Right at Home Bedford

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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 2 breaches of the legal regulations. Concerns were identified in reporting safeguarding concerns, incidents and accidents, managing medicines, care planning, ensuring equipment was safe and staff training. However, feedback from people was positive about staff, raising concerns and the provider's initial assessments. We did not identify any concerns relating to infection prevention and control.

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.

Overall, people and relatives felt comfortable raising concerns and expressed satisfaction with how incidents were managed. A relative told us, "I would have no problem raising any concerns with them, but we don't have any." Another relative told us they had raised concerns about their relative's care plan not being reflective of their needs, and the provider had taken action and improved this.

In relation to our findings about complaints, staff concerns, and incidents not being recorded in line with the provider's systems, the provider communicated to us that they would make improvements around how staff reported concerns and that they would improve their auditing processes. We will check for improvement at our next assessment. However, a staff member confirmed the provider had systems to communicate effectively with staff. They said, "All new changes or updates regarding clients, teamwork and rotas are shared with us by email or on our team's group chat."

Complaints, staff concerns, and incidents were not always recorded in line with the provider's systems. This increased the risk of the provider not having effective oversight to review all concerns consistently and in a timely way. Where incident and accident forms had been completed, the provider had not always detailed their actions to manage future risks. This increased safety risks to people and the risk of incidents and accidents reoccurring.

Overall, feedback was positive about how the provider conducted initial assessments and how they involved people and their relatives. One relative said, “The home visit and introduction to their service is great and they explained everything to us as a family.”

A staff member told us they felt things were going well with a person who had recently started to receive care and that they were taking things a week at a time to ensure things worked well for the person. They told us they worked flexibly to support the person in attending their health appointments. Leaders gave us examples of when they had worked with external health professionals, such as community nurses, to meet people’s health and care needs.

We shared concerns with the local authority that we identified during this assessment, and the local authority responded by carrying out a review of the quality of the service. The local authority has also identified that improvement was needed relating to care planning, risk management, and ensuring that referrals were always made promptly in response to people's changing needs. The local authority asked the provider to ensure people had contact details for their Adult Services Contact Team and Care Standards Service and took action to review people's care packages where required. Currently, the local authority is monitoring and supporting planned improvements at the service. The provider has shared improvement plans with the local authority.

We could not be assured people always received safe care on their care journeys. The provider's systems had not always effectively ensure consistent assessment and monitoring of people's health, safety, medicines administration, staff training, and environmental safety. As a result of CQC identifying these concerns the provider developed action plans to improve and promote people’s safety.

People and their relatives told us they felt safe and had no safeguarding concerns to report.

The provider told us they would complete notifications for allegations of abuse they had not reported to CQC and acknowledged safeguarding concerns, which should have been referred to the local authority. In addition, the provider communicated to us that following our assessment, they had refreshed safeguarding training for managers, made more best practice guidance available and reviewed their systems to better identify potential safeguarding concerns. We will continue to monitor the information we receive about the service and check for sustained improvement at our next assessment. However, staff we spoke with confirmed they had received safeguarding training and knew how to escalate safeguarding concerns. For example, a staff member said, "If they did not listen, I would escalate to CQC.”

Safeguarding concerns had not always been reported to the local authority safeguarding team or independently identified by the provider. This included prompt referral for a person at risk of self-neglect and a concern about a visiting health professional. The provider had not always ensured they reported allegations of abuse to CQC without delay.

We could not be assured people were always involved in managing risks. Most people and relatives we spoke with had not seen their care plans. We visited a person who had a copy of their care plan from early 2023, and it did not accurately reflect their mobility-related risks. A relative told us they had to direct the provider to use charts to monitor a person's health-related risks. However, other people and relatives told us people were safe. A person said, "I have not had any accidents. However, I feel quite safe with the carers who attend me each day."

The provider told us they would take action to review people's care plans and risk assessments. This included identifying more staff who could support the development of people's care plans and ensuring they had received training in order for them to do this competently. We will check for improvements at our next assessment. Staff we spoke with had a good awareness of the risks people could experience. For example, a staff member felt people's care plans did not always contain enough details for staff who visited people less regularly. They gave us examples relating to footwear a person needed to wear that was not in a care plan and that a person was able to wash their intimate areas independently, but the care plan stated staff needed to assist them in doing this.

