Sambhana Care Ltd

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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

The rating for the key question of safe is good. The areas where there were shortfalls at the last inspection have been addressed. There had been improvements in the management of risk and medicines. There were enough staff to meet people’s needs and there had not been any missed calls. Staff had been recruited safely. Staff had received an induction and their competency had been checked to make sure they had the skills to support people safely. There were systems in place to protect people from abuse and discrimination, staff understood their role in keeping people safe. Risks to people’s health and welfare had been assessed and there was guidance in place to mitigate the risks. People received their medicines as prescribed.

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 told us they felt safe being supported by staff. They were supported by a consistent group of staff and trusted them to keep them safe. Relatives told us they thought their loved ones were safe and were happy to leave them alone with staff. One relative told us their loved one had been apprehensive about having carers, "But now they wouldn't be without them." Relatives told us, staff speaking the same language as their loved ones helped, "They can have a conversation now and more importantly work out and let us know if anything is wrong."

There was a safeguarding log in place where concerns were recorded and the action taken. Concerns had been reported to the local authority when people were at risk. For example when an increase of support hours were required, these had been agreed by the local authority, to maintain people's safety. The registered manager had been open about incidents which had happened and had worked with the local authority to put strategies in place to reduce the risk of them happening again.

Staff confirmed they had received training in how to recognise and report abuse and discrimination. They described how they would recognise abuse and the action they would take including reporting to the registered manager and outside agencies if needed. Staff were confident the registered manager would take appropriate action to keep people safe. A staff member told us, "Safeguarding is protecting citizens health and wellbeing and human rights to live free from abuse and neglect." The registered manager understood their role in reporting safeguarding concerns to the local authority and taking action to reduce the risk of them happening again.

Staff told us, they had access to risk assessments within people's homes. They understood how to support people to manage risk. Staff reported any areas of risk they identified such as a change in a person's mobility, to the registered manager. Staff told us, the registered manager, would give them guidance to reduce risk including when new risks were identified. The service uses electronic care plans. The registered manager told us risk assessments were regularly reviewed at intervals throughout the year or updated and amended when there is a change or a new risk has been identified.

Potential risks to people's health and welfare had been assessed and there was guidance in place for staff to mitigate risk. Care plans had been signed by either the person or their relative to confirm they agreed with the information and the strategies which had been put in place. There were risk assessments in place to provide staff with guidance to support people living with diabetes, how to recognise when they were unwell and how to suppport them. When people had a catheter, to drain urine from their bladder, staff had guidance to recognise when people had an infection. There was guidance for staff about how to reduce the risk of infection.

People and relatives told us staff supported them to manage risks. One relative described how their loved one had started to burn themselves while cooking. They continue to cook but staff now supervised them, keeping them safe. All relatives we spoke with confirmed the registered manager had involved people and themselves, in the care plan. They had been given the opportunity to discuss what support they needed and how they wanted staff to provide the support. Relatives told us staff were responsive to a change in people's needs, and discussed how to manage this. Examples were given about days when people did not feel up to completing some taks and staff assisted them but still encouraged them to do as much as possible.

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

There were systems in place to make sure staff were recruited safely. The registered manager carried out safe recruitment checks for staff to ensure staff were able to support people. This included confirming their identity, right to work checks, references and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. New staff had completed an induction and had their competency checked before they worked with people in their own homes. Staff had completed relevant training to their roles, including first aid, mental capacity act, moving and handling, dementia and infection control. Staff who did not have a diploma qualification in care had completed or were enrolled to complete the Care Certificate, to make sure the care they provide meets the national standard. There was a manual process to work out the travel time between calls. This was completed by a staff member who used to be a carer, so the time allowed was realistic and reduced the risk of staff not attending calls on time.

People and their relatives told us that they were supported by regular staff who arrived on time and supported them in a respectful and dignified way. People told us that staffing had improved dramatically. Previously people were supported by different carers but staffing was now consistent. Relatives told us they were able to request extra calls if needed and these requests were always met. Comments include "We saw quite a few different faces but now we have much more regular staff" and "Staff have always been there, no issues with timing. We have 2 carers we see the same faces more often than not and they have always turned up. Can’t fault them they stay the length of time. They often ask if there’s anything else can be done." Relatives told us if staff were going to be late, they always rang and apologised, One relative told us, "The staff roughly come on time, this morning the girl came from 4/5 miles and was caught in traffic, quite common where we are."

Staff told us there were enough staff to meet people's needs, staff confirmed when people required the support of 2 staff there was always 2 staff on the call. Staff felt supported by the provider and registered manager, they were confident to raise any concerns about staffing levels when people's needs changed and extra staff were required. They felt there was enough staff within the team. Staff confirmed spot checks and supervisions had been completed by the care supervisor. All staff told us they felt confident in asking for support from the management team. The provider and registered manager stated they have had no issues recruiting staff. They have recently been granted a sponsorship license to recruit overseas workers.

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.

The registered manager told us that spot checks and competency checks are completed on all staff to ensure that medicines administration is safe and correct. Staff told us, " Some clients require just prompts; others need to be given the medication." and "One client always refuses. We give them time and encourage them, then ask again later and they take it." Staff understood the process to report if people did not take their medicines, they told us, "If a person refuses medication they can’t be forced to take it." Staff said they would inform next of kin. If they don’t have a next of kin then they would report it to the registered manager. Staff told us they had their training with Sambhana Care Ltd. Staff were supervised giving medication by the registered manager until they were assessed as competent.

Most people we spoke with managed their medicines themselves or with relatives support. People who were supported by staff to have their medicines were positive about the experience. One relative told us their loved one required support with their medicines and they told us, " Yes medicines are managed really well. That's if [loved one] chooses to take it." They went on to tell us that the staff do their best to encourage them to take their medicines.

There were systems in place to make sure staff received appropriate medicines training for staff providing care at home. There were records to confirm staff had been assessed as competent to administer medicines. Audits had been completed, when there had been shortfalls, action had been taken to reduce the risk of them happening again including additional staff supervision and training.