Santos Care 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

The service was not safe and the rating remains inadequate. Not enough improvement had been made and we identified 3 breaches of regulation. People did not always receive safe care as risks were not adequately assessed and managed and guidance was not always available to the staff who supported them. Staff did not adequately record support provided with repositioning and nutrition which placed people at risk of receiving inconsistent care. Where staff administered prescribed medicines, this was not recorded safely. People’s capacity to make specific decisions had not always been assessed and it was not clear if potential restrictions, such as the use of bed rails, had been made in people’s best interests. However, feedback about staff was positive, support visits were mainly on time and staff files we reviewed showed staff had been safely recruited.

This service scored 34 (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’s relatives told us they felt safe with staff. One relative said, “I think [person’s name] is safe in the care of the staff, they seem to know what they are doing and the district nurse has been today and said her skin is intact and the cream has been applied well by the staff.” Another relative said, “I feel [person] is safe with the carers from Santos, I trust them being alone with them and I know [person] is okay with them.”

Staff confirmed they had received training in safeguarding. Two staff referred to undertaking refresher training recently. Staff understood different types of abuse and knew how to report concerns for people’s safety or well-being. Staff had a basic understanding of the MCA and were able to share with us how they read body language and facial expressions in order to assess people’s agreement or consent to care. The Nominated Individual told us there had been no recent safeguarding incidents.

Procedures for terminating people’s package of support were documented, but not followed. The nominated individual and registered manager were unable to provide clear information about notice periods for packages, including those that were described as 24/7 care. The registered manager told us “We normally give notice by phone. We just confirm they have sourced care elsewhere, don’t ask for a name.” The registered manager told us “We might pressure them but we don’t just leave them.” Following the site visit we made safeguarding referrals for people whose support had been ended with an unconfirmed notice period as we could not be assured of their safety or that their care needs were being met. Although some people’s care plans reflected they lacked capacity to consent to care, or the information contained in their care plan, there were no MCA assessments or best interests decisions documented for review. Where people had bed rails in place care plans stated that relatives had consented to this, but there were no MCA assessments relating to this, and no record of best interests’ meetings. This place people at risk of being restricted unlawfully. There was a process in place to ensure staff undertook training in safeguarding. Audits of accidents and incidents reflected there had been no reported incidents in 2024.

Relatives told us people received support to manage risks. One relative said, “Yes she is receiving the right care, they are really good and meet all her needs, check she hasn’t got pressure sores, if she has had a fall they record this too.”

Staff we spoke with were aware of people’s risks. They told us they used information in the care plans to guide them in how to support people. Staff shared examples with us of how they supported people’s specific needs in relation to mobility and epilepsy. The nominated individual advised they were aware that further improvements were needed relating to the details in people’s care plans. These improvements were needed to ensure staff had access to all the information they needed to ensure safe and consistent care was provided.

When the assessment was announced the nominated individual advised they were providing a regulated activity for 3 people. This number was confirmed by the nominated individual during the site visit. However, when documentation was reviewed in the days following the site visit it showed there were 5 people in receipt of support. Two days after the site visit, the registered manager and nominated individual advised there were 7 people in total receiving personal care. This lack of transparency and clarity meant it was very difficult to confirm whether people were involved in managing their risks and whether people’s needs were being met, as we were not able to confirm the number of people who were in receipt of personal care. Care plans lacked detail on health conditions such as epilepsy and guidance on repositioning to maintain people’s skin integrity was not clear. Some daily records completed by staff were of poor quality and did not always reflect the detail of care provided, for example, a person’s nutritional intake, or repositioning. This meant people were at risk of receiving care that did not meet their needs or receiving inconsistent care. Information about medicines remained unclear. Care plans stated staff were not involved in medicines administration, however daily records completed by staff showed staff were applying prescribed creams, supporting with prescribed nutritional supplements, and medicines used for the management of epilepsy. There were no Medicines Administration Records (MAR) in place. This meant we could not be assured that medicines were being managed safely. Audits relating to people’s risks were not effective. The provider’s medication audit for December 2023 contained 2 people’s names which were not included in the list the provider sent reflecting who they had provided a regulated activity to since October 2023. All medication audits from January 2024 stated ‘not required’ despite staff confirming they applied prescribed medicines.

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

Feedback from relatives reflected that they trusted the staff who supported their family member and were confident they had the skills required to support them. One relative said, “If there is an issue, they will ring to say they are running late. I have the office number and out of hours. In the early days [there were] some missed calls where there were problems but that’s improved.” Another relative said, “No late calls, if they think they may be late they will ring so [person] is aware.”

Feedback from staff reflected some issues with traffic on morning calls, which could impact timing of calls, however there were no direct examples shared of this impacting on people’s care. Staff described the process of contacting the office to advise if they were going to be late to a call. The nominated individual explained the process for staff reporting absence or lateness and this was reflective in feedback from relatives and staff.

We reviewed 3 staff files. Sufficient pre-employment checks had been carried out to ensure staff were safe to work in people’s homes. However, we were unable to confirm the total number of staff employed by the provider. This was because staff lists shared with us changed during the assessment timeline as staff named on the staff list did not always match names recorded in people’s daily care records, training records and completed audits. Staff training records reflected training deemed as ‘mandatory’ by the provider had been completed by some staff as well as training in specific areas such as dementia and epilepsy. However, training information was only provided for 12 staff members, so we could not be assured that all staff working at the service had completed the training required to enable them to carry out their roles safely. Call records showed people received support from the number of staff they required according to their care plan. Although some calls were logged as later than the time agreed, this was not persistent and an explanation was given by staff in their notes. There was evidence of some reviews of call data since the last inspection. However, audits for 2024 were sparsely populated which meant we were unable to ascertain whether the monitoring was effective.

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.

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