People's care plans and risk assessments were not always accurate and did not always contain enough information in managing risks people could experience in areas such as their mobility, oral health, choking-related risks, diabetes and epilepsy. This increased risks to people's health and safety.

People and their relatives did not inform us of any concerns related to how staff supported them in their home environment.

The provider told us they would improve people's care plans and had introduced systems to document service dates and important information relating to people's equipment used to deliver care. We will check for improvements at our next assessment.

Service dates for people who used lifting equipment for their mobility were not always documented in people's care plans, nor was key information about air mattresses and equipment used to manage health concerns. This increased the risk related to people's equipment safety.

People gave us mixed feedback about safe and effective staffing. A relative told us they had to intervene due to safety concerns when new staff members delivered care to a person they had not met before and were unfamiliar with how to use a person's equipment and support their mobility. Some relatives told us they had concerns in relation to staff turnover and how this had affected staff consistency. However, other people and their relatives spoke positively about staff attendance and punctuality. A relative said, "All the carers are very professional, efficient and kind. They all do a very good job. The timings are always fine." However, they then mentioned it would be helpful for them to receive details of staff schedules a little sooner.

In response to our findings in relation to a staff member's previous employment history not being fully documented, the provider told us they would undertake an audit of staff files. Leaders told us things had been difficult due to staff turnover and the lack of a registered manager. However, staff felt supported and confirmed they had received an induction before supporting people. Overall, staff felt they had enough travel time between calls, but traffic meant, at times, they could run late. A staff member told us they rarely ran late, but if they were, they would let the office staff know, who would, in turn, contact people to let them know.

Staff had not received training in supporting people living with epilepsy, diabetes and dysphagia. This increased safety risks to the people the provider supported living with these conditions. The provider promptly arranged this training following our sharing of these concerns. We reviewed the staff file of a newer staff member and found the provider had not followed all aspects of their recruitment policy to document all employment history. We reviewed a staff supervision tracker, which showed that the staff's recent supervisions were up to date, but not all staff had consistently received supervision throughout the year. However, the provider did have an effective system to monitor staff attendance and punctuality. Aside from the training staff had not received overall, there were good levels of compliance with staff who had completed the training the provider had identified they needed. There was evidence of the provider undertaking staff spot checks.

People and their relatives did not raise any concerns in relation to infection prevention and control or the support they received for managing household tasks.

Staff did not raise any concerns in relation to infection prevention and control, and records showed that they had received relevant training.

We identified the provider had not raised a safeguarding concern in relation to a visiting health professional's infection prevention and control practice. However, we did not identify any other infection prevention and control concerns.

A person's care plan stated they could manage their diabetes independently and that staff should not be supporting with this. However, their relative told us they had to show a staff member how to use equipment that took their blood sugar readings. 2 relatives told us medicines had not always been managed safely, with examples such as care plans not always being reflective of medicines they were prescribed. One person told us staff helped them with medicines, but the provider and their care plan stated they did not receive this support. This meant there was a risk that staff provided support with medicines when they should not have been and in the absence of up to date care plans and risk assessments.

We communicated safety concerns about medicines management to the provider and requested immediate reassurance. We followed up with an unannounced visit and were not assured by the provider's response and the evidence we observed on-site. We received assurance when the provider's senior leaders (franchisor) took operational oversight of the areas we were concerned about, specifically medicines safety. The provider communicated that they would improve their oversight, governance, staff training, and review of their systems around medicines. In addition, they told us they had taken action to ensure people's care plans were reflective of the medicines they took, and they were undertaking daily and weekly checks to ensure people had received their medicines safely. We will check for improvement at our next assessment.

Medicines were not managed safely. We found concerns relating to people not receiving medicines and medicines being out of stock, people not having protocols for as-required medicines, medicines not being stored safely, medicines administration records not being up to date, and the provider's audits not identifying all concerns. This increased the risk of people not receiving their medicines safely.