and did not include specific risks to people we identified during our previous assessment. There was an increased risk that people could be harmed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Systems were in place to analyse accidents and incidents and ensure future risks were mitigated. The service had recently implemented a system to identify any patterns and trends within safety events to further develop their learning culture. People and relatives could raise any concerns they had, and the provider apologised when things went wrong. Staff said there was good communication between the team.

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.

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. Safeguarding records were being completed and reported appropriately. Safeguarding checklists were in place and actions taken had been recorded. A RAG rating system was in place to ensure people with the highest need and vulnerability were prioritised if a situation arose where all care calls were not able to be completed as planned. RAG (Red-Amber-Green) is a traffic light colour coding scheme. Staff had received training in safeguarding and in the Mental capacity Act (MCA), they demonstrated an understanding of their responsibilities with regards to safeguarding and the principles of MCA, including capacity and consent. People and their family members said they felt safe. They told us “(Person) does feel safe, we did have an issue a while back but the problem was swiftly sorted, the office is very good with any issue.” and “(person) feels safe as would be agitated if not, no abuse, definitely not.”

The service did not always work well with people to understand and manage risks. We found a breach of the legal regulation in relation to safe care and treatment. One overall general risk assessment was in place for people. This covered areas including people’s physical and mental health, medicines and their home environment. However, where there were specific risks to people risk assessments were not always in place. For example, people who had diabetes, used a catheter or used moving and handling equipment did not have risk assessments in place, which covered these areas. This meant staff did not have information to inform them of the signs to look out for when a person may be unwell and should seek medical help. This was an area of concern we identified during our last assessment in April 2024. We did not find anyone had come to harm as a result of this. The service started to address this immediately. Following our on-site visit the care manager sent us their risk assessment action plan and examples of risk assessments they had put in place for some people, they provided clear information on signs to look out for and when to seek medical assistance. The risk assessment action plan had an action to review people’s moving and handling risks and following our feedback we were told catheter care would be added to the action plan. Staff had completed training in the areas where specific risks were identified and could explain the actions they would take to support people if they were concerned. People told us any risks to their care were well managed, one relative said, “No risks, all sorted after (person) had a fall last year, grab rails are on the banister now, staff are well trained and know (person) well.”

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

The service had made improvements and is no longer in breach of staffing and fit and proper person employed regulations. The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff were trained in mandatory and specific training to be able to support people’s needs. Supervisions, spot checks and telephone reviews were happening regularly. We reviewed five recruitment files. Where references were missing from two staff’s files we saw evidence the care manager had taken action to obtain these. Interview records did not contain sufficient information and there were gaps in applicant’s employment history. However, no new staff had been recruited since our last assessment and the care manager was in the process of auditing all recruitment records. The registered manager said the recruitment of new staff was on hold until they had reviewed their recruitment processes. An induction plan was in place to be used for new staff, this covered face to face training and E learning. Staffing levels were sufficient, no agency staff was being used. People told us staffing was safe and effective. They said “3 to 4 carers come on a rota basis, on time, ring if running late.” and “Absolutely skilled and well trained, no problem with any of them, all excellent.”

The service had appropriate infection prevention and control measures in place. Staff had been trained in infection prevention and control and had access to personal protective equipment (PPE). Staff knew when and how to use PPE correctly and how to prevent the risk of infection. Spot checks included observational checks of the correct use of PPE.

The service made sure that medicines were administered and managed safely, in accordance with prescriber’s instructions and best practice guidelines to make sure that people who used the service were not placed at risk. The service had made improvements and was no longer in breach of regulations. People were protected from the risks associated with the unsafe management of medicines. We reviewed 5 people’s electronic medication administration records (eMARS). Overall completion of medication records was good. Records contained clear information and carers had access to any specific instructions for medicines and body maps for the application of topical creams. There were several gaps in the signing of eMARs for one person, however care notes confirmed medicines had been administered. We were advised on our site visit this was due to the way the eMAR had been set up. The service addressed this during our assessment. Management were not being alerted to any missed administration of medicines so they could take action to ensure medicines were administered as prescribed. The service acted immediately to set up these alerts during our onsite visit. Medicines audits were completed monthly for some people, but not for all people who required support with medicines. The service sent us evidence a system had been implemented to audit all people’s medicines records monthly. Medicines audits had not picked up on the shortalls we identified during our assessment. Staff had completed medicines training and were knowledgeable around medicines processes. People and their relatives told us they were supported safely with their medicines. They said, “Medication given am and pm, kept safely in a dossett box, staff are well trained and know (person) well.” And “They check that (person) has taken their medication, I leave out what is necessary if I am out, they know the routine, I do the evening medication.”