Treasure Vince

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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 enough suitably qualified and skilled staff who worked effectively to provide safe care to meet people’s individual needs. At our last inspection we found two breaches of regulation. These were in relation to regulation 12 (safe care and treatment); regulation 17 (good governance). During this assessment some improvements had been made and the provider was no longer in breach of regulations. However, these improvements need to be embedded to ensure the required checks and documentation is in place.

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.

We did not receive feedback from people or relatives of their experience of whether the provider has a culture of learning. However, a relative did say they would complain if they felt the need and they know how to complain. People told us they felt the staff were suitably trained. Comments included, " Yes, the staff know what to do when they come. They just get on with it."

The providers induction process included observation of staff practice during their induction. The observation notes shared with us did not demonstrate how or if the provider gave the staff members further support to learn, the observations were recorded in tick box style with the ‘evidence’ section left uncompleted. Team meeting notes shared with us did not demonstrate a learning culture.

The registered manager had sourced a consultant to ensure they had tools and systems to monitor the quality of the service. These processes were not in place when we last inspected the agency. The registered manager is no longer using the consultant and the systems are not embedded. The registered manager should ensure the new processes are sustained and fully implemented. There was very little information recorded in their safeguarding log, key information was not recorded such as the nature of a whistleblowing, date and outcome. This did not demonstrate a learning culture.

People told us they were happy with the systems in place to contact the agency.

Staff told us there are systems in place to support them in their role, such as care plans and access to training. The registered manager said, “People have care plans and a care profile which has all the key information about the person such as medical history, allergies and medicines. I would provide a handover of this information to emergency services or hospitals.”

The registered manager told us they would share information to support people to move safely between services. The registered manager had processes in place to ensure staff had access to care plans, training and PPE (Personal Protective Equipment).

One relative told said, “I am happy with the care [person] receives and I feel [person] is in safe hands.”

The registered manager and staff were aware of their responsibilities to safeguard people from harm and abuse. The registered manager told us no safeguarding concerns had been raised by themselves. The registered manager said, “We have regular supervisions, where we discuss complaints and how to report safeguarding’s.”

There were systems in place to record safeguarding concerns although the registered manager had not fully completed the recording of the most recent concerns raised. Safeguarding was on the agenda of team meetings. This was to ensure staff were aware of their rights and responsibilities to request annual leave while the registered manager balances the need to ensure there is enough staff to provide people’s care.

We did not receive feedback from people or their families about the provider working in partnership to involve them in risk management. However, the Registered manager did tell us they work with people and families.

Staff said they had access to care plans and risk assessments. The registered manager said, “I ensure staff are aware of the risks to people and the measures to mitigate risk, such as turning off gas to cookers to prevent a fire or for one person ensuring staff know to check for trip hazards.”

During our last inspection we had concerns that risk assessments were not in place or robust enough to manage and mitigate risk. This assessment found risk assessments had been implemented for people who were at risk of falling and had the medical condition of diabetes. However, some risk assessments were not sufficiently detailed. For example, a risk assessment for person living with diabetes did not explain what staff should look out for if the person’s blood sugar was low which could result in the person being at risk of harm.

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

People were cared for by trained staff. Staff received training on a range of subjects including, safeguarding vulnerable adults, the Mental Capacity Act 2005 (MCA), moving and handling, first aid, medication and dementia.

One staff member said, “I feel supported by the registered manager.” Another staff member said, “They provide guidance, encouragement, and resources to help me succeed in my job.”

The registered manager did not ensure applicants work history was complete and did not always retain applicants’ application forms for each member of staff. The registered manager kept staff files securely and carried out checks with disclosure and barring service as well as right to work in the UK checks from the Home Office.

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.

During our last inspection we had concerns around the safe administration of medication. During this assessment we saw improvements had been made. Medication was no longer secondary dispensed into Dossett boxes. Medication Administration Record (MAR) forms were in place and were signed by staff. These were then audited by the registered manager.

Staff had received training on administering medication and competency checks had been carried out by the registered manager.

The registered managers check had not highlighted that some MAR charts did not have the specific times when medication had been administered, when medication was being refused there was no explanation why and that some documentation had scribbled out initials on.