Continuity Healthcare Services Private Limited

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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 assessed all the quality statements in the Safe key question. We found 2 breaches of legal regulations in relation to staffing and safe care and treatment. This was because staff were regularly significantly late or early for calls to provide people’s care and staff did not always have the training necessary for their role. Risks to people’s safety had not always been assessed and recorded. Plans to mitigate the risks people faced had not always been kept up to date.

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.

People and their relatives told us they had reported their concerns about the timings of visits with the provider. They said action had not been taken to learn from these incidents and make improvements.

Staff told us they were encouraged to share any concerns about ways of working. They said incidents were recorded, reviewed by the management and action taken to make changes to people’s care where needed.

There were procedures for staff to follow in the event of incidents and accidents. Incidents and accidents were recorded, with details of actions taken in response. Records demonstrated action had been taken to prevent a repeat of incidents for people. However, the provider did not have systems to formally assess whether learning from incidents needed to be shared to ensure changes were made for everyone using the service where relevant, not just the individual affected. The registered manager told us they planned to add this information to their recording systems.

People said their care package had been planned in conjunction with other professionals, such as social workers and hospital staff. One person commented, “I do believe there was continuity in the transfer of care services”.

The registered manager told us senior members of staff completed assessments prior to people starting their care packages. They said shortfalls identified by the local authority where assessments did not always identify all of people’s health needs, had been addressed with the assessors and action was being taken to make improvements.

Health and social care professionals we contacted did not raise any concerns about the way the service worked with other professionals to ensure people received continuity of care.

In some cases, people had care delivered by multiple care agencies. Records demonstrated staff communicated with those agencies to share information about people’s needs.

People told us they felt safe with carers from Continuity Healthcare in their home.

Staff told us they had completed safeguarding training. Staff were clear about how to report any alleged abuse and they were aware of the whistleblowing policy and process. Staff were confident the registered manager would take action if they reported concerns.

The provider had worked with the local authority safeguarding team where allegations had been made. Records demonstrated disciplinary processes had been followed with staff members where necessary. Actions from investigations had been completed, for example, additional training and competency checks for staff.

Most people and relatives told us staff knew what to do to provide care safely. However, some people expressed concern about staff skills. One relative commented, “Some of them don’t seem to know what to do and will avoid tasks by finding excuses” and “I don’t think it’s very safe, but I have to trust they know what they’re doing.”

Although staff said they received clear information and understood the support people needed to stay safe during our assessment we observed processes which did not keep people safe from harm. Although staff said they felt risks were well managed in the service and prompt action was taken when new risks were identified, during our assessment we observed ineffective processes to identify new risks.

Risks to people’s safety had not always been assessed and recorded. Plans to mitigate the risks people faced were not always up to date.

People and relatives said staff knew how to safely use any equipment they needed.

Staff told us environmental risk assessments were completed before they started using the service. These assessments covered the safety of the environment, and any equipment people used and set out safe ways to support people. Staff said they felt people were safe when receiving care.

If people had equipment this was recorded in their care records. The registered manager told us they employed a risk and safety officer to complete assessments and guidance on how to use equipment was sought from relevant professionals.

People told us staff often arrived late or early and they did not know which staff were due to provide care for them. People gave examples of staff being up to 2 hours later than their scheduled visit and not receiving any information about the delay. Comments included, “We never know who is arriving, or at what time” and “Many late visits since I started with this agency. I have tried to contact them to complain about the unacceptable timings, but they won’t listen to me or try to change things.”

The registered manager told us they had identified problems with the scheduling of staff and said their audits demonstrated 44% of the concerns raised with them related to staff being late or early. The registered manager said they had made some changes to schedules, which had unintended consequences for other people’s call times. They said people were not being informed about changes to their call times, which caused dissatisfaction with the service they provide. Staff said they had regular support meetings with their supervisor. Staff said they had completed an induction when they started work and had completed training necessary for their role.

People’s care records demonstrated staff regularly arrived significantly early or late for some calls. For example, 1 person experienced calls that were at least an hour early or late 6 times in a week. Another person had 5 calls that were either an hour early or late, one of which was almost 2 hours late. Staff did not always receive the training necessary for their role. Some staff, providing personal care to people with a learning disability, had not completed nationally recognised mandatory training. Not all staff providing care for a person prescribed rescue medicines for epilepsy had completed training in how to administer it. Pre-employment checks had been completed for staff before starting work. This included a check with the Disclosure and Barring Service (DBS), confirmation of the right to work in the UK and references from previous employers. The provider had obtained a work history for staff. However, the records for some people contained contradictory information which had not been identified by the provider . The registered manager told us they would review this information with staff to ensure contradictions were identified and corrected.

People and relatives said staff followed infection prevention and control procedures, using personal protective equipment when necessary.

Staff were aware of infection prevention and control processes they should follow and said they had received training. Staff said they never had any problems obtaining the personal protective equipment they needed.

The provider had an infection prevention and control policy, which was regularly reviewed and updated to reflect current guidance. The management team completed spot checks of staff, to ensure they were putting the procedures and their training into practice.

People who were supported to take their medicines told us staff did this well.

Staff understood the medicines procedures and said the systems worked well. Staff said they had completed training and their competency to support people with medicines had been assessed by the management team.

Medicines administration records had been fully completed. These gave details of the medicines people had been supported to take. Where people were prescribed ‘as required’ medicines, there were clear protocols in place. These stated the circumstances in which the person should be supported to take the medicine. Staff had completed training in the administration of medicines. However, this did not cover the administration of a specialist medicine for a person with epilepsy. The registered manager told us they had scheduled a date with the community nurse team for staff to complete this training.