Care To You Healthcare Limited

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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

Staff knew how to keep people safe and were knowledgeable about safeguarding and when to raise concerns, however the safeguarding policy was not clear for staff to follow. The provider reviewed and made immediate changes to the policy before the assessment concluded. The provider had referred safeguarding concerns to the local authority appropriately, however they had not informed CQC as they are required to. Immediately following the assessment, those retrospective notifications were sent to us. Recruitment processes were robust, which ensured that staff had the right qualifications and values for their role, but staff feedback was mixed about whether they felt well supported and valued at work. Staff understood people’s risks and how best to support them with those risks. Improvements are needed to information provided in care plans and risk assessments for staff to follow. Where staff had noticed health or medical changes, these had been recorded in their daily notes, however, they had not always reported these, in order for them to be followed up appropriately.

This service scored 72 (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.

People told us they felt safe when receiving support. One said, “I always feel very safe in their care. I have no concerns or complaints.” Another person described how they can sometimes feel dizzy in the shower which scares them, but the carer stays close by and reassures them that they are there if needed. A relative we spoke with told us how they are informed when carers are going to be delayed, and how staff ensure the person is comfortable and well before they leave.

Records showed that staff had received safeguarding training which was regularly refreshed. Safeguarding concerns were recorded in a tracking document to ensure that lessons could be learned from the outcomes. We saw an example where the provider had sought additional training for staff and discussions held in team meetings to share best practice examples. The safeguarding policy and procedures were updated during our assessment of the service, which provided staff with clear information about how to report abuse, and links to organisations that can provide support.

Staff were knowledgeable about abuse and felt confident to raise concerns when necessary. One staff member told us, “If I see something I would report it.” Staff told us that they felt able to speak about safeguarding concerns with the management team, and said that those concerns would be acted upon. One staff said, “The office team are very supportive.”

People told us that they felt involved in planning their care and support. One person said, “I had a meeting before my care started which my family were included. The Care Plan was written after the assessment of my needs.” Relatives said that they felt well informed, particularly where there were any issues or concerns, one told us “They have told me if they don’t think they’ve got things right.”

The management team were very knowledgeable about individual’s care and support needs, and told us that they were working on improvements to care plans to add more detailed guidance for staff to follow. The staff we spoke with understood people’s risks and how to support them to reduce these. Staff told us they knew where to find information in the new digital care app about risks and were knowledgeable about how they would record any issues or concerns.

Care plans lacked sufficient detail about people’s risks and how they should be managed. Staff were not guided on what action to take if they noticed changes to skin, for example. We discussed this with the registered manager who told us that this had been identified as an issue, and they had started to carry out a full review, adding further information and detail to risk assessments. We saw that where staff had noted changes or concerns, they had not always been followed up. The provider told us that they had also identified this issue and had recently implemented a system of daily oversight of care notes, as well as holding a weekly huddle meeting to discuss issues, and identify any emerging pattern or trends. We saw that these improvements were included in the service development plan. The plan is reviewed and updated each month. We also saw that there were plans to improve the amount of client feedback gathered and we had a discussion about using more open questions in feedback surveys to gain richer information and wider views.

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

We received mixed feedback from people and relatives about timeliness of support visits. Some told us that timings were not consistent and some said that staff do not stay for as long as they should. One person said, “The level of care at the moment is not consistent.” Another person told us, “I must have had 18 or 19 different carers”. Some people and relatives told us they were happy with the support call timings. One family member said, “They always arrive pretty much when they are expected” and one person said, “They always arrive on time and make sure they stay the full time that they should. They are lovely.” People said that staff were kind and caring. We heard comments from people such as “Lovely staff, who I get on great with”, “They look after me really well” and a comment from a relative saying, “They follow the care plan, very reliable and observe [relatives] likes and dislikes”.

We received varied responses from staff about working for the service. Some staff told us they felt well supported by the management team, and were given ample time to complete visits. One told us, “We have plenty of time to complete the tasks.” Most staff said they knew the people they supported and there was a consistent plan of regular hours and visits. Some other staff felt they were rushed and hurried with their visits and were expected to travel long distances and not allocated the hours they required. One told us, “Scheduling of visits is chaotic at best.” Some staff said they did not feel supported or valued by the service. One commented “It’s disheartening to feel undervalued and mistreated by the very people who should be supporting us.” We discussed this with the registered manager who told us they would gather views from staff to try to understand this better and plan improvements to their workforce wellbeing. The provider had carried out annual staff surveys, and staff had made some suggestions for improvements such as using a location app for more precise mapping detail to save time looking for addresses, others had requested more face to face training. We discussed some ideas for improving the quality of feedback from staff by increasing frequency and open-type questions which could be more revealing about some of the satisfaction issues we heard of within the staff team. All staff told us there is a good range of training made available to them, and that they attend supervision meetings which they find useful. One said, “Supervisions are useful, we discuss any client concerns and we can also discuss how we are feeling, or any members of the team we are worried about.”

We reviewed the training matrix which showed a wide range of training topics available to staff. There were some areas where compliance levels were low, such as Fire, Falls prevention and Learning disability training. We discussed this with the Registered Manager who told us this would be addressed. Staff were recruited safely with appropriate checks made prior to offering them a position. New staff were closely monitored so that areas for development or support could be identified quicky. We saw that processes were in place, and followed when managing poor staff performance. Quality of care was monitored through regular unannounced spot checks. Staff newsletters were regularly sent with training updates, welcome messages for new staff, and reminders about best practice. We carried out analysis of the call logs over four weeks. The provider had changed system half way through that period, and had told us that this change was made to make improvements to recording of call times, and effectiveness of staff log-ins. Our analysis showed a high level of support calls were recorded as ‘short’ (less than half their allocated duration), and there were issues with punctuality. We spoke with the provider who told us that this is an area of focus and that the new digital system will provide them with enhanced oversight. We saw that the feedback surveys collated more recently had shown people were more satisfied with their call times in recent months.

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 training matrix showed staff were up to date with their medication training. We saw that following a recent medication error, the service had reviewed and revised the procedures for recording medicines, to ensure clarity between staff and family members about delegation of tasks. The digital system had been set up to send alerts to the office team if a medicine had not been administered, and they could identify the reason why medicines may not have been given by clicking on the code recorded. Medicines that were given “as required” had detailed protocols for staff to follow. Medicine audits had been regularly carried out and had not identified any concerns.

We received some feedback of concern from a relative relating to medication administration, which prompted us to expand our assessment to review medicines procedures. Another person we spoke with told us that staff are knowledgeable about the medication they require, they said, “I take a lot of medication which the carers give me on time.”

Staff were knowledgeable about administering medicines and told us that they attended regular training sessions. Staff we spoke with told us how they could find information about the medicines to give as well as how people preferred to taken them, in the digital care management system. The management team understood their responsibilities and when they should raise concerns of a safeguarding nature related to medicines.