Care Sante Kent

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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

People were supported to be safe and free from abuse. They were involved in managing risks and staff knew people well to support with these. Staff demonstrated understanding of safeguarding people and who to refer to with concerns. Any concerns had been managed appropriately. People had enough staff to support their needs. Although staff raised concerns about office staff having to cover care calls and feeling rushed between calls, the registered manager was aware of this and actively trying to recruit.

This service scored 75 (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 told us they felt safe with staff. One person said, “I do feel safe, the staff support me well, I usually see the same two girls, both very good, I don’t have to say anything they know what I need.” People and their relatives also felt confident that staff supported them in ways that kept them free from abuse. One person told us, “No sign of any form of abuse ever, we have a laugh together.” A relative said, “Never any abuse, we always feel reassured, no concerns with safety, they are good girls.”

Staff told us they had all received safeguarding training and were able to explain types of abuse and indicator’s that this might be happening. One staff member said, "We have the training ongoing about safeguarding…..We have the CQC app with the quality statements and things to keep us up to date with the new policies.” Staff were clear in their understanding of how to report any concerns they had. One staff member said, "If they have anything to tell me which is confidential such as any abuse then I would have to make sure its reported to the manager so they are not at risk of further abuse.” Staff were aware of what it meant to whistleblow and told us there was a policy on this in the office, which was regularly shared. One staff member explained, “I will report it straight away to the manager and explain what's happened and that it needs looking into further if it’s a serious matter. If the issue does not get resolved then I will try find to find out who is higher up and raise it with them.” Another staff member said, “Yes the service does have a policy in place and I have the number written down should I ever need it. Being able to share your thoughts in confidence knowing it will be dealt with correctly and effectively and in confidence is important.” The registered manager told us, “Staff all have access to policies and procedures and whistleblowing is also raised in the team meetings and emails are sent to all staff with contact details. There are posters in the training room, and we remind staff via timecard app (emails to staff) or face to face.” The registered manager told us that they took every concern seriously. They said, “Any concern raised, regardless of what it is, I consider as a worst-case scenario and start preliminary investigations and notify LA, CQC. I visit the person and speak with staff concerned – lessons learned/outcomes are done every time.”

We saw that staff had all had safeguarding training, and there was a Whistleblowing policy which was regularly reviewed. When accidents or incidents occurred, there was evidence of the registered manager reviewing these and taking actions where necessary. The registered manager had also appropriately referred to Safeguarding when it was required.

People and their relative’s told us that staff managed risks to their safety well. One relative said, “My relative has a sensor mat by the bed, staff look after them and do everything they can. I haven’t got any complaints about staff and my relative knows them.” Another relative said, “No concerns around my relative’s safety, consistent team of carers, we all discuss safety around them being in bed, full bed sides in place now.” People and their relatives felt included as part of their care and involved with any risks and how to manage them. One person said, “Very caring girls, chat about what my needs are, check my walker is okay, one girl even bought me a jar of her Marmalade, always ask if they can do anything else for me.” A relative said, "The carers always liaise with my relative. They are quite able to speak to the carers or anyone in charge which they do. They enable my relative to live their life with help from us.”

Staff told us how important it was that they involved people in managing risks. One staff member told us, “I support people by helping them follow their care plan and suggest things like a different doorbell or other equipment that might help them stay safer.” When asked how they supported people to be involved in risk, staff gave examples of how they achieved this. One staff member said, “I just talk to my clients and read the care plans. If they want tea, I ask them how they want it. It is extremely important that my clients have a drink they want as it counts toward their daily intake of fluid.” Another staff member talked about getting to know people and how important this was to understanding and managing risk. The staff member said, “I talk with the person and get to know them. If I thought they needed the GP or DN, I would discuss this with them and check out their understanding of the situation. I constantly reassure them that they will be ok, and I will report any concerns and keep them involved.” The registered manager also emphasised the importance of keeping people involved at all stages of their care and supporting them to take positive risks. The registered manager said, “We always start from the point of deeming the person to have mental capacity; we want them to have informed choice, discuss the risks with the client so they are aware of the risks.”

We saw that people had tailored risk assessments to meet their needs. This included risks to people’s health, moving and handling, giving medicines and environmental factors. There was evidence throughout people’s documentation of this being reviewed regularly. Care plans highlighted the choices and decisions that people could make for themselves.

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 and their relatives told us there were enough staff to meet people’s needs. They said the same staff supported them, which meant positive relationships were built between people and staff. One relative told us, “1 or 2 come regularly, I see one more frequently but they are cheerful and chirpy and they get to know my relative and my relative gets to know them. I’ve got no complaints about the staff.” Another relative said, “Same staff usually, our team hasn’t changed for ages, the young girls are just as good as the older ones and my husband likes them all, no concerns around the staffing.” People and their relatives told us that staff mostly arrived on time and stayed to complete all care tasks. A person said, “Two carers visit at a time, very good time keeping, by and large same team of carers on the whole.” People were confident that the staff supporting them had the skills and experience to meet their needs. One person told us, “Definitely well trained, know what I need and how to support me.” Another said, “Skilled and trained to do the job, offer anything extra too.” Relatives were also positive about the skill set of carers. One relative said, “Their training and experience seem very good, good people, new staff shadow experienced carers.”

Staff told us there were enough staff to meet people’s needs. This included any people that required 2 staff to support them. One staff member said, “There is someone always there to support you and the client. It helps a lot.” However, most staff we spoke to raised concerns about feeling rushed between care calls. Comments included, “No you never get enough travel time. I can’t remember the last time I had enough travel time”, “They recently stopped doing travel time between calls so they are all back-to-back” and “The calls are back-to-back – some overlap – I will start a little earlier to ensure the clients get their time.” One staff member explained, “I don’t think we have enough staff to cover the unexpected like sickness and it becomes a stretch to get these calls covered when two people go off. I don’t think we are at the level where it is unsafe or not meeting clients need.” The registered manager was aware of these concerns and was actively trying to recruit more staff to improve. They said, “Recruitment is a challenge for the whole sector….. I am committed to improving the travel time system so carers have the fullest time with those who need it most and reduce risk of call cramming.” Staff explained how a thorough induction and shadowing more experienced staff, supported them to feel confident supporting people before they worked on their own. Staff told us they had regular training to ensure they had the skills and experience to meet people’s needs. This included any specialised training to meet any specific needs. One staff member said, “We just had a training last month and that was to do with stoma care as we have a client with a stoma. We found out a lot more information and it was quite interesting.” Staff also said they were continually supported with regular supervisions, appraisals and team meetings. This gave them opportunity to develop in their roles and discuss concerns.

We viewed rotas and could see that there were enough staff allocated to support people. These were nearly always the same staff ensuring that people saw them regularly. The registered manager showed us her action plan, where she had already identified call cramming as an issue and her plans to rectify it. Staff had been recruited safely; this included checks from the Disclosure and Barring Service and references from previous employment. There was evidence of a robust induction and supervisions and appraisals between staff and their line manager. The training matrix demonstrated that staff had attended a variety of training sessions to meet the needs of people.

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.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.