Abihealth Care - Southwest Office

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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

We assessed 8 quality statements in safe in relation to learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection prevention and control (IPC) and medicines optimisation. Incidents were recorded and acted upon. There were systems in place to support people accessing the service. Staff were able to tell us how to keep people safe from harm and abuse. Staff had received relevant training in relation to their roles. Required pre-employment checks had been completed for staff before they started work. Staff demonstrated a good understanding of IPC processes and told us they had received training. Following a series of medicines incidents, staff had received additional medicines training. Medicines competency assessments were in the process of being repeated for staff involved in these incidents. However, we found some care plans had conflicting information. Adequate processes were also not in place to ensure people received their medicines safely.

This service scored 62 (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 their relatives told us staff responded quickly to incidents. A relative told us they had contacted the office to raise a concern and it was resolved in a timely manner.

Staff told us they would report any incidents to the manager or care co-ordinator. Leaders told us “Incident reports are acted on immediately. The manager completes a reflective practice document and complete this with staff. There is a lessons learned session facilitated throughout the organisation to share good practice with all the staff.”

Incidents and accidents were recorded with actions taken. The manager had recently introduced feedback sessions with staff across the organisation to review incidents and accidents.

People and their relatives told us they had received good support to set up their care packages. One person told us “We did have a discussion in hospital where care was agreed. There was joint discussion with social services, Abicare’s manager and ourselves. We were listened to and so was [person].”

Staff told us assessments were completed for people who received support. One staff member told us “We speak to the people directly, family and any other social workers who are involved.” Staff also told us care plans were discussed and shared with staff including people who used the service. Leaders told us they had to chase professionals to provide accurate information to be able to provide safe care and treatment when people started using the service. The manager completed a checklist within 72 hours of support commencing to ensure all care plans and risk assessments had all the required information.

The local authority’s quality team acknowledged during a quality audit the provider’s feedback about the lack of information they received from professionals when people started support.

People’s records demonstrated needs were assessed before they started using the service. There was a dedicated assessment form which was used to transfer information onto care plans. There was evidence of staff liaising with professionals for more information on people’s needs. Most people and their relatives had been involved in care planning. However, although the service had an audit process to check the completion of care plans and risk assessments, these audits had not identified some of the concerns we found during the assessment. For example, a service users medicines had been changed by a GP and some medicines had been stopped. However, there was no documentation to support this and it was unclear if the correct medicines had been administered.

People told us they felt safe. Relatives told us people were safe. One relative told us “Yes, it is safe. They give medication. [Person’s] mobility is not great and carers accompany him in the house, going downstairs and in the bath. [Person] had no falls whilst with the carers. [Person] has no sores or bruises.”

Staff were clear about how to identify abuse and followed the processes to report abuse. Staff were aware of the whistleblowing policy and process.

Staff had received training in safeguarding, Mental Capacity Act (MCA) and Deprivation of Liberties Safeguards (DoLS). The manager kept a log of safeguarding incidents to ensure all required actions had been completed. The provider had a safeguarding policy which staff had access to. There were opportunities to discuss safeguarding during team meetings and supervisions.

Most people told us they were involved in setting up and reviewing their care plans to help keep them safe. However, not everyone we spoke with were aware of their care plan or felt the provider had discussed it with them.

Staff told us they followed people’s care plans. They told us, if there were any changes needed to the care plan or new risks identified, they would tell the care co-ordinator who would update the information on the centralised system. If identified risks were received from health and social care professionals, the care co-ordinator would again update care plans and tell staff verbally.

Some care plans had conflicting information. For example, one care plan stated a person “had a history of confusion and memory loss.” However, the health risk assessment stated that the person “did not have difficulty with their memory.” The manager had an action plan in place to address some of the concerns found about care plans, but it did not identify all the concerns we found during the assessment.

People and relatives told us they had access to the equipment they needed to keep themselves safe. They felt staff had the knowledge and training to support them with equipment.

Staff told us they felt safe accessing people’s properties and had access to all the information needed. The care co-ordinator or senior care worker visited people’s homes prior to care packages commencing. They completed an environmental risk assessment to ensure people’s and staff safety. There was a check in and check out system in place for home visits which was monitored by the care co-ordinator. Due to Wi-Fi issues, some staff were not able to log in and out at the correct times. However, the provider had a process in place where staff would contact the office directly to notify they were safe and home visit information was added retrospectively.

