Cott's Care Solutions

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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

We identified one breach of regulations. We found the provider had not always ensured safe recruitment practices were being used. People’s care needs had been identified and assessed as part of their initial assessment. Staff said they generally had the necessary information to support people, however there had been instances when this information had not been readily accessible. People’s care plans were detailed; however, staff would benefit from more detailed guidance in the management of people’s risks and the early warning signs of a decline in people’s health. People told us they were administered their medicines as prescribed; however, we found staff had not fully understood how to accurately maintain people’s medicine administration records on the provider’s new electronic care management system.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people's felt communication from the management team was good and they said staff addressed any minor concerns. People and their relatives told us they were aware staff reported incidents to the office. We were told they were contacted if managers felt the concern needed to be escalated to a specialist professional such as an Occupational Therapist.

Staff told us they would raise any concerns to their seniors and complete a report about any significant incidents. The registered manager told us they had oversight of all incidents or concerns reported to the office, by staff or people who use the service. Staff told us they received guidance from the managers regarding actions to take to prevent future incidents. Some staff told us they would welcome more opportunities to reflect after incidents to further support their learning.”

Incident reports showed that all concerns or incidents were reported by staff to the office. Incidents were documented, including any injuries sustained by the person and the actions taken, such as making referrals to appropriate health and social care services and informing relevant agencies. We found a small number of incidents had not been reported to CQC. This was raised with the registered manager, who agreed to re-examine their procedures to ensure CQC was appropriately notified.

Feedback about people’s assessments and their experience of receiving care from the service was mainly good. One person said, “Yes, I was assessed and told about the service - they asked me what support I wanted. I feel very spoilt - they are very good and do anything I ask.” However, some people told us their assessment of needs was completed after they started to receive care, and they had to show staff their preferred support requirements. Some people were not aware that they could access their care plan on the provider’s electronic care management system.

We received mixed feedback from staff on how they learnt about the needs of new people and their introduction to people’s care needs. Most staff said the information they needed was on the provider’s electronic care management system or they were informed by care coordinators if people required care in an emergency. However, a small number of staff reported they had to support people with very limited information about the person’s needs. The registered managers said every effort was made to communicate the available information about those people to the staff.

Professionals reported staff worked well with them and they were responsive to their recommendations. However, one professional expressed concern regarding the staff's understanding of how to support people diagnosed with diabetes, particularly in relation to their dietary needs.

The care coordinators and managers were responsible for assessing the needs of new people who required a package of care. In emergency situations, people received initial support without a care plan being in place to provide staff with detailed information and guidance regarding people’s specific needs. Although managers tried to ensure staff had the necessary information to assist people with their care needs in emergencies; they recognised that developing a comprehensive care plan, in a timely manner needed to be addressed. This would ensure staff had access to the detail they required to safely support people.

People told us they felt safe being supported by staff. One relative said, “He does 'generally' feel safe. He speaks to the visiting care staff about anything he needs to.” Some people reported they didn’t always know the name of the staff who supported them, and they occasionally faced challenges in communicating with staff because of language barriers.

All staff told us they would report any safeguarding concerns directly to the office or managers. However, although managers told us they had oversight of any reported safeguarding concerns, staff told us they were not aware of the external safeguarding agencies that could be contacted if the managers did not act on their concerns.”

Systems were in place to record and report any safeguarding concerns to external safeguarding agencies. However, we found there was not always a consistent approach in notifying CQC of concerns. This was discussed with the registered manager who agreed to review their incident systems to ensure CQC is notified of all types of abuse or neglect. Processes were in place to ensure all staff had been trained in safeguarding to an appropriate level for their role; however further training was needed to support staff to ensure they were aware of the role of external and local safeguarding agencies.

People's experience was mainly positive about the care they received, and the support staff provided to help manage their risks. However, some people stated they experienced inconsistency in the quality of care they received, which they attributed to frequent changes in the staff who supported them. Some relatives also shared they were not aware of how to access people’s care plans and to read about the support people received during each visit.

The registered manager told us people’s risks were assessed by a senior staff member. Staff had a good understanding of people’s needs and managing people’s individual risks such as risks of skin breakdown. They told us they felt trained in the management of people’s risks and would escalate any emerging concerns or decline in people’s health to the care manager. Staff recorded their completed support activities and delivery of care on the provider’s electronic care management system.

