Optimal Care Plus

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

We reviewed all 8 quality statements under this key question; learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risk, safe environments, safe and effective staffing, infection prevention and control and medicines optimisation. At this assessment although we found concerns about safety were listened to, investigated and reported to the relevant authority where required, the provider had not always notified the Care Quality Commission when incidents occurred at the service. The provider submitted the relevant statutory notifications retrospectively after our onsite assessment visit. Information was shared with staff to learn from and make improvements to the quality of service people received through staff meetings. Improvements were needed to ensure all areas of the recruitment process were followed. We found the verification process for identification documents such as passport, driving licence had not been followed, and gaps in staff employment history had not always been obtained despite prompts to explore this area during the interview process. The provider addressed our concerns immediately after the assessment. There were enough suitably trained staff to meet people’s needs. People’s medicines where required were being managed and administered by trained staff whose competencies were regularly undertaken. There were effective infection prevention and control measures in place.

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 and relatives, we spoke with were happy with the service and the care and support they/their loved one received. Comments included, “Staff are well trained and have ongoing training, the registered manager comes out and reassesses everything. She has recently put 2 carers in,” and, “I think they do lots well, particularly with communication which is good. The training of their carers is also very good, they seem to be strict with them and have clear rules and standards to meet.”

Staff told us when incidents had occurred, these were reflected on and used a discussion point in general staff meetings and 1:1 supervision. The management team described actions they had taken to support continued learning and to help identify themes and trends to improve the service.

Systems and processes were in place to support continued learning. These included supervision, appraisals, additional training where required, spot checks on staff practice, investigations of concerns and the completion of logs for incidents, accidents, potential safeguarding events and complaints.

People and their relatives spoke about how the management team and staff had supported them when first commencing with their package of care. A relative told us, “The care is coordinated really well, the office visit and review [person’s] care package which I think is important.”

A care coordinator told us, “The registered manager carries out the assessments. I read the support plan to find out if we need next of kin information. If a person’s package of care started today the first review would be in 2 weeks then every 3 months. If client went into hospital, we would also carry out a review.”

We requested information from partners however, we received no information in response to our request.

People’s care and support needs were assessed prior to admission to the service and the information used to create a person’s individual care plan. These were reviewed and evolved with the person as their needs changed. This ensured the care and support people received met their needs.

People and relatives told us they/their loved ones felt safe. Comments included, “They [staff] go twice a day, morning and lunch and yes I feel safe because they just seem to know what we need,” and “I feel absolutely its safe because they care and there are 3 staff I have got to know quite well.”

Staff confirmed they had received safeguarding training and demonstrated they knew how to prevent, identify and report allegations of abuse. They were confident the management and office staff would take appropriate action if concerns were raised. A staff member told us, “If I felt my concerns were not being addressed, I would report to other professionals, the person’s social worker and local authority.”

The provider had systems in place to ensure all safety concerns were investigated and action taken to ensure people’s safety. Records showed the provider had made/responded to safeguarding alerts to the local authority when necessary. However not all incidents which had occurred had been reported to the Care Quality Commission. The provider submitted the relevant statutory notifications required after our onsite assessment visit.

Care plans and risks assessments included information on how to support people safely. A relative told us, “I am confident staff have the right training as they seem to know everything on how to care for [person] and conscious of where their legs are when hoisting them, and aware of skin conditions etc. They even make suggestions, for example, they said to me they think [person] is too weak to get up and explained why and were confident with their knowledge.”

Staff knew people well. They explained people’s current needs and how the person wished to be supported. A member of staff told us, “When assisting people with their meals if they have any swallowing difficulties, ensure food is in appropriate bite sizes to avoid the risk of choking, allow the person time to swallow. For clients using a quad stick to aid mobility, I ensure their environment is clear when they are mobilising so there are no obstructions that could potentially lead to them falling.”

During the assessment visit, we reviewed people’s care plans. They contained information regarding risks to people and guidance for staff about how to manage potential risks. We identified risk management around catheter care could be further improved to identify potential signs to look for. For example, blood in urine, strong odour, keeping the site entry clean to reduce the risk of infection. The registered manager updated the risk assessment and care plan immediately after our onsite assessment visit. Systems and processes were in place to cascade information regarding changes to people’s care. These were reviewed regularly by the senior team.