Staff had received training in manual handling. There was evidence of staff liaising with professionals to ensure people had access to the equipment they needed. Equipment being used by people was documented in care plans with guidance for staff on how it should be used. There was a business continuity plan in place which highlighted what to do in an emergency.

People told us they felt staff had the right skills and knowledge to meet their needs and were complimentary about the staff. However, some people told us they felt there were language barriers. In addition, most people we spoke with told us staff did not arrive on time and did not always stay for the full duration of the scheduled calls. For example, one person told us “Visit time arrival can be on and off. Mostly they are on time but occasionally late. Not late enough for me to complain though. They tend to leave when they are done. I feel they should stay for the full time of an hour’s visit instead of going in 30 minutes. It depends on the carers. About 50 percent stay the full time and 50 percent go quickly.” Some people told us they did not receive a call when staff were going to be late. The provider had evidence which showed people were visited within the contracted timescales.

Leaders told us they had several vacancies and were working on a local recruitment campaign to secure permanent staff. At the time of the assessment the provider was utilising 5 agency staff to support people. They were exploring a bike scheme to attract staff who could not drive or did not have access to a vehicle. Staff told us they had enough time to meet people’s needs without rushing. Staff told us they had regular supervisions, unannounced spot checks and team meetings.

Required pre-employment checks had been completed for staff before they started work. This included a check with the Disclosure and Barring Service (DBS). Staff had the appropriate checks for the right to work in UK. Staff had received a contract of employment, had clear job descriptions and completed an induction. There was evidence of staff training appropriate to the role. The manager had introduced additional workshops for staff across the organisation to collaboratively share knowledge and experience on subject matters relating to their roles. There was evidence of some recent supervisions taking place. The provider had not received any reports of concern from service users or relatives regarding language barriers.

People and their relatives told us staff followed good IPC measures. Comments included, “They [carers] are absolutely very good with gloves and aprons. Hygiene is very good.”

Staff demonstrated a good understanding of IPC processes and told us they had received training. Staff told us they did not have problems obtaining the personal protective equipment (PPE) from the provider. Leaders told us PPE was ordered centrally and delivered to staff.

The provider had an IPC policy and procedure in place. Staff had received training in IPC and this was completed annually in line with the provider’s policy.

People told us home visits were sometimes delayed which meant they did not always receive their medicines on time.

Staff told us they received annual medicines training and competency checks. Following a series of medicines incidents, staff had received additional medicines training. Medicines competency assessments were in the process of being repeated for staff involved in these incidents. Staff were not always aware of the difference between prompting and administering medicines. Staff told us there were sometimes issues with connectivity to the electronic systems when they were in people’s homes which meant they could not complete the required documentation in a timely manner.

Medicines policies were in place; however, these were not specific to the provider and did not provide staff with adequate detail to carry out their role. Staff were not following the provider’s medicines policy, for example Medicines Administration Records (MAR) did not contain people’s allergies as outlined in the medicines policy. Processes were not adequately in place to ensure people received their medicines safely. For example, records reviewed showed medicines were regularly delayed. Poor documentation of medicines administration meant that we could not be assured people were receiving their medicines as prescribed. The provider was not always following national guidance in relation to medicines. Where people were prescribed medicines that required additional safety monitoring, these had not been risk assessed in all cases. Where risk assessments had been completed, these did not always contain adequate person-centred information. Body maps were in place to document the application of topical medicines. However, the administration of these medicines was not documented on the Medicines Administration Records (MAR). The provider took steps to resolve this issue during the assessment. Medicines Administration Records (MAR) showed that medicines care episodes were delayed on most occasions. Staff told us this was due to poor record keeping rather than delayed administration. However, this meant we could not be assured medicines were being given as prescribed. A system of medicines audits had been introduced in May 2024 and as a result was not yet fully embedded. Initial medicines audits had identified issues with medicines, and the provider had begun to take action to rectify these issues. However, these audits had failed to identify some of the issues that we observed during the assessment. We saw evidence showing people were visited within their contracted timeframes.