Gill Care Services

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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

People told us they felt safe. Incidents and accidents were being documented and lessons learned. Risk assessments were in place however, some of these were only completed following our assessment. Staff were recruited safely and had the training they needed to undertake their role. PPE was available and infection prevention and control audits had been done. The registered manager, (who was also the nominated individual and the provider), took action to ensure medicines were being managed safely.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt safe with the service and raised no concerns. Comments included, “Yes (They are) very good. No complaints with them at all” and, “Yes, yes well I would ring up the boss (If there were safety concerns).”

Staff told us they knew what to do in the event of an incident or accident. They said, “I would contact 111 or 999. There is a form to fill in on one plan (Electronic recording system)”, “(I have) not had to deal with incidents. (I would) Call the nurses or ambulance, it depends on the incidents. I have done training and the policies are in the office” and, “I would report any concerns to the [registered] manager.” The registered manager told us they had made improvements to the way incidents and accidents were acted upon.

Improvements had been made in relation to recording and monitoring incidents and accidents. Incident and accident records had been completed and included evidence of lessons learned and actions taken. This would support improvements and reduce potential future risks. A log had been developed to ensure these were monitored and followed up. Evidence of notifications submitted to the Care Quality Commission were seen. There was a contingency plan in place however, this related more to a care home rather than domiciliary care.

People and relatives confirmed an assessment of their needs had been undertaken. They said, “We had an initial meeting at the hospital” and, “Boss [Management] came last week to find out how things are going. They call or come out every few months.”

Staff told us how they were informed about new people who used the service and where the assessments of people’s needs were located. They said, “The [Registered] manager will tell me about new clients [people who used the service.” The management team discussed the relationships with a range of professionals. We saw communications with professionals had been recorded.

Positive feedback from professionals was received about the service and the care they provided. One said, “I have had a very positive experience of this care service.”

Records included assessment information about people’s needs. Records of these were seen and there was evidence which confirmed they linked in with a range of professionals to support people’s care. We saw evidence of a pre admission assessment in one person’s record.

People and their families felt safe and raised no safeguarding concerns. They were happy with the care they received from the staff. They told us, “Yes very good no complaints with them at all” and, “Yes, I think so. I think [Person] is happy.”

Staff demonstrated their understanding of the signs of abuse and how to act on any concerns. They said, “I have had training, learnt about different types of abuse and how to protect people”, “I have done safeguarding training. Any concerns I would report to the senior. I have never had to deal with any concerns but I would be confident they [the management] would act on the concerns” and, “If I suspected abuse I would report this straight away to the senior or the [Registered] manager.

The management had developed a new system to record and monitor safeguarding allegations, and take actions to undertake lessons learned, to reduce any future risks. Records were seen in relation to safeguarding concerns, these had been reported to the relevant authorities. The registered manager provided evidence notification had been sent to the Care Quality Commission and confirmed they would ensure an audit trail of the actions they have taken were available. Training records confirmed all staff had undertaken safeguarding training. Safeguarding policies and guidance was available and staff confirmed they had access to this.

People and their families were confident in the services and staff ability to manage risks. They told us, “Gill [Gill Care Services] have their own process; I would go to them, social worker or occupational therapist. I am happy with Gill Care” and, “They ask and talk to [Person].”

Staff knew what to do to support people’s needs and risks, and would take action if there were any concerns that people’s needs had changed. One told us they would report any concerns to the registered manager. The management team told us risk assessments had been reviewed. Some individual risk assessments were required for two people. The management team took action to ensure detailed individual risk assessments were in place. They gave assurance they would ensure all people’s assessed needs included risk assessments according to their individual needs. Staff knew where people’s risk assessments were and they were informed when people’s needs had changed.

Individual and environmental risk assessments had been completed. Not all people’s individual risks had comprehensive assessments in relation to people’s health needs to ensure individual risks were managed safely. We discussed this with the registered manager who took immediate action to ensure these were in place and they gave assurance all people’s care records would be checked to ensure all individual risks had been comprehensively assessed.

