Courage Limited

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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 the following quality statements: Safeguarding, Involving people to manage risks, Safe and effective staffing and Medicines optimisation. Improvements were required to recruitment and staff deployment. Safe recruitment processes were not always followed, and staff did not always attend care visits within the time they were expected. The provider was monitoring people’s care calls and recent improvements had been made. Staff training records did not reflect staff had received all the training required to carry out their role. The service is a specialist service that is used by autistic people or people with a learning disability and not all staff had received training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. We found breaches of the legal regulation in relation to safeguarding and safe care and treatment. Staff did not always identify allegations of abuse or make referrals in line with policy. Staff did not always assess risks to people's health and safety or mitigate them where identified. Risk assessments were incomplete and did not include risks we identified during our assessment. People’s medicines were not always administered safely.

This service scored 53 (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 look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were not always provided with safe care. Two people’s relatives described unsafe care being provided to their family member. We shared this information with the local safeguarding authority, as they had not been informed of these incidents by the provider.

Staff told us they had received safeguarding training and senior staff regularly discussed safeguarding with them. However, not all staff were able to explain what abuse was or describe what they would do if they had concerns about abuse. This meant we could not be confident staff would always respond appropriately to concerns of abuse.

The provider had not always ensured staff followed safeguarding policies and procedures. This meant incidents had not always been investigated or steps taken to mitigate future risk. Not all incidents had been reported to the local authority safeguarding team as required. Allegations and incidents of abuse had not been appropriately recorded. Safeguarding records lacked the detail required to ensure people were protected from abuse.

People told us risks were not always effectively managed. People’s relatives provided examples of care that did not mitigate people’s risks in relation to continence needs, personal care and equipment. People were at risk of harm due to unsafe care.

Staff told us people’s risks were assessed and the relevant information to mitigate risks was provided within people’s risk assessments and care plans. The registered manager acknowledged the information contained in people’s care records was confusing for staff to understand as it was not always current and lacked detail.

Risks to people were not always adequately assessed. Support plans and risk assessments did not always contain current, detailed information about people’s needs in relation to moving and handling, nutrition, falls, continence, pressure ulcer prevention and specific health needs. This meant staff did not have access to the information they needed to support people in a safe way and mitigate risks to their safety and well being.

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

We received mixed feedback about the timing and consistency of people’s care visits. Some people told us they were not always informed when staff were running late, and staff did not always stay for the full length of the call. People and relatives said staff didn’t always have effective training in meeting people’s needs. For example, staff had visited one person to provide care and did not know how to use the equipment the person used to help them move.

Staff told us they underwent a range of recruitment checks before they were deployed to work with people. However, recruitment records showed these checks were not consistent.

Safe recruitment processes were not always followed. For example, the provider did not hold a full employment history for all staff and gaps in employment were not always explored. Staff training records did not reflect staff had received all the training required to carry out their role. Several modules of training, including safeguarding adults and children, medicines administration, moving and handling, fire safety awareness and infection prevention control had not been refreshed by some staff and were out of date. Not all staff had completed training in how to interact appropriately with people with a learning disability and autistic people, at a level appropriate to their role. There was also a lack of specialist training being completed by relevant staff including diabetes awareness and catheter care. The provider facilitated care in different geographical areas. However, electronic call monitoring was only in place for people in one area. In other areas the provider relied on senior staff checking paper records of care calls. The electronic call monitoring showed that staff were sometimes late for care calls. The provider was monitoring people’s care calls and recent improvements had been made.

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.

People told us medicines were not always safely managed. Some people told us staff did not know how to apply creams properly. One person’s relative said, “I worry about the medication. On one occasion they [staff] left tablets all over the table.”

Staff told us they had completed training in medicines administration and had their competency to administer medicines assessed. Staff were able to describe how they administered medicines that were only to be given when required.

Medicines records showed that medicines were not always managed safely. Information provided to staff was incomplete and not updated when needed. Care plans did not detail who was responsible for ordering and collecting people’s medicines and it was not always clear who was responsible for administering people’s medicines. There was a risk medicines would not be administered as required. People’s care plans contained a list of prescribed medicines. However, the medicines listed did not always match the information on people’s medicines administration charts (MARs). Topical medicines administration charts (TMAR) and body maps were not always in place for the application of creams. There was a risk staff would apply creams incorrectly. MAR charts did not contain all required information about people’s medicines. For example, staff were administering eye drops for one person, but no MAR chart was in place. There was a risk the person’s eye drops would not be administered as prescribed. Staff had not always signed people’s MAR charts to demonstrate medicines had been administered correctly. People’s MAR charts did not always contain information about their allergies. People were at risk of ill health due to staff not following safe medicines management.