Competent Healthcare 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

During this assessment we looked at 4 quality statements in the key question of safe. The overall rating for this key question combines scoring from quality statements we looked at during this assessment and quality statements scores in line with findings from our last inspection, where the service was rated good. There were not effective systems in place to manage risks related to people’s health, medicines and delivery of care. This included risks around time critical medicines, medicines administration guidance, business continuity, choking risk assessments and environmental risk assessments. These failings put people at increased risk of coming to harm. This was a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Staff had a good knowledge of safeguarding, but concerns were not always fully followed up and actions were not always recorded to demonstrate how people were kept safe. There were enough staff in place to meet people’s needs. However, staff did not always arrive at planned times, specifically when care calls required 2 staff. Staff told us they had received appropriate training relevant to their role, but records of staff training were not available, therefore we could not verify or be fully assured in this area.

This service scored 66 (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.

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.

People and relatives told us they felt safe receiving care from staff. They said that they knew the staff that visited and new staff were introduced to help ensure unfamiliar staff were not providing care. Comments included, “I used to always have the same staff, but lately that has changed. I have got to know them all though.” People told us staff supported them to feel safe in their own home by supporting them with their home security arrangements. Comments included, “`I’m safe as they make sure that I`ve locked the door” and, “I`m very safe. They (staff) check to see if the doors are locked and we get on very well."

Staff had a good knowledge of safeguarding procedures. They were confident in identifying concerns about people’s safety or welfare and clear in actions to take to safeguard them in response. Staff understood the principles of The Mental Capacity Act 2005 and told us they had received training around ensuring care was least restrictive as possible.

People’s care plans identified where there were potential safeguarding concerns related to their care. However, some contained contradictory information about the level and nature of the risk to people. This made it unclear how staff should recognise or respond to concerns if they arose. The provider had made some referrals to local safeguarding teams when incidents occurred. However, there was limited evidence around how incidents were analysed and whether learning was implemented to reduce the risk of recurrence. We identified one incident where the provider did not take robust action in response to concerns about a person’s medicines supply. The provider had not reported these concerns to safeguarding authorities and had not fully investigated or mitigated the risk of this incident happening again.

People told us they were happy with how risks were managed and that they had no concerns about safety regarding their care. This included when they received support from staff mobilising around their home. Comments included, “Staff support me and watch me walking, especially when I`m walking upstairs” and, “They know about my health (and how it affects my mobility) and seem well trained."

Staff confirmed they had received training around the use of moving and handling equipment, which they used when supporting people with their personal care. Senior staff were responsible for creating risk assessments and care plans. However, it was not always clear how senior staff had used best practice guidance or involved professionals in care planning around people’s specific medical conditions or health needs.

Care plans did not always detail how assessed risks were monitored and mitigated. For example, one person’s care plan stated they were at medium risk of choking. There was no record of a choking assessment having taken place. The care plan states that food should be cut up well. However, this does not follow terminology used in best practice International Dysphagia Diet Standardisation Initiative (IDDSI) guidance. This put the person at increased risk of staff not supporting them with appropriate textured foods. People’s moving and handling risk assessments were not detailed in providing appropriate instruction for staff to identify and reduce risks. For example, risk assessments did not identify the mobility equipment people used, how many staff were needed, instructions around the use of the equipment and who was responsible for the maintenance of these items. Therefore, assessments were not effective in detailing how people could be kept safe when mobilising around their homes.

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 and relatives gave mixed feedback about staffing. 9 people were positive about staffing, telling us they received consistent care at planned times. Comments included, “They [staff] are nearly always on time, never really late and on the rare occasion that they were I got a call from the office explaining why.” However, 5 people and relatives raised concerns around the inconsistency of care call times, staff not staying for the full duration of designated visit, staff for double up calls arriving at different times. Comments included, “The [staff] don’t arrive on time. One turned up today and then the other one came 5 minutes before the end! There should be 2 carers. This never used to happen but now it seems to be happening more and more."

Staff were positive about their working arrangements, telling us they had consistent working patterns and sufficient travel time. They told us they had received training relevant to their role, which helped them to carry out their duties in an effective way. They told us they felt supported by senior staff when they requested assistance and support.

The system to oversee staff’s ongoing training needs was not effective. The provider was unable to produce an overview of the specific training each member of staff had completed and when a training refresher was due. Senior staff were unclear as to who was responsible for monitoring staff’s ongoing training needs. This meant that it was not always possible to determine the exact training staff had received. Senior staff had not always completed sufficient training to demonstrate the required experience and skills in carrying out key tasks in their roles. This included completing moving and handling assessments or assessing staff competency. We reviewed 6 staff recruitment files and found some gaps in required recruitment checks. The provider was able to locate this information during our assessment, but their processes around staff recruitment were not always robust in ensuring candidates suitability was fully assessed.

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.

The majority of people and relatives were happy with the support they received around managing their medicines. People told us they received their medicines at the right time. One person told us, “They [staff] do the tablets and never miss (an administration).” However, one relative raised that staff did not always inform them in a timely manner when their family member’s supply of medicines were running low. They told us, “They [staff] were telling us when [my relative] only had two tablets left. I can’t organise things with the doctors and the chemists in 2 days. I need more notice!"

Staff were able to explain how they would follow best practice in medicines administration and how they would contact senior staff if they had concerns. However, Staff did not always follow the instructions in people’s care plans around the administration of medicines. For example, one person’s care records reflected occasions where staff recorded that the person had already taken medicines before the care visit. There were other instances where staff left out medicines for the person to take independently. Their care plan stated that the person had a cognitive impairment and that they needed full support in the administration of their medicines. This meant staff could not be assured the person had taken their medicines as prescribed.

People’s medicines administration had been missed or medicines were not always administered as prescribed. For example, one person had been prescribed medicines which needed to be administered in 4 hourly intervals. We found that between 1 and 29 March 2024, there were 20 occasions where this medicine had been administered significantly outside of this 4-hour window. In another example, another person had missed a significant number of prescribed medicines due to lack of supply. For the above examples, there was no evidence of the provider consulting with a medical professional in response to people not receiving medicines as prescribed. There was no evidence that these incidents had been addressed with staff to determine the causes of these omissions to reduce the risk of incidents reoccurring. People’s care plans for ‘when required’ medicines did not always contain sufficient detail about how and why these medicines should be administered. For example, missing information included, actual and maximum dosage prescribed within a 24-hour period, details around medical conditions and when to escalate concerns if medicines were not effective. People’s medicines administration records did not always state why ‘when required’ medicines were administered. Therefore, it was not always clear why staff administered these medicines or whether administration had desired effect.