Care at Home Group Cheshire East and West

On this page

• 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 8 quality statements under the safe key question, identifying both good practices and areas of concern. The overall rating for this key question is requires improvement. We found 1 breach of the legal regulation in relation to safe management of medicines. Systems were in place to report and record events, including the analysis of wider themes and issues, which were shared with staff and leaders. The provider had a safeguarding policy, and incidents were reported to the local authority. However, we found some incidents which should have been reported to the CQC had not been submitted. People’s care was assessed before care calls began, risk assessments and care plans were developed for staff to follow. Feedback on how care plans were updated was mixed, some staff described instances when they had updated the office staff after working with people to address changes in their care. Improvements were needed in the safe management of medicines, the manager responded promptly to concerns we identified in this area. Feedback from people, relatives, and partners highlighted issues with rostering and inconsistency of calls which had impacted on people’s safety. However, we also received some positive feedback about recent improvements in this area.

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.

Overall people felt safe with the care provided. However, we received mixed feedback over the competency of care staff and the inconsistency of care calls. Comments included, “[Staff member] is really lovely with him and we do feel that [Person] is safe” and, “Some staff seem a lot more competent than others, but they've all been lovely.”

The manager told us staff reported any incidents/concerns through the providers electronic systems and these would be investigated. They told us where they had identified any themes, actions would be taken to address these.

There was a system in place for staff to report and record any incidents or accidents and further analysis was undertaken. Where wider themes and issues had been identified the manager shared learning with the staff team through meetings and newsletters. Managers across the organisation met regularly to share learning and good practice.

People’s needs were assessed prior to their care package starting. However, we received mix responses over any follow up following the initial meeting or access to their care plan. We were told, “I have got a copy of my care plan and there are some telephone numbers for the office on the information.” Other comments included, “I haven't got a copy of a care plan, and I haven't had any care plan reviews or meetings” and “I've made adjustments to it (care call), but I don't think the care plan itself is up to date.”

Senior leaders completed initial assessments prior to care being provided to people. Staff discussed inconstancies over information of care for people prior to supporting people for the first time. Comments included, “With new clients, some care plans are not ready” Another staff member told us, " Sometimes I feel like I'm walking in blind." This being in reference to supporting a person for the first time. However, other staff told us care plans were on the provider electric care system and paper copies accessible in people's homes. We were told, " Care plans and risk assessments are in people’s homes and on the Birdie app."

The local authority confirmed Care at Home Group Cheshire East and West worked with them with new referrals and packages of care.

The provider had systems in place to ensure people’s needs were assessed and care packages were arranged in line with their needs. This also included the provider's electronic care system monitored care call tasks, an alert is created if staff have not confirmed a care task was not completed. This system also enabled staff to create alerts to the management team when events occurred. The manager contacted social workers if they identified concerns or changes in people’s needs. This was an area where managers were encouraging staff to always ensure they escalated any issues or concerns, for appropriate action, as the manager had picked up this did not always occur.

Feedback overall indicated people felt safe during their care calls. We were told, “I do feel very safe with [staff member], who is like a daughter to us now” and “I do feel safe with most of the carers, even the new carers as they come in and introduce themselves.”

Staff told us they completed safeguarding training as part of their induction and felt confident they would then take all appropriate steps to safeguard the person. They were confident the provider would act accordingly to concerns raised over people’s care.

Systems were in place to ensure safeguarding concerns were shared and reported as required. The provider had a safeguarding policy in place. There was a system to record any concerns and the actions taken to keep people safe. However, although concerns had been correctly reported to the local authority, the provider had not ensured they notified CQC of all relevant incidents as legally required.

People told us they felt supported by staff to manage risks. However, we received feedback over frustrations of late calls, missed calls and male care staff attending calls where female care staff were requested which impacted people's feedback on safe care. Comments included, “A couple of times they've missed a call altogether. Adding, “I rang the office to say that nobody had come. They said they would look into it, but nobody ever got back to me” and, “We requested all female carers but every now and again they try and send a male carer, and I phone the office.” Following the assessment the provider clarified that during the initial assessment preferred gender of staff is discussed with people however, also discuss this cannot always be met.