Systems were in place to assess people’s care and support needs. People’s care records were person centred and provided staff with the information they needed to support people. However, some care plans needed to be improved to include more specific information and guidance for staff. For example, risk associated with diabetes and catheter care. Also, more information and guidance was needed on when to escalate concerns. This would support staff with clear guidance on how to recognise changes in people’s health.

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

People said staff were kind and friendly although they were not always sure of which staff were due to support. People said they mainly received their care calls on time and were confident in the staff members who supported them. One person said, “Two of them have been twice and one of them has been once - usually they come only once. They are very friendly.” Another person said, “No they always turn up. They have been late only once because she got lost. Everyone else has always been on time.”

The registered manager told us that staff had been recruited from abroad using the home office sponsorship scheme. We received mixed feedback from staff about their experiences of working for Cotts Care Solutions. Most staff told us they felt trained and supported in their personal and professional life to adjust to living in England. They told us they also felt supported to understand the provider’s requirements when delivering care. However, some staff shared they had not always been treated fairly but felt things were improving. Some staff shared they felt the working hours across the service had not always been fairly distributed. Staff told us they accessed their rotas on the provider’s electronic care management system; however, rota’s were sometimes changed at short notice. The registered manager was aware of the challenges when recruiting from abroad and shared how they had supported staff to integrate into the local and British culture. They said they had been made more aware of staffs’ concerns since recent changes in the management structure and believed having an open-door policy enabled staff to share their concerns.

We were not fully assured that safe recruitment practices were always used. Most staff had been recruited via the Home Office Sponsorship Scheme who completed a number of suitability checks to ensure potential employees could legally work in the UK and ensured providers worked within the agreement of their sponsorship license. Whilst these checks had been completed, there was no evidence that the physical or mental health conditions of the staff were considered to ensure reasonable adjustments were implemented to help staff carry out their role. Records showed the majority of staff had received online training to support them to carry out their role. The provider was enhancing staff E-Learning with classroom-based training to reinforce their understanding of key safety subjects. Staff had received training in relevant topics relating to people’s risks and needs. However, the provider had not always ensured training of specific conditions such as diabetes was fully understood by staff. This was supported by feedback from a professional who was not assured staff understood how to fully support people’s diabetic needs. Records showed staff had received supervision meetings where the care they provided was observed. However, more detail was needed to evidence the care manager’s observations and discussions with staff about their skills and professional development. Systems were in place to inform staff of the working rotas and the people they were required to support. We reviewed a sample of completed care rotas and noted the record of staffs’ visit times were not a true reflection of their call visits. This meant the registered manager was unable to check the accuracy of the length of people’s care calls and whether people experienced late or short calls. We were told this was due to a technical issue. Since our assessment, the provider has since addressed this issue and supplied new phones to some staff to enable them to accurately log their call times.

Most people and their relatives told us staff wore personal protective equipment (PPE) when they supported people with personal care needs.

All staff told us they had access to sufficient quantities of PPE and they wore PPE when supporting people with their personal care needs. Staff told us they were aware of the importance of washing their hands, changing PPE between different care and hygiene tasks and disposing of single use PPE at the end of their visit.

Effective systems were in place to ensure staff had access to PPE. Records showed spot checks were completed to check if staff were wearing correct PPE when delivering people’s care. These records did not show whether the spot checks also checked staffs’ donning and doffing practices (putting on and taking off of PPE), correct PPE disposal practices and hand washing techniques. However, we were provided with an example of a PPE audit tool which the provider would implement to check whether PPE was being used in line with guidance. This would ensure safe infection control practices are being sustained to help reduce the spread of infection.

People who received support with their medicines told us staff supported them to administer their prescribed medicines.

All staff told us they had received medicines training and their skills to manage and administer people’s medicines had been assessed and checked by their care manager.

Records showed staff had been trained in medicines management. However, the records demonstrating staff competencies did not robustly demonstrate how staff had been assessed. People’s medicine administration records (MARs) had not always been completed in a consistent manner or in line with the records coding system. The provider had not ensured that staff fully understood how to accurately maintain people’s MARs on the provider’s new electronic care management system.. This meant the registered manager could not be assured people had received their medicines as prescribed. A person-centred protocol for ‘as required’ medicines were not in place. This meant staff did not have sufficient guidance to enable them to understand when to administer and how to monitor the effectiveness of these medicines. This is important for people who may not be able to communicate their needs. Staff would benefit from more information about their role and responsibilities when the administration and management of people’s medicines was shared with people’s relatives or when people were known to occasionally refuse their medicines.