People told us they had the equipment they needed to meet their care needs.

Some staff knew where to access risk assessments and told us they had read these. No one raised any concerns about equipment and the safety of people. They confirmed they had received relevant training including, moving and handling and the use of the hoist. One said, “I feel people are safe and live in a safe environment.”

Environmental risk assessments in people’s homes had been completed and included details of risk. The registered manager told us they had engaged the local fire safety team in assessments for people to ensure fire safety had been assessed.

People and relatives raised no concerns in relation to skills of the staff who provided their care and confirmed their visit times were met. They told us, “Yes we have 2 carers all the time. Very occasionally they are late and they always let us know” and, “We always have the staff we need. More often than not it is the same 2. I am pleased with who we have.”

Staff told us they had sufficient time to undertake their role. They said they had completed all relevant training, competency and spot checks to undertake their jobs safely. Comments included, “I am happy, feel supported. I am up to date with training and I am informed when it is due” and, “If I feel I need training on anything, I ask and they give it. They give you every opportunity to learn.” Staff told us there was sufficient time to undertake their tasks and enough staff to support people’s needs. They told us, “There is enough time to get to each client and enough time to spend with people” and, “I have enough time to do my job, not pushed on time.”

Duty rotas were completed. Staff files were in place, which included information in relation to the recruitment processes. The provider had developed a record to explore employment history and gaps in employment but these needed more details. The registered manager took immediate action to ensure records were more detailed to include full dates of employment. Training certificates were in staff files and the training matrix identified all of the staff team were fully up to date with their required training. There was evidence of competency checks taking place along with spot checks during the delivery of care, and appraisals as required. The registered manager had developed a system to ensure all checks on staff and training was completed as they required. A range of policies and guidance was available and accessible to the staff team, to support the delivery of care to people.

People and relatives raised no concerns in relation to infection prevention and control.

Staff mostly confirmed they had undertaken infection control training and had access to personal protective equipment (PPE) supplies. Comments included, “I have had training. We have access to PPE at the office. There is always a supply” and, “The [registered] manager provides us with gloves and aprons. We can get more from the office when needed.” However, one staff member did not understand what PPE was. The registered manager gave assurances they would ensure all staff received updates in relation to infection prevention and control and PPE.

Infection control policy and guidance was available to support staff in the delivery of the care to people. Staff had been observed by the management at visits using PPE, ensuring they understood the importance of PPE. A thorough infection control audit had been completed.

People and relatives raised no concerns in relation to the management of their medicines. They told us, “The medication is in blister packs, [person who used the service] knows the routine and if other medicines are needed like antibiotics they let us know” and, “I have no complaints on how it is done.”

Staff told us they had completed medicines training and competency checks had been undertaken to confirm they had the skills to administer medicines safely. They told us, “I have had training and the [registered] manager comes and watches me do medicines. We have also had training on tube feeding” and, “I have had training and competency is checked regularly.” We discussed medicines management with the registered manager and team co-ordinator. They gave assurances about the actions they had taken to make improvements in the medication administration records and liaising with professionals around people’s medicines administration. They told us a dedicated member of staff had been introduced as medicines champion in the staff team.

Medicine administration records had been completed by the staff however, these required further detail about ensuring medicines were given in line with their prescriptions. For example, medicines which needed to be given at specific times or where the doses needed to be spread out throughout the day did not have the time of administration recorded. This meant there was a risk people were receiving their medication too close to the previous dose. The registered manager took immediate action and developed a new medicines administration recorded that could include the times and doses of medicines where required. They told us they had shared this immediately with the staff team and introduced it into people’s home. Staff told us they had been informed of the immediate change. One person required their medicines to be given in a specific way, The registered manager told us, and provided evidence of the actions they had taken, including linking in with professionals to ensure relevant authorisations were in place. Training records and competency checks had been undertaken. Staff had access to policies and procedures to support the management of medicines.