TrustBridge Care

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. We identified some improvements were needed with the management of medicines that were prescribed to be given at specific times; the provider made these improvements during our assessment. We observed sometimes staff worked long shifts. We discussed this with the registered manager who told us they would introduce further checks to ensure staff worked safely. There were enough staff employed and recruitment checks were completed to help the provider employ staff suitable for the role. Staff completed training relevant to their role. Infection prevention and control measures were followed. There was a culture of ‘learning to improve’ evident in the service. People felt issues were resolved and any accidents and incidents were reported and reviewed to help prevent the same situation happening again. People felt they received safe care and systems were in place to ensure people’s care safely transitioned between settings, for example, if a person spent a time in hospital. People’s views were included in their care plans and people were supported to be involved in managing any risks identified associated with their care needs and their home environment.

This service scored 75 (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 staff were open and honest and were quick to try and resolve any issues. They told us they were involved in meetings about their care, and this helped them feel listened to.

Leaders told us they reviewed any reported accidents and incidents and took actions to help prevent any recurrence where possible. They said they provided staff with training and information on safety protocols and reporting. Staff told us they had clear procedures to follow to report accidents, incidents and near misses. They told us incidents were reviewed and if any changes were needed, they were identified and implemented. Staff confirmed care plans and risk assessments were updated. Staff feedback helped to demonstrate there was a learning culture at the service.

The provider had a system in place for the recording of incidents, accidents and near misses and staff followed this. This helped to ensure safety incidents were recognised and reported so that actions could be identified to help reduce further risks.

People told us where they had used emergency care services, staff had supported them to do so when needed. People told us assessment processes identified where any additional help, such as from using equipment, had been identified and arranged for them.

Leaders told us they routinely asked staff their views on the safety of the service. Leaders held team meeting where staff could share their views as well as receive updates on training and good practice. Staff told us they felt people received safe care. When people were new to the service or had re-started their care after a return home from hospital, staff confirmed they had care plans and risk assessments in place. They said they had time to read these before providing people with their care and this made sure they knew what the person needed. They told us they would make referrals to other services, such as for advice from district nurses or occupational therapists, when they identified this would benefit the person’s care. Staff confirmed information on people’s care needs was accessible to emergency services should the person need this. This helped to ensure safe care was provided through transitions and different healthcare pathways.

Partners fed back staff worked cooperatively with them if they were involved in assessing clients for any specific support they may need. For example, when assessing clients for what help they may need to mobilise safely. Partners told us staff would raise any queries or feedback if a person’s needs had changed so the next steps could be appropriately identified. Partners felt staff worked well to support people throughout their care pathways and any transitions on their care.

Care plans showed where the provider had worked with external health and social care professionals when assessing people’s needs. This helped to ensure that the provider understood any specific health issues the client may have, it also meant the provider knew who to contact for any specific advice. This helped ensure that there was a safe and co-ordinated transfer of information to help ensure the person received consistent support.

People told us they had positive relationships with the staff and people told us they felt safe. People confirmed they knew who to contact should they have any concerns and they had been provided with information on local safeguarding procedures. This helped to promote people’s safety.

The provider followed the local authority safeguarding reporting process. This helped to protect people from abuse and harm. We identified the registered manager had not always notified CQC of allegations of abuse. We discussed this with them, and they took action to identify and submit statutory notifications for the relevant incidents during our assessment. Staff confirmed they had been trained in safeguarding. Staff understood how to identify potential signs of abuse and how to report their concerns using the local safeguarding procedure. This helped to promote people’s safety and helped to prevent abuse.

A safeguarding policy was in place and staff had been trained in how to identify and report safeguarding concerns.

People told us risk assessments were used to help manage risks. For example, 1 relative said, “There were lots of risk assessments to begin with. [Name of person] is immobile and needs to be hoisted so all that equipment needs to be used properly.” Other relatives told us how staff understood people’s body language to pick up on if they may be in pain. These actions helped to include people’s views in any management of their risks.

Leaders told us people’s care plans and risk assessments were created with them and this helped them to be involved in managing their own risks. Leaders explained staff had access to people’s care plans, risk assessments and any updates to help ensure they knew about any risks to people. Staff told us how they would help involve people in understanding and managing risks associated with their care. Staff described how they worked safely and minimised risks to people. For example, by checking for any changes in people’s skin when washing to help early identification and treatment of pressure areas.

