Caring Connections - Warrington

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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 one breach of the legal regulations. Risks relating to people were not always assessed and placed people at risk of harm. Safe recruitment checks were not always completed for new staff joining the service, and there were no recorded safeguarding referrals or accidents and incidents for an extended period of time. Risk assessments relating to people's needs were at times, incomplete or unavailable. Staff were not always aware of how to raise a safeguarding referral, or how to locate the safeguarding policy. Staff completed training in their role, but at times this was out of date. Medicines were not always managed safely, and people did not always receive their medicines as prescribed. However, people told us they felt safe when receiving care.

This service scored 19 (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. One relative said, "Yes I think [person] is safe, if it wasn't they would shout." Another person said, "I feel very safe with the carers."

Most staff were aware of their roles and responsibilities to keep people safe from the risk of abuse. One staff member told us, "I would report any concern to the office and I would be happy that they would raise it." However, another staff member told us, "I have not exactly had any training and wouldn't know what to do. I would ask the client if they wanted me to report it." Staff told us there was a safeguarding and whistle blowing policy in place. However, not all staff knew how to access this. One staff member told us, "I am not sure where it is, but I am aware of it."

There was a safeguarding and whistle blowing policy in place, which included all of the necessary information. The manager completed a quarterly tracker, which included information regarding safeguarding referrals to the local authority. However, these records were at times, incomplete. At the time of the assessment, the local authority had concerns about the service. Actions taken in response to safeguarding incidents were not always clearly recorded or evidenced.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 did not feel there were enough staff to support their needs. One relative told us, “I don’t think they [provider] are coping with the increase in care.” Another person told us, "I had three different carers in one day, they are absolutely run off their feet." People were not always aware of which staff were supporting them. One person told us, "Some staff are better than others. There are good carers and then not so good. One carer doesn't come through to me, so I don't know who they are." However, some people spoke positively of the staff. They said, "I think they are great, I have no complaints" and "The staff are lovely and very polite."

Staff did not feel there were enough staff to support people safely and in a timely way. One staff member told us, "There is absolutely not enough staff." Another told us, "There is not enough staff at the minute. We are picking up extra clients and shifts, it's a bit stressful." There were mixed views in relation to staff training. One staff member told us, "I feel I have received enough training." However, another staff member said, "I have done online training, however, I am waiting to to do face to face training." Another staff member told us, "I've not exactly had any training. I wouldn't know what to do."

Safe recruitment policies were not always followed. There were gaps in staff members employment history which were not always accounted for. References were in place but these were not always obtained from the most recent employer. Staff did not always receive effective and timely supervision. The provider was aware of this and was in the process of embedding supervisions into practice. Staff rotas evidenced overlapping care calls, which resulted in people not receiving their support on time. Staff were only provided with five minutes travel time between people's homes, despite some journeys taking longer. The duration of people's care calls did not allow for the safe administration of medicine where doses were time specific. Staff had not always received their mandatory training prior to commencing employment and induction processes were not always effective.

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 did not always receive their medicines as prescribed. One person told us, "I am not getting them [medicines] when I need them." Another person told us they do not always receive their topical medicines when needed, and staff did not always assist them with their eyedrops. However one relative told us, "They [person] need medicine throughout the day and there are no issues at all."

Not all staff had received effective training to support them in the management of medicines. One staff member told us, "Medicines training was going out with the a senior staff member and watching them do it and then they watched us. This was at the beginning when I started." Staff told us they had not had their competency assessed to administer medicines safely. One staff member said, "No one has done my competency. If they [provider] had concerns they would do it I think."

Medicines were not always administered or monitored safely. We found the time intervals between medicine doses were not always adhered too. Rotas evidenced the gaps between care calls were not always sufficient to allow for appropriate spacing of doses. Protocols were in place for as and when required medication. However, these lacked person centred detail to enable staff to recognise when the medicine should be administered and in what dosage. The administration of topical creams was not always recorded effectively. Some people were prescribed trans-dermal patches for support with pain management. However, records failed to evidence rotation of the patch as per the medicines guidelines. Not all staff had been assessed as competent in relation to the safe management of medicines. This placed people at risk of harm from unsafe medicines management.