OASIS West London Office

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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 assessed 8 quality statements in the safe key question and identified 1 breach of legal regulations in relation to safe care and treatment. The provider did not always assess risks to people's health and safety or had effective plans to mitigate them where identified. Care plans did not always have enough information in them to guide staff to manage risks and to care for people. However, there were effective systems in place to safely recruit staff. People’s medicines were managed safely. There were systems in place to monitor and manage complaints, accidents/incidents, and safeguarding concerns. People and relatives told us they felt safe and had no concerns regarding safety.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives told us they had regular opportunities to speak to staff about any concerns or issues. Overall people and relatives told us they were happy with the agency and staff were attentive to their needs. One person told us they requested a change of care worker due to communication difficulties. In this case a different care worker was sent to the person. This showed that the provider was listening to people and acting on their requests.

Overall staff told us there was more emphasis now on learning lessons when things went wrong. One staff member told us, “We have lessons learned so we don’t repeat the same behavior, we work closely with teams and families we follow up on complaints.” The registered manager told us things had improved since the last inspection. They said, “We do lessons learned, how to report issues for example, the new system, information now goes to the care worker’s phone.” Another staff member said, “We have really improved since last inspection, working with a detailed improvement plan, continuously keeping staff on board and people with changes involving them getting feedback etc."

The provider had a process in place for learning lessons when things went wrong. Team meeting minutes showed there was now a new section on reflective practices. The emphasis here was for the care team and leaders to look at a variety of issues and propose new ways of working, for example, the new care planning system was modified to include more options for care staff to record information about people’s mental health. This meant staff could alert the management team in real time if a person needed additional support. In addition, care staff were encouraged to follow up any changes in people’s health with a call to the office for advice.

People and relatives told us they were informed and involved in people’s care and support planning. Overall people were happy with the care provided by the agency.

The registered manager shared some examples of referrals made to the local authority. In both cases risks to people’s health had been identified. Clear communication had taken place between the registered manager and the hospital discharge team and local authority. As a result, people had additional measures put in place to reduce the risks of harm.

There was evidence from the provider that they worked well with the local authority. The local authority had referred people to the care agency. Overall, the referral and transition process was viewed by the local authority as working well.

The provider had a process in place to ensure people had a safe journey when moving between service. The agency worked closely with other health care professionals and the local authority. There was a referral and admission process in place. This meant people could feel confident they would receive joined up care, if there was more than one agency involved in their care and support.

People and their relatives told us they felt safe and were well looked after. Some comments were, “She [person using the service] is safe, she feels supported”, and “I have no worries over safety.” People told us the staff were good and they would raise any concerns with them if they needed to.

Most staff we spoke with were not able to clearly explain the safeguarding procedure. Staff lacked knowledge in this area. We spoke with the registered manager about this, and they informed us that staff had up to date training in this area. The registered manager explained that safeguarding is discussed in both team meetings and supervisions. Two out of 12 staff members were able to clearly explain the procedure for safeguarding .

There was an effective safeguarding process in place. Safeguarding concerns were reported both to the local authority and the Care Quality Commission, (CQC) as required. Safeguarding concerns were investigated, and measures put in place to protect people from harm. Staff had training in safeguarding, however out of 12 care staff we spoke with, 6 staff members were unable to explain abuse and how to report it. This meant people could be put at risk of harm. There was a safeguarding policy and procedure in place for staff to use if needed. The provider had a tracker set up to monitor and capture accidents/incidents and safeguarding concerns. Entries showed that actions and outcomes were recorded. This meant the provider could use this information to drive forward improvements.

People were involved in care planning and reviews. However, some care plans showed that risks which had been identified had little or no information in them to manage those risks. The lack of details in assessments could put people at risk of harm. However, people and relatives told us staff were aware of health concerns for example, one relative said, “I prepare [my relatives] food, but they [staff] know [my relative] is diabetic, so they know not to give her sugary food, although she likes sugar.” We did not receive any concerns or complaints from people or relatives regarding staff managing known health risks.

Staff did not always assess risks to people's health and safety or mitigate them fully where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. People did not always have enough information in care plans to guide safe practice. However, staff were able to explain how they would manage some of these known risks, as they knew people well

The process for involving people to manage risks was not robust enough. Prior to starting a care package, an assessment of care needs was undertaken. Some risks of harm to people were identified at the initial assessment and this information was included in care plans. However, in some care plans we sampled there was a lack of guidance for staff, for example, in one risk plan there was a risk identified of pressure sores. There was no description of what signs to look out for and when to seek medical advice. Overall, the lack of details in risk plans put people at risk of avoidable harm.

