Adejom Staffing Care

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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 not protected from the risk of harm. Staff did not follow safeguarding procedures. Risks to people were not identified and mitigated. Accidents and incidents were not documented, reported and improvements made. The provider did not share rotas, so we could not be assured there were sufficient staff. Training records confirmed staff did not have the skills and experience to support people safely. Staff were not recruited safely. The provider could not evidence people were supported to receive their medicines safely. We found 4 breaches of the legal regulations in relation to safeguarding, safe care and treatment, staffing and fit and proper persons employed.

This service scored 41 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While some of the relatives we spoke to expressed that they were generally happy with the care their loved one received, our assessment found care did not meet the expected standards. A relative told us they were not kept updated in relation to issues with their loved one’s care, and they had received minimum communication from the provider. A relative told us, "They never contact me to say how [their loved one] is." A relative told us there was an incident where staff caused a fire risk by putting items in a tumble dryer. We found no record of this documented, and no information to state how improvements had been made, and lessons learnt.

While some of the staff we spoke to told us they understood their responsibilities in relation to reporting of incidents and accidents, our assessment found they were not always reporting incidents. For example, when we spoke with staff relating to incidents, staff explained an incident where they picked a person up from the floor following a fall. This was not documented or investigated by the provider. Staff we spoke with were not able to give examples of where lessons had been learnt following an incident or accident.

The provider failed to demonstrate there were systems and processes in place to ensure they learnt lessons when things went wrong. The provider did not have a system to record and investigate accidents and incidents that occurred. The provider did have a complaints log, which detailed some incidents, however the actions taken to address complaints made were not recorded. For example, someone complained that mouldy and expired food had been found in a person's house, there was no information about the actions taken, or how to share learning with staff. We found not all incidents had been logged and reported. We reviewed one person’s daily notes which detailed three incidents that had not been documented. For example, staff had found a person on the floor and described drag lifting them; the provider told us they were unaware of this incident. Another incident detailed staff arriving to someone's house and finding them in a state of undress, with the front door unlocked. This was not reported to any authority and no investigation documented. This placed people at risk of harm.

While some of the staff we spoke to told us they were aware of risks to people and that referrals had been made to the relevant healthcare professionals, our assessment found there was no evidence to support this. The provider told us they worked with other professionals to provide joined up care, however they were unable to evidence this was the case in relation to any of the people we reviewed. For example, when people transitioned into the service or out of the service, the provider was unable to demonstrate how they supported people to do this safely.

There were not clear systems and processes in place to support people transitioning from services. There was no evidence within people's care plans that they were involved in planning their care. Systems to listen to people and gain their views were ineffective; the complaints log did not demonstrate what action had been taken and what learning was implemented as a result of feedback and complaints from people. The provider was unable to demonstrate policies were aligned to other key partners to ensure shared learning to drive improvements.

While some of the relatives we spoke to expressed that they were generally happy with the care their loved one received, our assessment found care did not meet the expected standards. A relative fed back their loved one had been in the same clothes for 7 days, and staff had not reported this to them. Their loved one had not received support to wash or change their clothes during this time. Staff failed to identify and report this safeguarding concern to the provider, or the local authority safeguarding team.

While some of the staff we spoke to told us they understood their responsibilities in relation to safeguarding people, our assessment found this was not the case. Staff had not always reported safeguarding concerns. Staff did not always know how to escalate concerns outside of their organisation, for example to the local authority safeguarding team. One staff member explained to us how they drag lifted a person from the floor following a fall. Although the staff member told us they had informed the provider, this was not documented within the providers safeguarding log, and the staff member failed to recognise this was an incident of abuse.

People were not protected from the risk of abuse. The provider did not have effective systems in place to ensure staff identified and reported safeguarding concerns. When safeguarding concerns were identified, they were not always reported to the local authority safeguarding team. For example, when staff identified one person had no food in their house, this was not raised as a safeguarding by the provider. There was not an effective system in place to document and investigate all safeguarding concerns. The provider had a safeguarding log, however not all safeguarding concerns and incidents were documented within the log and the provider could not evidence action had been taken to investigate and act on all incidents of abuse. Incidents of abuse had not been identified, reported and investigated by the provider. For example, daily notes showed one person was drag lifted from the floor. The provider was unaware of this incident and had not investigated or reported it to the local authority safeguarding team. Daily notes recorded another person frequently self-neglected, however this was not reported to the local authority to ensure the person could be supported and safeguarded.

