Total Health Support and Training Services 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

Risk assessments and management plans were in place and reviewed regularly. However, these were not always effective. Some risk assessments did not contain sufficient information to keep people safe. Staff had received training in safeguarding and knew how to report any safeguarding concerns. The registered manager had systems in place to investigate and report concerns. There were systems and processes for staff to follow, and incidents and accidents were analysed.

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.

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 and their relatives told us they felt safe. Their comments included, “Yes, very safe. In the past they [staff] have pointed out hazards such as silky sheets that meant [person] could slide onto the floor or a rug they could trip over”, “I feel safe. I have a key safe and the Carers[staff] are very competent” and “Yes, I do feel [person] is safe with them [staff]. I can leave them with them and go out. I don’t have to worry.”

We spoke with staff about safeguarding vulnerable adults. Staff demonstrated a good knowledge of safeguarding and a commitment to report concerns. Their comments included, “If a client [person] is abused, I will report my concerns to the line manager or on call as applicable”, “If I suspected abuse, I would immediately report it to my line manager or safeguarding lead. If necessary, I would also contact the relevant authorities, such as adult safeguarding teams or the police. It’s crucial that such concerns are addressed immediately to ensure the client's safety” and “The protocol in my company is to report all suspected client abuse to my line manager who can then take the appropriate actions.”

Systems were in place to record, report and investigate safeguarding concerns. People’s rights under the Mental Capacity Act 2005 were considered when keeping people safe. Records confirmed the registered manager worked with the local authority safeguarding team when dealing with safeguarding concerns.

People and their relatives told us staff were well trained, competent and knew people and their risks well. Their comments included, “Carers [staff] are aware of all [the persons] medical conditions and dementia. [Person] will shout as they get frustrated, but they humour [person] and talk to them and have a laugh with [person]”, “Carers have known [person] for a very long time” and “Carers are friendly, caring, and competent. They know everything about me in a professional way.”

Staff knew the people they supported, and the risks associated with their conditions. We asked staff about risks, particularly where people suffered from diabetes or epilepsy. Their comments included, “Yes, we review the risk assessment regularly, involving the families of the client [person] and other necessary personnel like the social worker. lf a client has epileptic seizure, l will check for danger signs around to avoid injury to the client and remove anything that can cause injury, then put the client in a recovery position while checking the time, then call 111or 999 if they are taking longer to recover. lf a client has hypo diabetic episode, l will call 111while checking the client [person] is breathing and their responsiveness. If the client is breathing, l will give him something sugary to eat or drink” and “. If a client [person] suffers an epileptic seizure; I would first of all note the time the seizure started and keep the client safe by making sure the surrounding is free from any harmful objects. I would protect the head with a soft pillow and would turn the client onto the recovery position to keep their airways clear loosen tight clothing around the client's neck. After the seizure, I will monitor the client's vital signs, which are pulse, breathing rate, and consciousness level. Then, if the seizure lasts longer than 5mins, or the client has another seizure soon after the first one or the client is injured during the seizure, I will call 999.”

A system of risk assessments was in place to provide staff with guidance to enable them to manage people’s risks. However, the system was not always effective. For example, one person suffered from diabetes. The risk assessment stated, ‘family prepares [person’s] meals and administers insulin’. No guidance was provided for staff relating managing this person’s blood sugar levels. There was limited guidance on how staff would recognise high/low blood sugar levels or what action to take. This could place the person at risk of harm. Another person’s care plan stated the person suffered from ‘epilepsy’. This was confirmed following an assessment by a doctor at a local NHS Trust. The HR manager confirmed to us this person had epilepsy. However, there was no epilepsy plan within the person’s care plan and no guidance for staff on what action to take should the person suffer a seizure. This placed the person at risk. We spoke with the HR manager about these issues, and they told us they would take action to address these issues and review all people’s care plans and risk assessments.

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

People told us they felt there were sufficient numbers of staff who were usually punctual and stayed for the full visit. Their comments included, “[Staff] time keeping is good and it suits us. They [staff] always apologise if late”, “There is a core of regular carers [Staff]” and “Carers [staff] stay the allocated time and sometimes over their time if he needs be. They are normally on time but Carers phone if running late. I get my regular Carers.”

Staff told us there were enough staff to support people safely and effectively. Their comments included, “Yes, we have enough staff to support our clients and staff are always punctual”, “Yes, we have enough staff, I am able to come and start my shift on time and stay for the full visit”, “We have enough staff to cover the shift, we never had any shortage of staff. If any staff can’t come to work due to any emergency the office will be informed in advance and assign enough staff. I’m always punctual and sign out after completing all my shift” and “Yes there is enough staff.”

Effective systems were in place to ensure sufficient staff were available to support people. Recruitment processes were robust, and background checks were conducted to ensure staff were suitable to support vulnerable people. Correct procedures and checks were conducted when recruiting staff from overseas. Staff rotas evidenced planned staffing levels were consistently maintained, this included where two staff members were required to support people.

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 and their relatives told us they were happy with staff managing their medicines. Their comments included, “Carers [staff] informed me that [person] wasn’t taking their meds, so now they help [person] with a blister pack”, “‘Very, very good. I couldn’t manage without them [staff]” and “I use a blister pack, I would recommend [the service] they are excellent.”

Staff told us they had been trained to administer medicines and their competency to do so was regularly checked. Staff comments included, “I have been trained, I’m confident administering medication and I’m checked regularly” and “We engage in continuous learning, both individually and collectively. Training sessions and meetings serve as avenues for learning. I have no problems with clients [people’s] medicine,”

People received their medicine as prescribed. An electronic medicine management system was in place. This recorded medicine records electronically in real time. The system alerted the office if any delays in administering medicines was detected. Medicine risk assessments were in place and records were accurate and up to date. Spot checks were conducted by senior staff to ensure staff were competent to administer people’s medicine.