Evolve Supporting Prospects

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

We identified three breaches of the legal regulations. We found concerns in relation to the safe management and administration of people’s prescribed medicines. Clear assessments and administration records were not accurately completed to demonstrate people received their prescribed medicines safely. Records to guide staff in the management of specific areas risk were not in place or sufficiently detailed to help minimise areas of risk, such as risk of choking, medication and safe moving and handling techniques. Robust recruitment checks were not completed prior to new staff commencing their employment; nor had staff received the necessary induction, training, and support to develop their knowledge and skills in specific areas of support. People said they felt safe and well supported by consistent staff who knew them. However, sometimes they felt staff were rushed needing to get to their next visit. A review of visit logs, showed staff did not always arrive at the planned time or stay for the agreed duration. Therefore, we could not be assured people’s support was safely and effectively planned and delivered. Staff understood their responsibilities to safeguard people. The provider worked with the local authority to address any identified concerns. Areas of learning from recent concerns had been shared with some members of the team.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff told us they had received training relevant to their role. Whilst learning sets had been held following recent issues, these did not include all members of the team. Ongoing learning and development helps staff to develop new skills as well as offering consistent care and support.

Governance systems were not sufficiently robust to help identify areas of learning; nor demonstrate these had been consistently shared across the team enhancing their knowledge and skills of staff in line with best practice.

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 told us they felt safe and were well cared for by staff. This was supported by people's relatives. Comments received included; “I trust them completely. I can do nothing but praise them. They look after all my needs. I am very pleased with them. If I have had any issues, they have sorted everything out” and “[Person] is safe with the carers; I have no issues with any of them.”

Staff were able to demonstrate their knowledge of safeguarding and the actions they would need to take to ensure people were kept safe. Staff confirmed they received training in safeguarding and would report any concerns where necessary. One staff member told us, “Yes, we have training every year, this includes the types of abuse. I would report anything to the office, and I would escalate if needed including whistleblowing. I am confident the manager would respond appropriately.”

Policies and procedures to guide staff in the protection of people, such as safeguarding adults and mental capacity were available. However, information needed to be reviewed and updated to reflect current practice. The Provider held records of any safeguarding concerns raised and cooperated with the local authority to address any issues raised. Learning from recent incidents had been discussed with some members of the team. This learning should be shared across the team to help develop staff knowledge and understanding and improve care practice.

People we spoke with said staff assisted them to keep safe and where necessary had access to any equipment needed to meet their individual needs. People and their relatives told us, “They make sure [person] has her Zimmer. In the shower we have a stool and there are anti slip mats”; “We have a pack of information in the house, with phone numbers I can call” and “All safety aspects are set up. If I need anything moving out of the way they will move it". People said contact numbers had been provided should they need to contact the agency in the event of an emergency.

Managers completed assessments of risk. We were told these assessments were reviewed annually or more frequently if needs changed. This was not reflected in all care records we looked at. Where necessary people had access to necessary equipment to minimise such risks, for example the use of a hoist and walking aids. Staff told us the main area of risk for people was in relation to the risk of falls. Staff said they would monitor people’s movement and had completed training in moving and handling each year. Staff said care plans identified areas of risk and they were kept up to date when people’s needs changed. Additional support and advice were sought from other agencies, where appropriate.

Policies and procedures in safe working practice and risk management were in place. However, these did not reflect the practice undertaken ensuring effective systems were in place to help keep people safe. People’s risk assessments were not personalised reflecting their individual needs, nor did information provide clear direction for staff ensuring people received safe and effective support. Furthermore, assessments had not been completed by someone competent to do so. This meant there was a breach of regulation of safe care and treatment. Contingency plans were in place in the event of an emergency occurring, which may impact on service delivery. An out of hours on-call system was also in place should staff require assistance. However, there was no information summarising peoples support needs for staff and no, record of any calls received from people. This information would enable the service to effectively respond to people’s needs as well as monitor any themes, which may need further review.

