Clarissa's Home Healthcare Services 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

We identified a breach of the legal regulation relating to safe care and treatment. We were not assured the service had a strong awareness of the areas with the greatest safety risks. The accidents, incidents and near misses log had not consistently recorded care plans and risk assessments had been updated. The complaints records did not always provide clear information and there was no clear pathway of the complaint from start to finish . Where people were at high risk of falls or people had an underlying condition that increased the risk of falls, the risk assessments and care records did not provide clear guidance on how people were to be supported. Some people's care plans lacked clear guidance for staff about their role in monitoring and supporting people with their care and support. Although some people received regular, others experienced different carers, leading to potential inconsistencies in care delivery. The records did not always provide clear guidance on how communication needs were to be supported, including when people were in discomfort. There was conflicting information recorded in the care records with regards to DNACPR (Do not attempt cardiopulmonary resuscitation). A review of the care plans identified people were to be offered pain relief but PRN (pro re nata) care plans were not in place. We identified medication was not always listed accurately within the care plans. The records did not always provide clear information in relation to providing up to date training records for all staff including safeguarding. The recruitment records did not always show gaps were explored. Where references had been obtained, these did not always match the employment history on the application form.

This service scored 59 (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, “I sometimes have a lot of different carers and when they arrive, they know nothing about me – that’s very difficult” and “They did try to put it right but at first one would come in who didn’t know what she was doing, we would complain and then they would send another one.” Relatives told us the office were, “Quick to solve any problems/issues should any arise” and “They came out and acted quickly on my complaint.” However, people also told us they did not feel the carers were well trained and the carers did not always know where to stand when support was needed equipment. People told us, “They don’t know anything about me when they first come”

Staff told us, “we need to keep them safe.” Staff told us if something changes, they report incidents to the line manager and complete an incident form. Staff told us they learn from incidents by, “analysing incidents.” In addition to this, staff told us, they identify and report incidents as well as investigate and learn from incidents. Staff also told us, “normally care plan would be assessed if something happened to the client.” Leaders told us they complete the incident forms, inform the manager and be honest and truthful with the client and family. Leaders told us they check incidents as a learning curve and “take advice from other departments and put systems in place to make sure it does not happen again.” Leaders told us they assess why a person was falling over more, look at medication, environment, or were they ill. Leaders told us they work with professionals to include social workers and doctors. Leaders told us they would action training to “make sure same thing does not happen again.” However, a review of the processes identified the leaders had not established effective processes in line with their policies.

The service had policies and procedures for duty of candour, accident and incident reporting and complaints, suggestions and compliments. The accidents, incidents and near misses log had not consistently recorded care plans and risk assessments had been updated. There were a number of falls recorded on the accident, incident and near misses log. However, it was not clear what action was taken with each fall recorded. The records showed for one person they were found on the floor on almost every visit from December 2023, yet the accident, incident and near misses log did not have this recorded. The information was incomplete, inconsistent and the records did not always provide clear and accurate information as to what had happened, actions taken, lessons learnt to mitigate and reduce risk. The concerns, complaints and safeguarding records did not always provide clear information and did not clearly explain the lessons learnt and outcomes. The concerns, complaints and safeguarding log did not clearly explain the lessons learnt and outcomes. The dates were not consistently recorded of the outcome. Therefore, there was no clear pathway of the issues from start to finish. The records did not always show learning had been shared to improve on staff practice and embed high quality care. The review of the processes identified the leaders had not established effective processes in line with their policies.

People commented they have a care plan and they were involved when the care plans were actioned. People told us about the manager, “once when I had an appointment to have my eyes checked he came and he picked me up and came with me and went into the appointment with me too. He was very good.” People told us, “I have contact with the District Nurses and lots of hospital contact but that has no connection to the carers.” People’s relatives told us, “There was good co-ordination by the service with us when [person] went to a care home.” People’s relatives commented they managed referrals to professionals and took their relative to appointments, such as the GP, hospital or clinic and, “We book volunteers to take [person] to the hospital or take [person] ourselves.” However, people’s relatives also told us the carers remind them if the person needed something and if the relative was unable to take the person to an appointment, the carers were available to accompany the person.

