Dale Care - Beechfield Court Extra Care

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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

There were regulatory breaches identified with regard to safe care and treatment and medicines management following this visit. Medicines were not managed safely. Improvements were needed to rota management to ensure people received safe, timely and consistent care from staff whom all knew their care and support needs. Risk was not always well-managed as the service did not have effective systems in place to proactively identify and manage risks before safety events happened. Some actions taken were not always timely, when managing risk. Systems were in place for people and staff to raise concerns, however, they did not feel confident that they would be listened to, and their concerns would be addressed. Incidents and complaints were investigated and reported. However, lessons were not always learned from safety incidents or complaints, resulting in repeated incidents and concerns. Information was not always available about people if they moved between services to ensure their safety and continuity of care. People, and the majority of relatives felt included in decisions about their care, including how risks were managed to support them to continue with day-to-day tasks safely. Information was available about people's mental capacity to consent.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Most people told us they felt safe and staff responded immediately if they needed support. A person commented,“I feel safe living here, I just press my pendant if I need anything and usually staff respond fairly quickly, not always at night, although they are improving.”

Staff told us they were encouraged to report incidents and some staff described how they had self- reported medicines errors. Any incidents about people's safety was discussed with staff, but actions taken to mitigate further risks was not always effective. While learning was identified for individuals in response to an incident, staff felt wider learning did not seem to be identified and shared.

Improvements were needed to ensure people’s safety and safety concerns were acted upon. Staff filled out accident and incident forms which were reviewed by management. A more robust analysis of all accident and incident reports was needed to help mitigate risk to people’s safety. Lessons should be learned from incidents, with learning widely shared with the staff team to prevent similar incidents occurring and to raise awareness of complying with standards and safe working practices.

Information was not always available about people if they moved between services to ensure their safety and continuity of care. A relative commented, “The carers do call the GP or an ambulance if my loved one is unwell, I try to accompany to hospital as the staff don’t go, however if there are any appointments I have an agreement that a member of staff will attend if I cannot go”.

Staff were aware of when people had health or social care professional input. They said they felt confident working with other agencies. Recommendations from health professionals or other professionals had been implemented. They did say there was not standard information that was sent with a person if they went to hospital, it was up to staff what information accompanied the person.

We did not receive any feedback from partner agencies relevant to this quality staatement.

Systems were not all in place for staff to work with people and partners to establish and maintain safe systems of care, in which safety was managed, monitored and assured. Information such as a hospital ‘passport’ containing standardised information about people’s care and support needs was not available to ensure people received a continuity of care when either visiting another service or discharged from the service. Before a person started to use the service, information was collected to ensure their needs could be met by staff and that the service was right for the person, as well as the person being right for the service. People, their relatives, health and social care professionals were involved in the planning.

Most people told us they trusted staff and felt safe with their support. A person commented, “If I have any concerns, I relay it via the carers if not actioned, I ask to see the manager who comes to my flat, usually everything is actioned quickly.”

Staff members told us they knew to raise any safeguarding concerns to management, they said they felt confident they would be dealt with appropriately. A staff member told us, “I have completed safeguarding training, it was good and provided me with knowledge and understanding of recognising and reporting abuse/potential abuse.” A manager told us, “The staff are good at reporting any concerns. I have done level 3 local authority safeguarding training.” Handover procedures to staff had improved, to ensure more effective recording and communication. We discussed with the scheme manager the over reliance on the current communication book to record personal information, and any changes to people’s care and support requirements, that should be recorded in people’s care records.

Processes were in place to protect people from avoidable harm, unfair treatment, or abuse. Staff had received training on identifying and reporting abuse and knew what action to take if they identified abuse. Concerns were mostly being reported to the local authority as appropriate and we discussed with the scheme manager they should also be reported to the CQC. We received feedback from a partner agency, “We are concerned in regard to staff identifying what is safeguarding and reporting in a timely manner.” Safeguarding incidents were investigated but they did not show evidence of effective lessons learned as there was no sustained improvement and there were recurring themes. Oversight of incidents needed to be more robust to identify improvements and review action plans. Safe staff recruitment helped ensure people were protected from staff unsuitable to work in the care sector. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Records around people’s capacity contained all relevant information and were completed in line with national guidance. Records showed mental capacity assessments had been completed with people and their representatives. People’s capacity and ability to consent was taken into account, and people and their representatives had been involved in planning their care and support. Where people could not make decisions and consent to their care, there were processes in place to make sure any decisions would be made in their best interests.

People, and the majority of relatives felt included in decisions about their care, including how risks were managed to support them to continue with day-to-day tasks safely. A person told us, “I feel totally safe when using the hoist and I trust the carers they allow me to be as independent as I can but also supportive, the carers know my routine and are confident and competent.” A relative commented, “I am included in the care planning of my loved one’s care, the carers are very good we have a good rapport, plenty of banter and laughter, they respect my loved one and allow them to be as independent as they can.”

Staff understood where people required support to reduce the risk of avoidable harm. Staff knew the risks to people and told us they were kept up to date if there had been any changes to people's care and support needs.

Processes were in place to assess and manage risks to people’s safety. Staff received health and safety training and training about safe working practices. They understood their responsibilities for reporting accidents, incidents, or concerns. There needed to be more regular management review of accidents and incidents to reduce the likelihood of re-occurrence. Staff worked to mitigate any identified risks, however, risk assessments and care plans, that contained information on the actions staff needed to take to keep people safe, needed more regular review to monitor people’s well-being and identify any current risk and reflect people’s changing needs.