The provider’s initial assessment process checked for any risks associated with the person’s health and care needs. Care plans and risk assessments were reviewed regularly. This involved obtaining feedback from the person and their relatives about how their care was provided and whether any changes were required.

People told us staff took actions to help ensure their homes were kept safe and secure. They told us staff would use a key safe system so keys were kept secure and would ensure doors were locked. People told us staff were respectful of their homes when they visited. One relative told us, “Yes, they are very respectful of their home. Everything is left immaculate.”

Staff told us people’s homes were checked to help ensure their safety and to reduce risks from any hazards. They told us if they noticed any changes they would report it and actions would be taken to review or make improvements. For example, staff told us if they noticed a problem with any equipment people used, for example a zimmer frame, they would report this so it could be replaced or resolved. These actions helped to create a safe environment where people received their care.

Environmental risk assessments were completed. These helped to identify and mitigate risks in people’s homes where staff would be working. When staff used their vehicles to travel for work, the provider had a process in place to ensure staff had appropriate vehicle insurance and vehicle checks in place.

Some people told us staff had not always stayed for the full length of the care call. However, staff would always check whether the person needed anything else doing before they left. People felt some improvements could be made to the timeliness of staff calls. Some people told us staff were sometimes late due to traffic or other understandable events, although, staff did inform people when this happened. Another person told us they felt timekeeping did vary depending on the time of day the call was scheduled for, and they felt it could improve. Some people felt staff at times had needed to do more training. For example, 1 relative told us, “[Staff are] mostly safe, I do think that some of the carers need to do more training.” Another relative told us, “From what I have seen with the training, there were 2 that came along that were not confident with the hoist, so they had to be re-trained and were shadowed for a while to get [their] confidence up.” People appreciated that they usually received care from the same staff and that there were enough staff to cover calls when the regular staff were not working.

We identified the potential for some staff to work long hours and discussed this with the registered manager. They told us they would start to monitor this more closely to help ensure all staff were working safely. One staff member told us at one point they had felt overwhelmed by the long days they worked. Whilst the provider had taken action to resolve this for them, they felt the provider could have resolved this more promptly. Overall, staff were happy with the hours they worked and told us this was planned around their availability. Staff told us there were enough staff to meet people’s needs. They said if a person needed 2 members of staff to ensure their safety, then 2 members of staff always attended. Staff did not feel they had to rush people’s care. They told us they would report to their managers if they felt a person’s care call was not long enough so the length of the call could be reviewed. Staff told us they went through the provider’s recruitment process when they were appointed, and this included checks such as from the Disclosure and Barring Service (DBS). Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff told us they completed training and worked with experienced members of staff prior to working on their own. They told us this helped them understand their job role and feel competent to provide safe care.

The provider used staffing rotas to plan the staff needed to provide people’s care. Staff training was monitored to ensure staff completed the training required by the provider. Staff recruitment records showed the provider had checked staff had a valid disclosure and barring service record (DBS).

People told us staff wore aprons and gloves and that any waste was disposed of properly. These actions helped to prevent and control risks from infections.

The provider had processes in place to help ensure all staff had the personal protective equipment (PPE) required for their job role and received training in infection prevention and control. Staff told us they worked safely to help prevent and control risks from infections. They told us they had plenty of gloves, aprons and masks and would wear these when providing personal care to help reduce the risks from spreading infections.

The provider had an infection prevention and control policy to guide staff actions. Whilst this ensured the principles of infection prevention and control would be followed, it had not been updated to reflect the latest updates in this area. We provided feedback to the registered manager so they could update this policy.

People managed their own medicines when this was their preference. When people had help from staff, people told us staff helped them take their medicines as prescribed. They told us this included any creams prescribed for their skin.

We identified and made leaders aware of some improvements needed regarding their management and administration of certain medicines. Leaders made the required improvements during our assessment. Staff told us they had their competency to administer medicines checked. They understood how to report any medicines errors and what advice to seek in the event of an error. Staff knew people needed different levels of support with their medicines, for example staff said they prompted some people to take their medicines and for other people the service as involved in the ordering of their medicines. Staff reported medicines processes worked well.

Some medicines administration records did not always show medicines had been given at the right times. For example, when some medicines were required to be given at specific times of day or at specific times before food. Leaders made changes to the processes they used during the assessment to improve this. When staff administered people’s medicines this was recorded, and people had medicines care plans and risk assessments in place.