Staff commented on how they supported people to move between different services and the continuity of care. Staff told us they referred to the care plan, “to provide the best care.” Staff told us they, “provide relevant and accurate information” and “be transparent and make communication a circle.” Staff informed us they are “encouraged to work in partnership with other organisations, agencies and people.” Staff told us they support people with their continuity of care by, “We assess their mobility and make sure that all equipment to be used to get them from the hospital to their residential place is in place and in working order.” Staff commented, “It is essential to share pertinent information with health and care professionals within a care team as required to facilitate patient care.” Leaders told us they worked with people, families and multi-disciplinary teams. Leaders commented, “communication is key.” Leaders informed us they, “talk to the care home and provide information and work with the social worker in the community.” In addition to this, leaders told us, “some care homes, they came and visited. You can give the information, the updates, likes and dislikes, what can and can’t the client do.” Leaders told us they took the stress off the person and family and worked with them to how best suited them.

Professionals told us although the service communicated well with them, they told us it would be helpful if the service was more proactive in taking the lead in matters that influence the quality of people’s lives. However, professionals told us the service was ‘open and transparent’, the service knows the people’s needs and, “they have always communicated effectively with us, when needed.”

People had Personal Emergency Evacuation Plans (PEEPs) which outlined the equipment required. However, the PEEPs did not always contain enough information to support information sharing with the hospital and professionals if people were admitted in an emergency. The PEEPs did not always contain information to include allergies, the specific medical needs and where the medication was stored. Therefore, the provider did not have effective processes in place to support continuity of safe care.

People told us they felt safe and relatives commented they felt their family members were safe. People commented, “I feel safe with the carer” and ‘I never feel rushed.” Relatives told us, “[Person] is safe with them because [person] is happy with them” and “we are happy with the agency and [person] is safe.” In addition to this, relatives told us, “They keep [person] safe and most important they keep [person] at home where [person] wants to be.” People told us, “I am pleased to have carers, I couldn’t manage without them.”

Staff told us they had completed safeguarding training. Staff told us, “Making sure client is safe and protecting their mental wellbeing” and “If I have a safeguarding concern I will report it to the manager in charge.” Staff knew to report safeguardings to the manager, follow the policy and procedure along with recording what had happened. Feedback from staff demonstrated their understanding of safeguarding as they told us, “Providing care that is safe and protecting people from harm and abuse” and “Safeguarding is to protect them from harm and abuse.” Leaders knew to report safeguardings and refer to professionals if there were concerns. In addition to this, leaders told us they would involve people, families, action assessments, action welfare checks, check the environment was safe and the equipment was working properly. Leaders told us they had completed safeguarding training. However, the review of the processes identified there was conflicting and inconsistent information recorded with the training matrices provided by the service. The training matrices did not accurately reflect safeguarding training had been completed nor were all staff listed on the training matrices.

The service had policies and procedures in place for safeguarding and Mental Capacity Act (MCA) 2005. The service provided more than one training matrix and we found there was conflicting and inconsistent information recorded between them. The training matrices did not accurately reflect safeguarding training had been completed nor were all staff listed on the training matrices. We attempted to contact the registered manager concerning the training matrices and requested that as the previous versions of the training matrices submitted appeared to be inconsistent and it also appeared that not all staff were included, to submit the full, current and most up-to-date training matrix. We did not receive a response. The review of the capacity assessments identified there was conflicting information between the care records and capacity assessments nor was there clarity recorded on how decisions were reached. There is conflicting information recorded as to whether or not people had capacity. The service did not have effective systems, processes and practices in place in line with their policies.

People told us, “I have a care plan – it was done with me when I first had the carers” and “it’s what I needed, I have a copy”. Relatives told us, “usually assessments for risks had been actioned by the manager and measures to support the people were put in place.” However, relatives also told us falls risks assessments had not been actioned, mobility issues had not been taken into account and, “I’m not aware of risk assessments being done.”

