Community Care Direct 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

Staff were recruited safely. Safeguarding policies and procedures were in place to help ensure people were cared for in a safe way and protected from the risk of harm. Any concerns were shared appropriately with the relevant external agencies. There was a culture of safety and learning from any past incidents. People’s rights, including their human rights, were protected under the Mental Capacity Act 2005 and the Equality Act 2010. Medicines were managed safely and were administered by staff who were trained and had their competency assessed. Although staff knew people well and were aware of any risks to people’s safety, people’s records did not always reflect this. We could not be fully assured people had been involved in their assessment of risks. People’s records lacked guidance for staff on how to manage and mitigate risks. At the time of our assessment, the manager had begun to implement person centred risk assessments for people.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they felt able to raise any concerns and that they would be listened to. A relative told us how they had raised a concern about a staff member and how satisfied they were with the manager's timely action. They felt they had been listened to and that the event had been investigated and reported on thoroughly, "[Manager's Name] took immediate action and investigated, I am happy with how it was dealt with and handled."

The provider demonstrated a proactive and positive culture of safety based on openness and honesty, in which concerns about safety are listened to, safety events are investigated and reported thoroughly, and lessons were learned to continually identify and embed good practices. Feedback from both the manager and staff confirmed the provider was open and transparent and lessons were learnt from any incidents and/or concerns. The manager told us, "There is a learning culture here. All staff have access to policies and know how to report any incidents. We discuss anything in meetings - I have a hand over every morning from the senior on duty - if there any issues, I will action right away, and a message goes out to staff. It's a proactive approach." Comments from staff included, "Yes - there is a learning culture here - any past events we will discuss in detail. We talk about what we could have done better and what we can do," and "We do talk about any incidents. We learn from this, and I think we are all good listeners!"

The new manager was open and honest about when things went wrong and adhered to their obligations under the duty of candour. Practices were in place which enabled any incidents to be discussed openly within the staff team with discussion focusing on how to improve. Policies and procedures (such as the safeguarding and whistle-blowing policy) were in place to help promote an open culture of learning.

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.

Feedback from both people and their relatives was positive and helped to evidence the provider worked well with people to understand what being safe meant to them. People's rights were protected, primarily their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Any potential safeguarding concerns were shared quickly and appropriately. Comments from people included, "I feel safe and feel they [Staff] know what to do" and "I feel safe with them [Staff] all." A relative commented, "Mum is in safe hands - 100% - I am overly happy and overly impressed."

Feedback from staff demonstrated they understood how to work with people to ensure people felt safe when being supported. A member of staff told us, “People are kept safe because we know the people we support very well, we notice any little change and when we do we report on this right away.

The provider worked with people to understand what being safe meant to them. The manager demonstrated concerns were shared and acted on quickly. Feedback from people, their relatives and staff confirmed this. Staff demonstrated a knowledge and understanding of the safeguarding policy and on how to report on any incidents. Staff had received training regarding the Mental Capacity Act and were able to explain their obligations under this Act.

People's feedback confirmed the provider understood and managed risks by thinking holistically so that the care and support meets their needs in a way that was safe and not unduly restrictive.

Staff we spoke to stated that people were supported to remain as independent as possible and staff were able to access the information they required to support people effectively.

Although the feedback from people and staff demonstrated the provider understood and managed risks by thinking holistically so that care met people's needs in a way that was safe and not unduly restrictive, people's care plans did not contain individualised risk assessments. We could not therefore always be fully assured that people were involvement in risk management and had been properly recorded. The manager had identified this in the short time she had been at the service and was in the process of implementing person centred care plans. Good methods of communication were evident. The manager had daily handovers with senior staff members so that any changes to people's needs/risks to safety were identified and acted on in a timely way. A new care assessor post had been created to help implement person centred 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.

Feedback from people and their relatives about the care and support they received from staff was consistency positive. Comments from people included, "Staff are professional, I would recommend this company" and "Staff are professional, caring and well trained. Excellent." Relatives confirmed, "Amazing carers and are they so responsive - they are in tune with Mum's changing needs" and "It's a good service and the staff are good."

Staff told us they felt well trained and supported, comments included, "I feel very supported - I am very happy here - under the old manager - staff were so unhappy - it was an awful place to work and I was ready to leave - but not now." and "Yes training is all up to date and we have a new platform in place now since the new manager started, so it's easy to keep track of. "The manager told us, "Staff training is up to date, and I feel supported by the provider. I have come here and made big changes including new senior staff - introduced new IT systems, all of which costs money - [Provider] has fully supported me with this and has provided everything I have asked for."

The provider was able to demonstrate via its processes and practices there were enough qualified, skilled, and experienced people, who received effective support, supervision, and development. Staff worked together effectively to provide safe care that met people’s individual needs. Training and supervision records demonstrated staff had received training and support appropriate and necessary for their roles. A robust induction and training programme was evidenced.

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.

Although people we spoke with did not receive direct support with medicines, a relative told us staff were very receptive to their loved one's needs and liaised well with the district nurses to help control their pain management. The relative told us, "Although the district nurses manage Mums medicines, staff are so receptive to any changes and feed this back to the nurses."

The provider had made recent changes to help ensure medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen. The manager told us, "All staff are trained and have had their competency assessed - I have repeated this since starting due to the safeguarding which occurred under the old manager. There is nobody that gives out medicines who is not trained." Staff told us they were up to date with their training and had their competency assessed. Both the manager and staff told us there was nobody who was prescribed any 'high risk' medicines. One member of staff told us, "Yes - I have had medicines training but to be honest its mainly just prompts and creams we do." The manger confirmed this, "We are only really dealing with creams at the moment - we have a lot of palliative care people and district nurses see to the syringe drivers. We are dealing with low-risk medicines at the moment, nonetheless, I have provided anyone who has medicines with a risk assessment."

Although the provider had made recent changes to help ensure medicines and treatments were safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen, medicines had not always been managed in a safe way. This also included the in progress work of making care plans person centred. Although we were assured the manager had made recent positive changes to improve the safety of administration of medicines, a recent safeguarding incident had caused harm to a person, as staff had omitted to provide the person with medicines required to manage a serious condition. Although the former manager had completed medicines audits and identified shortfalls in practice. there was no evidence any action had been taken to help address the shortfalls and improve practices. This meant people were at risk of harm. Further time was required for new processes to embed, care plans to be more person centred and to help evidence that medicines were managed in a safe way.