City Home Care Limited

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

During the assessment we found people did not always have relevant risk assessments in place or in some cases detailed enough to keep them safe and maintain their wellbeing. Risk mitigation plans were not clear. Completed incident and accident forms did not record the outcome or preventative action required and care plans were not always updated to reflect the most up to date information. Failure to ensure when risks associated to a person’s health and wellbeing were identified, actions were put in place to reduce risk and appropriate guidance provided for care workers was a breach of safe care. We did not assess all the quality statements within this key question, as we did not identify concerns in the areas we judged as being met at our last inspection. The service had systems in place to help ensure staff were suitable in their role. There were enough appropriately trained staff. Staff had support through induction, training and supervision. Medicines were managed safely. People and their relatives confirmed staff arrived on time. We did not assess all the quality statements within this key question, as we did not identify concerns in the areas we judged as being met at our last inspection.

This service scored 69 (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 knew who to speak with if they wanted to raise a concern and told us someone from the office did visit them. Comments included, “A guy did come round a couple of months ago to see how I was and they do ring me very occasionally but generally the carers and I sort everything between us” and “I have had a couple of calls to see how things are going since [person] started with them.”

Staff told us the agency helped them to learn from incidents and improve their practice to help prevent a recurrence. One staff member confirmed, “I always follow company policy and procedures and if any accidents or incidents happen, I report it and learn how this can be avoided and what caused it.” The registered manger said, “…we learn from incidents…and share with carers to let them know this has happened.” Team meetings provided the opportunity to discuss concerns or incidents.

The provider had appropriate processes in place for managing safeguarding alerts, incidents, accidents and complaints. However, these had not always been operated effectively as we identified incident forms did not always have the section on preventative measures completed and how to prevent a similar incident in the future. The provider tracked incidents on a spreadsheet, however there was limited analysis of the incidents which meant these records could not be effectively used to monitor and plan for people's care and improve service delivery for them.

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 relatives told us they felt they received safe care from staff. They generally had the same staff provide care and this enabled them to build a relationship with their carer. One person said, “I do feel safe with them as they have an understanding of me” and a relative commented, “I think it's brilliant how they do try to make sure that [person] gets the same person or people and they even look to see who's been before if they have to cover the regulars visit. We feel that [person] is safe because they seem to know what they're doing.”

Staff understood safeguarding and knew how to respond to concerns including abuse. They had also undertaking training around the Mental Capacity Act (2005) to help ensure people had choice and control and care was as least restrictive as possible.

Appropriate safeguarding policies and procedures were in place for safeguarding people from abuse. The provider worked with the local authority safeguarding team and other professionals to help investigate concerns and to help keep people safe.

People and their relatives felt that staff supported people appropriately to manage risks. One person told us their care worker supported them to reduce risks by, “…[making] sure that I've got my frame nearby and they make sure that there is nothing for me to fall over on the floor.”

Staff had training to help understand about best practice when supporting people to move, look after their skin and use equipment. However there was not always clear guidance for staff to follow. The registered manager told us training included face to face, videos and shadowing.

The provider had systems and processes in place to help keep people safe including risk assessments. However, we found that some risk assessments such as moving and handling, hydration and nutrition were generic. Two people had insufficient risk assessments for diabetes and 3 people who required continence care did not have risk assessments around skin integrity. For one person who regularly misused substances, we saw an incident form regarding this but there was not a risk assessment in place to reflect this concern. Two people who had falls, did not have their risk plans updated to reflect this. The lack of appropriate risk assessments meant there were not risk mitigation plans to provide staff with clear guidance on how to help keep people 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 using the service and their relatives told us overall staff arrived on time. One person said, “Again because they know me they know everything that I might need and make sure that I have access to it” and a relative told us, “I do feel that my relative is safe with them because they've got to know [person] well. For example, if they get [an infection] staff are straight on to me and I phone the GP.” In terms of staff training a relative said, “I don't know what kind of training they get but all I can say is from what they do for my relative they seem to know what they're doing.”

Staff were positive about working for the provider and told us they had useful training and were supported by the management team. Comments included, “This training was useful because it provided me with the necessary skills and knowledge to perform my duties effectively and safely, ensuring the well-being of my service users”, “[I feel] very supported. Managers are approachable, provide regular feedback and are available for advice when needed” and “As a carer I am very happy and the company is good. We have regular team meetings and communication with the whole team and our clients are very happy.”

The provider followed safe recruitment practices to help ensure only suitable staff were employed to care for people using the service. These included checks on their experience, skills, and eligibility to work in the United Kingdom. After being recruited, staff undertook an induction and training, so they had the required knowledge to care for people. Staff undertook annual refresher courses or when a need was identified.

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 using the service and their relatives told us they generally had no concerns with medicines administration. One relative told us until they explained to the staff how the medicines worked and what happened when the medicine was not given at a consistent time, the staff were giving medicines at different times.

Staff had completed medicines training with an annual refresher and competency testing to help ensure they were competent to manage medicines safely.

Medicines Administration Records (MARs) we reviewed were completed correctly. Regular medicines audits were undertaken to identify any concerns, mitigate any identified risk and improve practice. Where people were prescribed creams such as moisturising creams, these were not were not always addressed in the care plan. Therefore, it was not clear if the cream was flammable and required a risk assessment.