CSS 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. For this key question we assessed the quality statements relating to; learning culture, safeguarding, involving people to manage risk, safe and effective staffing, infection prevention and control and medicines optimisation. We identified 3 breaches of the legal regulations. The provider did not respond to safety events appropriately and systems to learn from incidents, accidents and safeguarding concerns were not embedded. Risks to people had not been fully assessed and their healthcare needs had not been considered, meaning staff lacked guidance around how to keep people safe and monitor for deterioration. Records relating to medicines lacked detail around when and how people needed support with medication administration. The provider failed to ensure recruitment systems were robust enough to ensure staff were suitable to work with vulnerable people. Whilst staff said they felt supported they did not have access to induction, training, supervisions or appraisals in line with the provider’s own policies. Inconsistent records relating to people’s visit times and gaps in scheduled support, indicated there were not always enough staff deployed. People said they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, policies and systems in the service did not support this 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.

Feedback on the culture of safety and learning was mixed. People did not always feel confident concerns would be dealt with proactively and lessons were not always learnt. A person using the service told us, “I call to speak to the manager, she doesn’t always answer and never gets back to me.”

Some staff we spoke to could not clearly explain their responsibilities for recording and reporting incidents, so we could not be assured safety events had been appropriately investigated.

Processes were not embedded to ensure lessons were learned from safety incidents or complaints. There was an accident and incident file in place, but no entries had been made despite a recent incident.

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.

Whilst some people said they felt safe, others had not always been appropriately supported and gave examples in which they had experienced abuse or neglect. One person said, “Sometimes staff get irritated with me. After I’ve had a shower, they don’t dry me properly and try putting on my clothes when I am still wet. They get nasty when I complain”. Another told us about a serious concern they had raised with the service, it was unclear if this had been investigated properly or reported to the appropriate authorities. People said they were supported to understand their rights under The Mental Capacity Act 2005 (MCA); staff encouraged them to make their own decisions and respected their choices.

There was not a strong understanding of safeguarding within the team. Although some staff were able to talk to us about safeguarding, others were not familiar with the provider’s safeguarding policy and seemed unaware of the steps to take should they suspect abuse.

There was a lack of effective systems and processes to protect people from abuse and neglect. Safeguarding concerns had not been consistently recorded, and there was little evidence of action taken in response to abuse or neglect. Concerns were not reviewed by the provider to ensure lessons were learnt and prevent re-occurrence. Mental capacity assessments and best interest decisions were not always completed in line with best practice guidance. This meant we could not be assured people’s capacity and ability to consent had been taken into account when planning, managing and reviewing care and treatment.

People were informed about risks and how to keep themselves safe and well. Relatives confirmed staff supported people to help prevent incidents such as pressure sores or falls. One person said, “I’m not able to move hot pans [myself]. Carers make sure there are no sharp objects I can fall against, and I am getting corner protectors for my table”. Relatives told us most staff understood people’s communication and support needs in relation to their dementia, and confirmed training was planned to further improve staff confidence.

Staff we spoke to understood risks and could tell us what action they would take should an incident or accident occur.

Risks were not always assessed. Risk assessments about care were not always person-centred, and we could not see evidence they were regularly reviewed with people’s involvement. Risk assessments relating to falls and people’s health conditions had not been consistently completed; some were unfinished, and we noted a lack of information to guide staff around people’s specific needs. At times, information also conflicted with that in people’s care plans.

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 and relatives gave mixed feedback around staffing levels, and the frequent use of agency staff affected continuity and impacted the quality of some people’s care. One person told us, “[Staff] never turn up at the same time. They also miss visits sometimes. It is always different staff, and they don’t know my needs.” Others spoke of shortened and inconsistent visit times.

Though staff confirmed they had an induction when commencing employment, we received mixed responses around training. Some staff could not confidently tell us about courses they had undertaken. A staff member told us, “I completed a new one today, moving hands [moving and handling] and personal care, and another one but I have forgotten.” Leaders acknowledged significant concerns around recruitment processes and advised these would be developed. Staff we spoke to felt there were appropriate staffing levels; confirming they had enough time to meet people’s needs and travel between visits.

Recruitment practices were not robust or safe. Gaps in employment were not explored, and satisfactory evidence of conduct in previous employment was not available for all staff, meaning the provider could not be assured they were of good character. Procedures were in place to assess the competence of prospective staff, but these were not fully embedded. A candidate was deemed ‘unacceptable’ using the provider’s own interview scoring system, yet they were still employed. There were gaps in the training matrix and staff had not received all training appropriate to their roles. For example: some people had health conditions such as diabetes, but there was a lack of training to enable staff to deliver safe and effective care in these areas. Staff did not receive ongoing support to ensure they delivered safe and effective care; they had not received regular supervision in line with the provider’s own policies.

People were protected as much as possible from the risk of infection. People confirmed staff supported them to maintain their personal hygiene and keep their homes clean and tidy where required. Staff wore personal protective equipment (PPE) at appropriate times.

Staff confirmed us there was a plentiful supply of PPE available to them as required.

Staff were not always clear about their roles and responsibilities around infection prevention and control due to a lack of training. Whilst learning was available to staff, compliance in this area was poor. The manager responded to our concerns by sending reminders to staff.

We had limited information to review; most people we spoke to advised they managed their own medicines or received support from relatives to do so though we were not assured this had been done safely. One person we spoke to confirmed staff checked and documented their medication during visits, supporting them to manage their medicines.

Staff gave mixed feedback around the safe management of medicines. Some staff told us medication records were not always up to date, whilst others said they were accurate. Feedback about competency checks and training was also inconsistent, meaning we could not be assured the current approach to medicines reflected best practice guidance.

We found several shortfalls in the systems and processes used to manage medicines. Accurate, up-to-date information about people’s medicines was not always available. Medicine administration records (MARs) lacked details about how or when medication should be administered and there were gaps in recording, meaning we could not be assured people were receiving their medicines as prescribed. We also noted inaccuracies with the spelling of medication and codes used by staff. Records identified staff had not had their competence checked regularly, to ensure they maintained the skills required to administer medicines safely.