Overall staff felt they had information about people’s care and identified risks. However, some feedback we received highlighted areas of inconstancy and examples when staff had been dependant on people to inform them of their care needs. Staff confirmed they updated the office to make changes to care plans. We were told, “Yes we update the office” and, “The office is not being updated, so we update them.” This was in reference to staff attending calls and changes had been made to a person's care however, the care plan was not yet updated to reflect those changes. The manager confirmed they were addressing improvements required in this area.

Risks associated with people’s care plans were assessed and care plans devised to guide staff about the support people required. Following a provider audit, some gaps were noted in assessments and care plans. Records had all been reviewed to ensure all information was up to date and included.

People told us staff supported them with equipment aids such as standing aids and slings when needed. However, feedback was mixed over staff competency in this area. Comments included, “We do have a piece of equipment, but one of the staff who came out didn't know how to use it, so I had to show them” and “I wouldn’t describe [staff] as unsafe they are really nice carers, but they don't always know what [Person] needs them to do.”

Staff indicated they had access to the information they needed to keep people safe. However, we did receive some feedback over a lack of training to use equipment to support a person. We were given examples where staff were reliant on people themselves to provide them with information in these areas.

Environmental risks were assessed within people's home and any actions required recorded within the needs assessment.

We heard mix feedback from people over competency of some staff and inconsistency of care calls which had impacted people’s experience of the service. Comments included, “The timings of the visits can be unpredictable. I now get a timetable, but they can't always stick to it” and “I don't think they always get as much training on the personal detail as they should.” A person told us of a response when staff failed to attend a care call, “I'd ring the office to ask where they were, they just say that they were on their way, but nothing happened.” However, other people were positive about the support they received. We were told, “I have a lovely relationship with my regular morning carer” and, “[Staff] are really lovely with [Person] and we do feel that they are safe with them.”

Overall staff felt the training provided was good and ensured they had adequate competency to carry out their role. However, some feedback indicated a lack of training with using equipment to support a person. We were told of one occasion were managers had taken action to support staff to access further specialist training, where one person's care needs had changed.

The provider been through a period of ongoing recruitment to ensure there were sufficient staff to meet people’s needs, also to support the management of the service. The provider had a business continuity plan and systems in place to prioritise calls in an emergency. Overall, we found people had been recruited safely. New recruits undertook an initial induction and shadowed other staff. There was a training and quality team who had oversight of induction, eLearning and refresher training. The manager shared an example were in response to feedback from people, they had arranged some specific training to better support staff in areas such as cooking. Staff were supported and their performance was monitored through supervision and observation. The provider had identified this as an area of improvement and the manager had begun to undertake action to make the necessary improvements. The manager confirmed they had developed a new tool to keep better oversight in future.

People told us staff wore personal protective equipment (PPE) at work and were aware of infection control. We were told, “They always look clean and tidy and wear the gloves and aprons, they always clean up after themselves” and “They always put aprons and gloves on and they wear a uniform.”

Staff confirmed they had access to PPE at work, with appropriate stock available from the office when required.

The provider had an Infection Prevention and Control policy in place and staff received training in infection control. PPE stocks were available to staff, and managers monitored to ensure staff used PPE correctly. This was also checked through quality monitoring calls to people. The provider PPE audits were effective, which ensured adequate stock was available to staff.

Overall people told us they received their medicine safely with minimum support from staff. Comments included, “Generally [Person] is managing their own medication or a relative was administering” and “They do give [Person] medication and as far as I know it's all been ok, although some do give the impression of being more competent than others.”

Staff involved in the administration of medicines advised that they had completed online training followed by having their competency reviewed by a senior staff member. We did receive some feedback that staff felt further training would be beneficial regarding completing documentation.

Systems were not sufficiently robust to ensure staff always administered people's medicines in line with the prescriber’s instruction. For example, records showed that staff had not administered one person’s tablets on several occasions. We also found examples where staff had not always followed the provider's medication policy. Care plans referring to people's medicines support did not always guide staff on administering medicines in line with the people care requirements. The provider carried out medication record audits, but these had not identified the issues we found. The manager confirmed they were addressing some of the care arrangements that these issues had highlighted.