While some of the relatives we spoke to expressed that they were generally happy with the care their loved one received, our assessment found care did not meet the expected standards. Risks to people were not mitigated by staff. For example, a relative told us they found bags of discarded food in their loved one's house, but this had not been reported by staff. Staff failed to identify there was a risk that people had not eaten for a period of time, or they could be at risk of consuming food that was out of date or not stored in line with the manufacturer’s guidance.

Staff did not have a good knowledge around managing risks to people. Some people had specific health needs which could put them at risk. While some of the staff we spoke to told us they understood how best to support people, our assessment found this was not always the case. Staff we spoke with were not always able to give detailed feedback about how they supported people, and the health conditions people lived with. For example, staff supporting people with stoma care (a stoma is an opening on the abdomen that can be connected to either your digestive or urinary system to allow waste to be diverted out of your body) lacked detail on how best to support the person and what risks to consider in relation to their specific health condition.

There were not robust processes in place to keep people safe and mitigate risks to people. Care plans we reviewed lacked detailed guidance to inform staff how to support people with complex health conditions. This included supporting people to manage their diabetes, information on how to safely support people to transfer, how to support people with wounds, and information to inform staff how to support people with a catheter (a flexible tube used to empty the bladder and collect urine in a drainage bag) or stoma. One person was at risk of financial and domestic abuse; there was very little guidance to inform staff how to support the person.

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

While some of the relatives we spoke to expressed that they were generally happy with the care their loved one received, our assessment found care did not meet the expected standards. A relative fed back they did not believe staff had the skills and experience to support their loved one with their dementia and staff lacked the ability to encourage them with their personal care. The relative told us their loved one was in the same clothes for 7 days and staff had not identified this was a concern or reported it to them.

While staff we spoke to told us they received the training they needed to complete their roles, our assessment found they had not received the training, and lacked knowledge and detail in how to support people. For example, staff lacked detailed knowledge on how to support people with catheter and stoma care, such as looking for redness or signs of infection. Staff told us they documented the output of the catheter in people's daily notes, but we found no evidence of this.

People were supported by staff who had not received relevant training to enable them to support people safely. The providers training matrix demonstrated not all staff had received training in key areas including stoma, catheter care, skin integrity, first aid, moving and handling, infection control, dementia, safeguarding, fire or supporting people with a learning disability and autistic people. Since 1 July 2022, all registered health and social care providers have been required to provide training for their staff in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability. This should be at a level appropriate to their role. There were not effective processes in place to ensure staff were recruited safely. Work histories had not been captured and any gaps in employment explored. Two staff had Disclosure and Barring Service (DBS) checks completed after starting their employment. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. We asked the provider to evidence that a risk assessment was in place, to mitigate the risk of staff commencing work prior to the DBS check being completed, they did not produce this. References received were not always from the most recent employer, in one case a reference had not been sought from a previous healthcare employer. We asked the provider to show us rotas and missed calls logs to evidence people received care they needed when they needed, however the provider was unable to produce this. The provider informed us an administer reviewed the missed and late calls data to ensure people were getting their calls as agreed, however they were unable to demonstrate this, or show us how they checked this was being done. The provider had poor oversight of people’s call times and could not evidence people were safely cared for.

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.

While some of the relatives we spoke to expressed that they were generally happy with the care their loved one received, our assessment found care did not meet the expected standards. Relatives we spoke with told us their loved ones did not have a MAR (Medicine administration record). There was an increased risk people did not receive their prescribed medicine appropriately. A relative told us, "They didn’t have a medical card (MAR) so I made one."

While some of the staff we spoke to told us they understood their responsibilities in relation to medicine management and administration, our assessment found they were not following best practice in relation to recording medicines administration. Staff we spoke with told us they documented medicines administrations within daily notes. However, we found no evidence of this within the 6 care plans we reviewed.

There were not effective processes in place to ensure people received their medicines as and when they needed. We asked the provider to produce medicine administration charts (MAR) for people they were supporting, however during 3 days of the onsite assessment the provider could not produce any MARs. The provider sent us some MAR charts remotely, but the MAR charts produced were not sufficiently detailed and they were not always signed by staff. The provider was unable to evidence they completed MAR when supporting people with medicated creams which meant people were at risk of creams being administered incorrectly. One person received a medicine 'as required'. Guidance around the administration of this was not robust and staff did not document why the medicine was given. We noted the 'as required' medicine was given every day for 29 days but there was no evidence the provider had alerted the person's GP this medicine was used so frequently. Another medicine was prescribed 'as required' for pain relief. Staff failed to document why the medicine had been given, and if it was effective. The provider was not able to demonstrate staff had received training in medicines administration or medicine competencies. They could not be assured staff had the skills and knowledge to support people with their medicines.