Errand Plus and Personal Services

On this page

• 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

Throughout the assessment, we found the service was not always safe. We found lessons learnt were not always being identified where appropriate and sometimes actions taken where not the most effective. Accident and incident forms were not being completed accurately. Systems and pathways were not being used to their full potential, for example we found lessons learnt illegible and evidence of their process being followed was incomplete. Processes for information sharing, held basic details and were incomplete. The service had a good knowledge of safeguarding, however their processes identified shortfalls and were unclear and we had concerns around their knowledge of the Mental Capacity Act. Risks were not always appropriately captured or assessed, and we had some concerns over the safety of medicines optimisation. example we found

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The majority of People within the service and relatives that we spoke with expressed they knew how to raise concerns. Some of them had raised previous concerns and they felt the actions that were taken were appropriate and effective. Although most people expressed, they were given the complaints procedure we had noted a shortfall in this, and it was not always accessible.

When we spoke to leaders they explained how lessons learnt were discussed on a regular basis with the staff. Staff expressed how they were spoken to when areas of improvement required immediate attention and other areas of learning were discussed within team meetings. We had identified concerns around the services reporting of accident and incidents and when we raised this with the registered manager, they told us this would be reviewed and an alternative procedure would be created.

We reviewed the services lessons learnt process and found some actions that were taken were not always appropriate and sometimes were missed. We noted all lessons learnt were identified through complaints and no other systems or processes within the service. There was no clear log of the lessons learnt so we were not assured the services was able to review the effectiveness and how they had been embedded. The service evidenced that safety incidents were investigated appropriately, however we were not assured that their reports were thorough and clear. There was an unstructured and inconsistent approach towards the investigation of safety incidents.

we spoke to several people who told us that they were supported by the service to book GP appointments and supported to order their medication. There were several people who didn’t require support to carry out these tasks.

Staff explained to us the process they took to put referrals through when required and told us that they always reported and recorded the actions taken appropriately. Staff explained the process of supporting individuals who required more care support by being part of the assessment process and offering emotional support to the individuals.

We received feedback from partners who had noted an improvement within the service. They felt there was a good working relationship with them to support the needs of the people using the service.

The service evidenced concerns with peoples care needs were always addressed in an appropriate timescale. However, there were other processes that were being used within the service and they were not being embedded firmly or used robustly. This prevented healthcare professionals having full access to required details to assess an individual’s needs appropriately.

People we spoke with said they felt safe and that they felt in control of their care and the staff would always access their consent over decisions to be made. We spoke to one person who we were concerned about, and the Registered Manager investigated and raised concerns to the Local authority.

When we spoke to staff, they could express what safeguarding meant and their duty to protect people from harm. They had a good understanding of the mental capacity act. However, the service lacked understanding on their responsibility in carrying out appropriate mental capacity assessments when needed. When we spoke to the Registered Manager about a safeguarding concern we noted they did not take it seriously; The service failed to identify the severity of the possible risk or harm.

All staff had completed safeguarding training and mental capacity training. The safeguarding process was not clear and there were occasions where relevant parties like CQC had not been notified of safeguarding concerns that had been raised. The reporting process was unclear and ineffective and this contributed to actions being missed. The service was completing accident and incidents inaccurately and we addressed this with the service and they said they would review their process around it.

All the people with spoke with raised no concerns and stated they always felt in full control of their care needs.

The staff told us how they supported people with managing risks and reviewing their risk assessments and care needs to make sure they were supported appropriately. We found some discrepancies around this and the risk assessments in place didn’t reflect the individuals needs.

We reviewed several care records and we noted the service had failed to identify where risk assessments were required. Where risk assessments were in place they did not reflect the accurate needs of people within the service and this put people at risk. Risk assessments were generic and not person centred.

People we spoke with assured us that they felt safe within their environment and that staff would help keep the environment clear. We reviewed visits logs and could see that people had the same staff that came to support them on a regular basis.

Staff expressed that regular spot checks were carried out and they knew their policies on lone working. They explained the checks carried out to ensure the environments were left safe and secure.

The service had thorough policies and procedures in place that clearly identified to staff the expectation when working in peoples homes to protect themselves and the people receiving support. This echoed what the staff had told us and evidenced it was embedded in every day practice. However we noted in 1 care record that the individual was to be locked in their house when the staff had left, there was no risk assessment in place for this and this made the environment unsafe. We reviewed the services calls logs and most calls were carried out within the allocated time frame and any that were delayed were escalated by the staff to call the people ahead and notify them.

People we spoke with confirmed they had the same staff most of the time and that they were given rotas to know who was coming and when, and they stayed for their whole allocated time and were informed of any changes.

The staff we spoke with could explain to us about recent training they had attended and what they had learnt from it and how they had been able to embed it in to their practice. They all expressed that they had the opportunity to develop and the majority of the staff we spoke with were currently undertaking an accredited qualification in Health and Social Care. We spoke to the registered manager around the lack of training on catheter care and diabetes management as there were people within the service that required this support. They informed us they complete train the trainer process however they were unable to evidence to us adequate certificates that confirmed this and we were not assured around the robustness or formalities of this process and how staff were assessed as being competent.

The service had recently used a consultancy firm to help with their HR records and we reviewed a sample of them. There were concerns around the contracts and the majority of their contracts stated working a minimum of 40 hours a week, however none of the staff had signed working time directive to opt out of this. We brought this to the Registered Managers attention who told us they were going to resolve this.

Everyone we spoke with expressed that personal protective equipment (PPE) was worn by the staff. However some of the people we spoke with expressed that PPE was put on before entering the premises, which would make the PPE not sterile and cross contaminated. We informed the service of these concerns. We spoke to the service about this and they informed us they would review their processes.

We spoke to the Registered Manager and he showed us the PPE supplies available for staff to use. Staff expressed to us that they always have access to PPE supplied. The staff expressed how often they should change their PPE. They informed us how they cared for people with illnesses and the importance of cross contamination and seeking medical help if they felt it was needed. However we found from speaking to people within the service there was some contradictions.

We observed the PPE in place for the staff and Infection prevention and control checks were carried out, on spot checks with the staff. Although a lot of a staff are still wearing masks within services and a lot of people have expressed to us that this has prevented them from being able to communicate effectively. The service said they would review their processes around this.

We spoke to people about how they were supported with their medicines and everyone expressed they were supported, however one person we spoke with expressed that the staff did not record where a transdermal patch had been applied on their skin to ensure that it was rotated.

The Registered Manager explained the process to us of the staff handling medicine, he explained all staff had a medication competency carried out on them. He told us that medicines were audited on a regular basis. Staff could tell us the different medications that people took and why and they could explain the process of pro re nata (when required) medication. However we noted their process was not being followed. The Registered Manager did evidence to us of concerns being escalated with the GP when people had refused their medication on a regular basis.

We reviewed 7 peoples medication administration records charts and founds several recording errors that the services internal audits had failed to identify. This showed they are not adequate or robust. The services policies around Pro re nata medicines were not followed and medication competencies were not thorough, there was no clear explanation of how the assessor was assured the individual was competent in that task.