Staff commented they would, “stick to the care plan”, “identify the risk” and ‘all the risks are in the care plan.” Staff told us they identify, analyse, prioritise, treat and monitor the risk. Staff told us, “The risk management approach is balanced, proportionate, and respects individuals' care choices” and “Risk assessments related to care focus on the individual, are well-balanced, and are revisited as appropriate.” Leaders told us they follow the risk assessments, treat people individually and assess individually. Leaders commented if people were high risk, the leaders would re assess and they would be assessing anyway as they are always observing. Leaders told us they follow the risk assessment and “know what they [people] suffer with.” However, the review of the processes identified systems were not in place to effectively support risk management.

The service had a risk management policy and procedure. Some people's care plans lacked clear guidance for staff about their role in monitoring and supporting people with their care and support. Where people were at high risk of falls or required equipment for support, the risk assessments and care records did not provide clear guidance on how people were to be supported. The records did not always show weekly checks had been completed regularly on equipment. From the records reviewed, it was unclear if a person was at risk of choking. The service did not have effective oversight of risks to people due to ineffective recording, assessments and guidance on managing these in line with their policy. The records showed risks had not been effectively reviewed, assessed or have clear plans in place with accompanying guidance for managing risks.

People told us about walking independently with a frame. Relatives told us about the many types of equipment people used which included walking aids, stairlift, commodes, electrical hoist and a hospital bed . In addition, relatives told us about an electrical hoist, “two carers know what to do” and “There are no trip hazards and the carers keep the space clear.” Relatives also told us when mentioning the equipment, “[person] is moved without hurting him or bruising him.”

Staff told us they would check the environment for safety and they would check for the people and themselves. Staff commented they speak to the manager if there were any issues. They told us, before they used the equipment, they would, “make sure it is working well” and “put the equipment in the right positions and make sure that the cleaning things are in the right places.” Staff commented they would make sure the environment was, “clean and free from tripping hazards” and “To keep the equipment safe it should always be serviced on time and fully charged and free from defects.” Leaders told us they checked the hoists were serviced, slings were checked to see if they are intact and the right size. They checked to make sure the floors are clear and when charging batteries, they made sure the sockets were suitable. Leaders told us they “check the dates on the slings” and before the slings are used the “carers have to check everyday.” Leaders told us with slings, if there was a hole, they would not use it and “report and get a new one.” They also told us hoists are serviced.

The service had documented in the care plans the wishes of the people to keep their environments tidy, clear of trip hazards, clean, free of clutter, clear pathways and equipment to be stored safely. Care plans had documented manual handling equipment was to be checked, well-fitting shoes to be worn and pendant alarms to be checked.

Relatives told us they thought the carers, “seem to be competent and well trained.” Yet people and relatives also had concerns about the training including communication and emotional skills. Whilst people told us, “I think they are reasonably well trained,” we were also told, “I do not think they are well trained when they first come to me. I always lead my own care with a new carer,” and “They aren’t very well trained.” We were also told staff do not always know where to stand when equipment (stairlift)was being used. The registered manager informed us they did not support people with a stairlift. However, a review of the records identified one person had a stairlift. Relatives told us, “I don’t think they are well trained,” However, people told us they did not think the carers were always well trained. People commented, “They aren’t very well trained” and “I’m not sure they are well trained.” People also told us, “I’m not confident that they are well trained,” and “I do not think they are well trained when they first come to me.”

Staff told us they were trained and completed refresher training. Staff also told, “the company encourage additional training.” Staff commented on, “continuous learning,” completing online training and management making sure there is the right mix of skills by, “providing training for everyone.” Leaders told us they have carers with a variety of experience and if a training issue was identified, the leaders would retrain the carers. Leaders also gave us an example if a person had dementia, they would identify carers that had experience in dementia to support the person. However, the review of the processes identified the service did not always follow their systems to support safe and effective staffing.

