A & A Services West Midlands

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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

Our rating for this key question has improved and safe is now rated as requires improvement. Improvements had been made in staff training and staff understood how to safeguard people from the risk from abuse. The provider had introduced a learning process and whilst this was investigating incidents the learning was not shared with staff. Staff training had improved, and all staff had up to date training in place, recruitment audits were completed, however these had not identified concerns with some checks not being in place. Risks assessment had improved, however some risks to people were not assessed and planned for. Where risks were identified to people’s safety, these had not consistently been assessed and plans had not always been put in place to reduce them. Where people received support with medicines administration improvements were needed to ensure safe practice.

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.

People had not experienced any incidents or accidents and were unable to comment if the organisation adopted a learning approach when things went wrong.

Leaders told us they had a system to ensure all incidents were reviewed to identify learning opportunities when things went wrong. Staff were unaware of the identified learning when things went wrong. They understood how to report incidents when they happened, but learning was not shared systematically with staff.

When incidents, safeguarding and complaints happened there was a process in place to review these and identify any learning. For example, where an allegation of abuse had been investigated a lesson’s learned process had been completed to identify where this could be prevented from happening again. However, the learning was not then shared with a wider staff group to ensure changes to practice took place.

People told us they felt safe using the service. A relative told us, “Nothing is too much trouble. Same staff have visited mostly for 15 months, they are a ray of sunshine. Just what we need first thing in the morning.”

Leaders told us they had systems in place to receive referrals, assess and plan for people’s care. Staff understood the processes in place to assess people and plan for their care. They understood the requirements for each care call. However, they were not always aware of wider risks posed to people’s safety from their health needs.

Partners told us they did not have contractual arrangements in place with the organisation. The provider had been advised to make improvements to the service following input from partners. However, some required improvements to care plans and risk assessments had not been consistently completed for everyone using the service.

Processes were in place to assess people’s needs, however where risks were identified there was not always a process in place to manage the risks. For example, where people had a history of falls there was no specific risk assessment or guidance for staff to prevent people from falling.

People told us they were safeguarded from abuse. Relatives told us they felt confident staff supported people safely and understood how to raise concerns should they need to. One relative said, “[Person’s name] is safe. They look forward to seeing the staff. They would speak to us if they were worried. We would go to the agency about this.”

Leaders told us they had systems and processes in place to ensure incidents of potential abuse were investigated and reported to the most appropriate body. Staff understood how to recognise potential abuse and described how they would report any concerns. One staff member told us, “I would look for changes in their behavior, marks on their body and any changes to their body language.”

The provider’s processes did not consistently operate effectively to ensure investigations were concluded and documented. For example, we found staff had reported concerns about bruising which had not been formally documented or investigated. We confirmed the person had not come to any harm during the assessment, however improvements were needed to ensure all allegations or evidence of potential abuse are investigated immediately upon the provider becoming aware of them.

People felt staff supported them to maintain their safety. Relatives told us staff supported people with their personal care and mobility safely.

Leaders told us they carried out risk assessments for people who had risks to their safety, and these were reviewed annually or sooner if needed. Staff were not consistently aware of risks to people’s safety. Staff understood risks relating to personal care and mobility, however they lacked knowledge of risks relating to people’s health conditions such as epilepsy and diabetes.

Processes in place to manage risks to people’s safety had not ensured all risks were assessed and planned for. Where people had risks associated with their care, they were not consistently assessed and planned for. For example, risks associated with epilepsy and diabetes had not been assessed and planned for leaving people at risk of potential harm.

People told us their home environments were safely maintained by staff. One relative said, “The staff do little bits of cleaning and tidying up. They make sure [person’s name] is safe, no hazards.”

Leaders told us they had environmental risk assessments in place for people using the service. Staff confirmed risk assessments were in place to help them manage risks related to people’s environments. One staff member told us, “Managers go out to do risk assessments in people’s homes. I report to the office if there are concerns or I think someone needs some equipment.”

Risk assessments took account of people’s environmental risks. Assessments considered stairs, ventilation and people and staff safety.

People told us they were supported by a consistent group of staff who attended calls on time. One relative told us, “We know who is coming and any changes they let us know. They are on time and let us know if they are running late. We have not had any missed calls.”

Staff told us they were supported in their role. One staff member told us, “I have had a full induction and training updates, and I receive regular supervision.” Leaders told us the current policy and process for recruitment did not ensure applicants full education and employment history when recruiting staff. This meant the provider could not be assured staff they recruited were suitable for their role. Following the inspection site visit leaders told us they had now changed the application forms to capture this information.

The policy and processes in place to recruit staff did not ensure newly appointed staff had provided a full education and employment history and appropriate references and checks before starting employment. This left people at risk of receiving care and support from unsuitable staff.

People told us they were protected from the risk of cross infection because staff followed infection prevention control procedures. One relative told us, “The staff all wear face masks and gloves.”

Leaders told us they had procedures in place for staff to follow to prevent people from the risks of cross infection. Staff had been trained and had access to protective equipment such as masks and gloves. Staff told us they had received training in how to keep people safe from the risk of cross infection. One staff member told us, “The office team provide aprons, masks, gloves and I change these between each call.”

Processes were in place to ensure staff protected people from the risk of cross infection.

People who we spoke with did not have any support with medicines administration.

Leaders told us all staff had been trained and had their competency assessed to ensure they were able to administer people’s medicines safely. They told us they had a policy to guide staff in safe medicines administration. Staff confirmed they had training and competency checks carried out. Staff described using the care application to record when medicines were administered and followed the guidance on a medicines administration record.

The medicines policy and processes were not accurate and up to date as the support people received with medicines did not always reflect what was recorded in the policy. For example, records showed a person had not been supported to have a topical medicine administered in accordance with their prescription. The provider told us this was because the person’s relatives had not ordered the medicine. However, the provider’s policy stated medicines would be ordered by staff.