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

All the people and relatives we spoke with felt staff had the relevant knowledge, skills, and experience to provide the support people wanted and needed. One person told us, "They are well trained. Some of them have been doing it for years. The younger people are observed by the manager, and they shadow older more experienced staff.” Prior to our visit we were told some people felt visits were rushed and not always at the time they wanted. Most of the people we spoke said there were sufficient numbers of staff available, staff stayed the agreed length of time, and they received consistent support from a regular care team. However, this was not everyone’s experience. Comments included; “The staff who come in the evening, I feel they are being rushed. They seem to have to rush off to their next client. We don’t experience this with the morning carer, so perhaps they do need more carers” and “They are hardly ever late. They stay and do all the jobs they should do.” A review of the electronic visit logs did not evidence people’s support was effectively planned or monitored. People told us whilst they did not have a copy of their staff rota, this was not always necessary as they knew who would be visiting. Some people also told us communication was improving and they were now better informed of any changes or if staff were running late. However, this was not everyone’s experience. One person said, “If they are late, they are calling us now. It didn’t use to happen I use to think they weren't coming, but now policy seems to have changed so we get a call.” Whilst another said, “They are usually on time, but one night they were very late, and nobody informed me what was going on.” Prior to our visit concerns had been raised with us about staff speaking in their first language with each other at the exclusion of the person being supported. Those people we spoke with told us they had no concerns, nor was there a language barrier.

Staff told us they had a stable rota and supported the same people each week so knew what support was to be provided. Staff said they had time to travel between visits however if they were running later, due to traffic, they would inform the office, who would inform people. Staff felt equipped to carry out their role and responsibilities and had received training in areas of care. One staff member spoke of bespoke training provided to meet the specific needs of one person they support. Staff said they completed a brief induction and were given handouts and an induction handbook to complete in their own time. Individual supervision sessions were not held offering support and direction. These sessions help support and develop staff as well as identify any additional learning needs, so staff are equipped to deliver safe care and support.

Robust recruitment processes were not in place. Internal policy and procedure did not reflect current legislation and best practice, particularly in relation to disclosure and barring checks (DBS) and the employment of international staff. In addition, on review of 3 new staff files we found shortfalls in the process for seeking and verifying references and DBS checks. We found the management of records was disorganised, and relevant information was not easy to locate. This meant there was a breach of regulation, Fit and Proper Persons Employed. Further concern had also been received in relation to staff not receiving the required training and support. At this inspection we found policies and procedures regarding staff training, development, and support were not being followed. We found new staff did not complete a thorough induction and individual supervision meetings to discuss their learning and support needs were not held. The programme of training also needed expanding upon to include all areas relevant to staff roles and responsibilities, so the required standard was met. The service offers support to people with a learning disability and autism. Training in this areas had not been provided. We were told sufficient numbers of staff were available due to a reduction in contracted work. However, a review of the electronic visit logs showed late or over lapping calls, staff not staying the agreed length of time, calls where 2 staff were required not arriving at the same time and no travel time between calls. This did not demonstrate effective management systems were in place to ensure people's support was safely and effectively monitored, planned and delivered. These shortfalls meant there was a breach of regulation, Staffing.

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.

Not everyone required support with their prescribed medicines. Where support was provided, people told us staff ensured they took their medicines when required and would liaise with family members when items needed reordering. People and their relatives told us, “The carers give medication, no problems. They know where it is kept. The evening staff are very good at applying the cream to [person] heels and legs” and “My morning carer sets out my medication for me in the morning."

Staff confirmed they had received training in the safe administration of medicines. They said managers would carry out an annual observation to check their practice was safe. However, we saw no evidence of these. Staff said they completed administration records when people had been assisted with their oral medicines or when applying creams. Any issues relating to people’s medicines were reported to the office. In the event of an error being made, advice would be sought from the on-call manager and the persons GP.

Systems to support staff in the management and administration of people’s prescribed medicines were not sufficiently robust to ensure people were not placed at risk. The agencies policies and procedures needed expanding upon to reflect good practice guidance. People’s care records identified if medicines support was required and the arrangements for ordering and disposal of items. However, there was little other information about how people wanted or needed to be supported. Plans did not include people’s health conditions, a list of their current prescription and how or when these should be given. Other records for additional prescribed items such as topical creams and thickening agents, which may be added to people’s food and fluids to minimise the risk of choking, did not provide clear direction for staff in relation to how they were to be used. For example, how much thickening agent and fluid is to be used to when preparing drinks. Records showed all staff completed training in the administration of medicines. We were told managers observed staff practice to ensure medicines were administered safely. We requested evidence of such checks however these were not provided. Competency assessments were also being undertaken by managers who were not sufficiently trained to do so. A review of the medication administration records (MAR) also identified gaps in administration, unexplained codes and changes made to a prescribed items. Handwritten entries were not checked and signed to ensure the information recorded was accurate and complete. Monthly checks had been carried out. These focused on the completion of the MAR. Information was limited and there was no formal action plan in place to address any shortfalls identified or action taken. From our findings we could not be assured people were safely and effectively supported in the management and administration of their prescribed medicines. This meant there was a breach of regulation, Safe Care and Treatment.