People lived in a safe environment which was suitable for their needs. Staff supported people safely and appropriate equipment was available if people needed assistance to mobilise. A relative told us, “The environment is safe and 24/7 support is available. My loved one wears a pendant and knows how to use it if they need to call someone.” Another relative commented, “Beechfield Court is a very safe environment with round the clock support, moving here has improved my loved one’s confidence and allowed them to be independent and have a life. We have lots of equipment and if anything is needed the management would contact the social worker.”

Staff told us they had received training in safe working practices and they felt safe working at the service. They said they had appropriate equipment to move people safely and had received training on how to use it. They felt supported when management were not on duty as an on-call system was available to provide support and guidance, in an emergency.

The building was maintained by the housing association who completed regular checks to ensure the environment was safe for people living at the service. Staff reported any issues to the housing manager who was based at the scheme, to help ensure risks to people’s safety were mitigated. Emergency plans were detailed and covered topics such as risk assessments in the event of fire. Environmental risks were assessed, with measures put in place to remove or reduce the risks. Regular health and safety checks were completed, this included of equipment such as, hoists and stand-aids.

People gave us mixed feedback about staffing. They said most staff were kind, caring and patient. They were positive about the relationships they developed with staff. A person told us, “I know some of the carers, they are good and helpful and easy to talk to, I feel safe when they help me transfer as they know what they are doing.” Another person commented, “Me and the staff get on like a house on fire.” Not all people or relatives told us they received continuity of care, with staff who understood their needs and preferences. Their comments included, “My loved one has 3 calls a day, different carers come each visit which [Name] finds unsettling, the carers often come late which causes my loved one to become agitated. If there was continuity the carers would know where they are up to there have been occasions where the carer has put the clothes in the washing machine and it has not been taken out till that carer has returned two days later”, “The staff are different some just don’t know what to do, others encourage [Name] to be independent.” Not all people and relatives told us they were supported by staff who were competent and had the right skills to support them. Comments included, “There are staff who work properly, and those who do not,” “I do not feel the staff know what they are doing, but I do think they would ring the Gp if I was unwell”, “I find it totally frustrating you have to tell the carer what to do” and, “I am fairly independent some staff help, and some are better than others, it is like they are from a different service.” Most people and relatives said staff did not arrive when they expected them to and they did not stay for the correct length of time. A person commented, “The carers don’t come at the time they are expected. It bothers me when they are late as I cannot get on with the day and I get the feeling the staff do not want to come or are not bothered, they occasionally ring up to say they are late and ask if I still want them to come

Staff told us staffing levels were improving to help ensure people’s needs were met in a safe and timely way. A staff member commented, “Staffing levels are better than they used to be, there are now additional runs on the rota, so there are gaps now between calls, so there is flexibility.” Some staff reported they did not feel as if staff worked as a team. They commented, “Staff morale is low. Some staff work better than others” and “We don’t have enough staff.”

Rotas were not managed effectively so people received care in a timely and person-centred way. This placed people at risk of harm. People did not all receive care when they needed it, impacting on their well-being and safety. Due to poor rota management, people did not receive care from a reliable and consistent team. People sometimes did not receive their medicines on time because their calls were very late. Safe recruitment practices were followed. New staff had appropriate pre-employment checks in place which included photo identification, work history, references and a Disclosure and Barring Service (DBS) check in place. DBS checks provide information including details about convictions and cautions held. Staff received training to give them insight into people’s care and support needs. A system of supervision and appraisal was in place to help staff.

We received mixed feedback about staff use of personal protective equipment [PPE] as they supported people. Most people told us staff wore PPE. A person told us, “Staff don’t always wear PPE when they should.” Another person commented, “The carers leave their used disposable gloves around the flat-not hygienic.”

Staff told us personal protective equipment (PPE) and all cleaning materials needed were available. They confirmed they had received infection control training. A manager told us, “Additional Infection Prevention and Control training [IPC] is to be arranged for staff.”

Infection Prevention and Control [IPC] policies and procedures were in place. They showed detailed information to guide staff in the actions to take to ensure they followed safe practices to prevent the spread of infections.

Care Plans were not detailed about what support people needed to take their medicines. Risk assessments for people self-administering some of their medicines but not all were not appropriately risk assessed to make sure they were supported safely to do this. Assessments and care plans for people that had capacity were not in place about when access to their medicines was restricted.

Staff told us training was available and there was a system of competency assessments annually or when errors were made. However, when staff made repeated errors there was no system of review. The manager completed a variety of audits. These had not identified all the issues we found.

We identified a breach of regulation 12: Safe care and treatment of The Health and Social Care Act 2008 Regulated Activities 2014. Medicines were not managed safely. Systems for ordering medicines were not effective and people went without their prescribed medicines. Many medicines were out of stock and could not be administered as prescribed because of the lack of a system for ordering and receiving medicines. Improvements were needed in the records of how people took their medicines, in the guidance and records for creams, patches and when required medicines including those with a variable dose. A clear reason was not recorded when medicines were not given to people. Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Guidance for how these medicines should be administered was missing for some people. The reason for taking a ‘when required’ medicine or the outcome was not always recorded to review effectiveness. Where a variable dose was prescribed it was not recorded how much had been given on each occasion. Processes for applying and recording creams and patches were in place. However, we found these was not being consistently followed by staff. Guidance was missing and we found that records were not accurately completed. There was a mixed use of non-administration codes in the eMAR system, so it was not clear whether medicines are stopped /discontinued/ not available or refused. Where medicines were administered by external health care agencies there was no clear record or care plan of their involvement.