The service had a recruitment policy and procedure. The recruitment records did not always show gaps were explored. Where references had been obtained, these did not always match the employment history on the application form. We were not assured the service followed the recruitment procedures in line with their policy. The service completed spot checks. The service provided more than one training matrix and we found there was conflicting and inconsistent information recorded. The records did not always provide clear information in relation to providing up to date training records for all staff. Some records showed the training had not started, had not been completed and was overdue. We attempted to contact the registered manager concerning the training matrices and requested that as the previous versions of the training matrices submitted appeared to be inconsistent, it also appeared that not all staff were included, to submit the full, current and most up-to-date training matrix. However, we did not receive a response. The service had a supervision policy and procedure. The registered manager informed us the staff who have not “got their supervision and probation documents are the ones who are less than 6 months within the company.” However, it was unclear from the supervision policy how often supervisions would be actioned and how many supervisions staff should have per year.

People told us, “They wear aprons and gloves and masks because they understand I am very high risk, “ and “They always wear gloves and they sometimes wear masks.” Relatives told us, “The carers wear gloves and aprons and clean up after them.” Relatives also told us, “Hygiene is absolute,” and “They [carers] always have aprons, gloves and sometimes masks. They put any waste and their gloves into bags and then in the bin.”

Staff were aware of their responsibilities in relation to infection prevention and control. Staff commented on washing their hands, wearing PPE, ensuring environmental cleanliness and proper waste disposal. Staff told us, “We put on our PPE, make sure you’re always doing that” and “I wash my hands making sure I’m not contaminating anything, checking expiry dates, medications.” Leaders told us PPE was used, hands are washed and spot checks are actioned to make sure staff are wearing PPE. Leaders told us different gloves are used for different activities. For example, the gloves worn for personal care were not used for preparing food. Leaders told us if a person had a cold, they allocated one carer to the person, the carer would not be allocated to other people and they do not want people to struggle.

The service had an infection control policy and procedure. The service completed audits and staff observations with regards to personal protective equipment (PPE).

People told us, “They do all my tablets and it’s fine” and where there is a dossett box, “I do them myself, they bring the box to me.” People also told us where they have a box “the carers put the medication into the box, I like that.” Relatives told us, “There’s no problem with medication.” Relatives also told us, “the carers give medication and there’s no problems” and “No doses have been missed.”

Staff told us when supporting with medication, “I know you must ask consent for everything” and “Client has a right to refuse to medication, if they refuse I will write it down.” Staff commented on involving the person with their medication. Staff told us about developing a care plan for medication and documenting the medication administered along with, “it's vital to deliver medication support with a focus on person-centered values, cultural sensitivity, respect for privacy, and commitment to safety.” Leaders told us they get consent from the client and if there are any concerns, the leaders worked with professionals such as the doctor, GP, pharmacies and district nurses. Leaders told us they gave people a preference on how they wanted the medication, for example, in a teaspoon or egg cup and documentation was completed when medication was administered. However, the review of the processes identified the service did not follow their systems to support medicines optimisation.

The service had policies and procedures in place with regards to medication errors and near misses, auditing and monitoring of medication, overarching medication, safe disposal of medication, administration of medicines and covert medication. The registered manager told us they did not administer medication forcibly and told us “we currently don’t provide personal care to a client that requires covert medications at present and to date we don’t have any clients that have PRN medications, but we have protocols, policies and procedures in place should we have a client in the future that requires either of these.” However, a review of the records identified people were to be offered pain relief but PRN care plans were not in place. There was inconsistent recording with regards to PRN medication within the care plan and the care plans did not accurately document the prescribed medication. The care plans did not always clarify if the paracetamol was self-administered or if the service were administering it. The records did not always provide clear information as the review identified for one person, there were 2 medication administration records (MARs) charts completed for the same month and the same medication. In addition to this, one of the MARS charts did not have the dosage stated for a medication nor was medication listed on a MARs chart but was stated on the care records. The records did not always how medication had been administered for the full month. The review of the processes identified the service did not follow their systems to support medicines optimisation.