Most people and relatives we spoke with told us they were aware of hazards in the home environment. The provider had carried out an assessment of the environment during the initial stages of setting up the care package. One relative said, “A supervisor came to visit and made some assessments. My [relative] and I were involved in the review. The company listened to what we had to say.” The assessments carried out involved health and safety checks. For example, checking the home for any trip hazards and recording this in the care records.

Staff and leaders told us they recorded hazards including fire hazards when they first visited the home or flat. Where hazards were identified staff would put measures in place to reduce the risks of harm to people. For example, staff explained to us they would check for hazards in the bathroom before offering a person a shower or bath. This may mean checking the water temperature. Staff told us they would check equipment before using it such as a hoist. This meant people would be supported in a safe environment.

The provider recorded environmental risks such as hazards in the home, for example, slip hazards such as uneven flooring. Guidance for staff was available. However, in some cases it was not clear from the assessments what control measures were needed. For example, in one risk assessment the wiring on an electric appliance was frayed, there was no record of how this had arisen and was it reported. There were no clear measures in place to mitigate the risks. This meant people using the appliance could be at risk of harm.

Everyone we spoke with told us the care team arrived on time and stayed for the allocated time. If there were any issues most people said they received a call from the office to explain any changes. People told us they had the same care worker each time and this was greatly appreciated. Comments included, “Initially the morning visit was around 10 to 11am. But visits have become more flexible, if he comes and [my relative] can’t see him at that time he leaves and comes back later. This is due to [my relative’s] needs.” And “The carer is never late and stays with [family member] as long as she needs to, the visits are very flexible, which is perfect for us.” This flexible approach meant people could arrange their support according to their preferences and wishes.

Staff told us they felt supported in their role. Staff said they liked working at the agency and their views were listened to and valued. Staff told us the training provided helped them to do a good job. Staff had team meetings and could raise concerns or seek support when they needed it. Overall staff were very positive about working for the agency.

Effective systems were in place to recruit staff. Background checks including criminal checks were carried out. This meant people could be confident that staff had been vetted before beginning their employment. Staff had full training in a range of topics to carry out their role. Staff competencies were checked in line with the company’s policy. The provider had an extensive training programme in place. This meant staff could be competent and confident in their role. Staff had regular supervisions and appraisals, which meant they could seek guidance when needed. Staff deployment was arranged according to people’s needs. This meant people could be assured that their care needs were a priority.

People and relatives told us staff used personal protective equipment such as gloves and aprons. This was to prevent the spread of infections. People said staff also washed their hands before handling food. People and relatives told us they observed safe practices about preventing the spread of infections during the call visits.

Staff and leaders had a good understanding of infection, prevention, and control procedures. All staff we spoke with explained these procedures clearly. This meant people could be protected from the risk of harm because staff knew how to prevent the spread of infections.

The provider had a process in place to prevent the spread of infections. Staff had training in the prevention of spreading infections. This meant they understood how to protect people from harm. However, in one case staff reported a pest infestation, this was reported to the local authority, however staff were not given additional information to prevent further outbreaks. We spoke to the registered manager about this, and they informed us they would address our concerns. Infection, prevention and control policies and procedures were in place. This meant staff had a resource to use when required.

People who had support with their medicines told us staff were competent in this area. One person told us, “There have been no problems with medication. It is in a blister pack and kept safe in the kitchen. The carer [care worker] writes notes about what she has given and what she has done each time she visits.” Relatives we spoke with also said staff administered medicine in line with how they were prescribed. One relative said, “‘Yes, she has support with medication, they check she has taken her medication. They have phoned up to tell me she has refused medication. I then phone her [family member] and chat with her.”

Staff and leaders told us they had a good understanding of medicine management including what to do if an error was made. Staff told us they would seek medical advice if needed and report any concerns to the office and management team.

The provider had an electronic monitoring system for medicines in place. This system recorded when people had their medicines. In most cases planned medicines administration times were respected with one hour window on either side of administration time. However, in a couple of cases medicines were not administered at the correct time . This could put people at risk of harm, as some medicines can be time critical. In addition, some people’s care plans detailed that people were able to manage their own medicines, but staff recorded that they assisted people or even administered their medicines .This meant staff were not correctly checking records which could lead to an error being made. Care plans reviewed had detail about what medicines people were taking. Staff had training in medicines administration, and this meant that people could be confident that their medicines would be administered safely. There were policies and procedures in place to give staff guidance when required.