203 Hoylake Road

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

People were safeguarded from abuse and avoidable harm. Safe staffing levels and robust recruitment procedures were in place. Staff told us they were well supported by the management team and felt confident to raise any concerns. People told us they felt safe receiving the service and systems were in place to identify, record and report any safeguarding concerns. The service had not always followed their own safeguarding procedure. We identified one event affecting a person’s wellbeing had not been reported to CQC in line with regulatory requirements. We raised this with the registered manager who has since advised that this was done retrospectively. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. Care plans and risk assessments were in place although some lacked detail. The guidance available to staff was not fully detailed to reflect people’s needs.

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.

People felt safe with the support they received and gave examples when staff demonstrated a culture of safety. One family member shared an example when a staff member shared concerns about a person’s medicines and the potential impact this had on their well-being. The family member appreciated this and felt the staff member cared about their relative.

Staff we spoke with were able to describe the process for reporting and recording accidents and incidents. Staff confirmed how reflective practice is completed post incidents and a debrief. They also described how learning is embedded to prevent future incidents.

Systems were in place to records and report events which occurred. Significant incidents were reported internally with evidence of reflective practice by the staff and management team.

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 protected from the risk of abuse. One family member told us, “I have no concerns. We have access to the electronic reports following calls and we can check what is being done. I have met the carers, and they all seem fine. I feel confident about the care mum receives.”

Staff told us they had access to safeguarding policies and procedures. Staff where able to describe the process for reporting incidents and events internally and externally. Staff told us they had completed online training on Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff were able to describe the principles of the MCA code of practice.

Staff knew how to identify and report safeguarding issues and were aware of whistle-blowing processes. The service had not always followed their own safeguarding procedure. We identified one event affecting a person’s well-being had not been reported to CQC in line with regulatory requirements. We raised this with the registered manager who has since advised that this was done retrospectively. Actions were taken by the registered manager following any feedback received in relation to staff conduct or safeguarding concerns. Records confirmed this.

People told us they felt supported to manage risks and staff were supportive. Most family members were confident in the support people received. Once commented, “All risks are managed by the carers, they keep me informed and up to date and will check things out with me if they are unsure.”

Staff advised care plans and risk assessments were accessible to staff they are involved in the review process for those service users they are key workers for. Staff described the policies and procedures in place for managing risk and health and safety when accessing the community.

Care plans and risk assessments were in place although some lacked detail. For example, some care was delivered by staff if a family member was not available. The guidance available to staff was not fully detailed to reflect people’s needs. This was discussed with the registered manager who amended one person’s plan based upon our feedback.

Family members told us staff did maintain peoples home environment to a high standard however, one family member told us staff did not always empty bins or tidy a person’s bedroom after providing care. We shared this feedback with the management team who told us they would address with staff.

Staff described the equipment used to support people and how they monitored equipment for any changes or faults.

Risk assessments were undertaken on peoples living environments. This ensured risks such as poor lighting or uneven flooring was identified, and appropriate measures could be put into place.

We received mixed feedback about consistency of staff who attend peoples care calls. Some people expressed concern about the number of different staff who attended the care calls. This view was not shared by all. For example, another family member told us, “We mostly have the same carer who we think is great.” People told us there were enough staff. One family member commented, “There are always enough staff, I have never had an issue with staff turning up late or not turning up at all.” Another family member told us “Never been let down for a care call. Sometimes they are late, but they will always ring me.”

Staff told us there were no staff shortages to effectively support people within the service and most staff worked full time on a shift pattern basis. Staff described the induction and training programme within the service this included face to face and online training courses.

Staff were safely recruited. Appropriate checks were undertaken before a staff member was offered employment. There were enough staff to meet people’s needs. Rotas were developed around peoples assessed needs. Systems were in place to monitor the time staff spend at calls and to ensure no calls were missed. Staff received an induction and were supervised on a regular basis to observe practice and check competency to perform their role. Staff receive training they need to meet peoples care needs.

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.