People/relatives told us staff from the office would routinely make visits to their home to check staff competency, provide training for staff on use of equipment, and check the equipment and home environment to ensure people’s and staff safety. A relative told us, “I’m confident they [staff] know how to use equipment, the first time we got the hoist the registered manager supervised the use of it until staff understood.”

The registered manager had effective systems and processes in place to monitor the safety of people’s homes and equipment staff used to support them. A member of staff told us, “It is important to ensure that the equipment used is safely maintained, the person’s room must be neat, practice proper hand hygiene, use all PPE. We ensure all hazardous chemicals and medications are in a locked cabinet and check electrical outlets regularly.”

Health and safety risk assessments were undertaken on people’s home. These included, identifying potential risks such as equipment being fit for purpose, risk of falls from rugs, trailing electrical wires, gas, electric and water shut off points.

Most people told us they were not rushed by staff and staff remained for the duration of the call time. Comments included, “Staff arrive on time and stay the whole time, but they are there 24/7 so no one leaves before another arrives. Staff do their handovers well, I will be honest with the provision and the service I don’t think there is anything they can improve on,” “We have not had any missed calls. We have the same team which is a main carer and an additional staff member. If there is a new one, then they come with the carer we know who introduces them. I’ve met most of them before.” And, “I wouldn’t say it’s the same staff no, as they seem to have so many different ones, but they all seem nice.” Some people told us they did not always receive their care calls on time. However, they did say if staff were running late the office would notify them.

Staff feedback in relation to travel time between scheduled call visits was positive. Staff reported they had sufficient travel time between visits and hold ups were generally in relation to traffic or bus timetable for those staff who did not drive. Staff reported the service had enough staff to provide all planned care visits and they were able to stay for the duration of their call visits unless asked to leave earlier by the person or their relative if all tasks were completed. Comments included, “Staffing levels are ok. My company give me enough travel time between my calls, though sometimes the buses are delayed, however I stay for the whole duration of the client scheduled call,” and, “We have enough time to travel from one person’s house to another. We must stay for the whole-time frame of the call. However, if we are asked to leave their house for instance, a visitor is coming, after we have completed providing the care required in their care plan, we call the office letting them know we have been asked to leave and why.”

Systems were in place to ensure there were suitably qualified, skilled, and experienced staff and safe recruitment practices were followed. However, of the 5 recruitment files checked we found some gaps in staff employment history which had not been explored during the interview process. The registered manager responded immediately after our assessment visit and addressed our concerns. Pre-employment checks had been carried out, this included disclosure and barring service (DBS) checks and obtaining up to date references. For those staff members recruited on a sponsorship licence, checks had been undertaken with the relevant authorities.

People we spoke with had no concerns relating to staff practice around infection prevention and control. A relative told us, “I feel confident they manage things as the carers have helped [person’s] pressure sore to heal and made sure they clean them well. Staff put on gloves as soon as they come in and wear aprons and masks and are equipped.”

Staff told us they had access to personal protective equipment (PPE) and had received training around infection prevention and control. A member of staff told us, “We are provided with PPE, hand sanitisers. I make sure I wear the correct PPE for each task. Wash and sanitise my hands regularly and change my gloves.”

Staff had undertaken infection prevention and control training and were provided with personal protective equipment (PPE) which was distributed out to staff at various locations. The provider had an up to date policy in place to support effective infection prevention and control and was following current guidance.

People received their medicines when needed. A relative told us, “They [staff] see [person] is ok, assist with showering, and give them their medicines. I think they [staff] just care for [person] well as I am not able to do what they do.”

Staff told us they had received practical medication training and the registered manager had assessed their competency. One member of staff told us, “We received physical training, shown sample medicines of what we need to look out for like dossett boxes, original packages, and if a person refuses their medicines, we have a chart in their home to record this and then report to the office.”

The provider had systems and processes in place for the safe management of medicines. Medicines were audited, and actions taken in the event of any errors or discrepancies being identified. Staff received training and were assessed as competent before administering medicines.