Onecall24 Healthcare 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question good. At this inspection the rating has remained good. This meant people were safe and protected from avoidable harm.

People received a safe service, were protected from abuse and neglect and had their human rights promoted. Staff and managers understood the reporting procedure for any safeguarding concern or allegation. Risks to people were assessed and their safety was monitored and managed, with minimal restrictions on their freedom. Accidents and incidents were monitored and analysed, so lessons could be learned, and recurrences could be avoided. The service followed robust recruitment procedures and there were enough suitably trained staff employed to meet people’s needs and keep them safe. Staff supported people to manage their medicines safely where required. Regular medicines audits were completed, staff were trained, and their competency was checked at regular intervals.

We did not assess all the quality statements within this key question. We did not identify concerns relating to those areas which we judged as being met at our last inspection.

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.

Most people using the service or their representatives told us the service had a culture of safety and learning. People said they knew who to contact if they had any issues and they were comfortable raising concerns. People confirmed that lessons were learned if things went wrong, and changes were made to improve the service and avoid recurrences.

For example, 1 person’s representative told us, “It is important to [Name] the way things are done. There have to be the right people in the right place. There are shadow shifts, and we get to know the new carers. If a new carer is not right, then [Name] and me will mention this and the person will be changed.”

Another person’s representative told us, “The management team come together as one if there are any issues and work together to resolve them. They truly care about everyone in the team and not just the client. They are open and honest if things do go wrong and calmly work with integrity until matters are concluded.”

Staff and the management team told us that people’s safety was a priority. They said safety was everyone’s responsibility and it was maintained by being open and transparent and making sure lessons were learned from experiences. Staff were supported and encouraged to raise any issues or concerns so they could be addressed, and risks could be minimised, without restricting people’s choices. Staff confirmed the management team shared information with them, to help ensure lessons could be learned.

For example, 1 member of staff told us, “In our care package we have very open communication. Open and honest communication is imperative to ensure safety for our client. The client is the priority.” This person also said they were comfortable raising any concerns with their nurse manager and reflections helped make sure the error was prevented from happening again.

Other staff told us that if things went wrong, information was shared with the staff team by way of team meetings and a company WhatsApp group. In addition, staff told us they received a weekly policy via email, to help guide their actions. Some staff told us their team had an information dissemination platform where issues were shared daily.

The provider had effective systems and processes in place, which helped enable learning from previous incidents where people may have been at risk. We saw the provider’s systems and processes promoted people’s safety as a priority, whilst not limiting their choices. People were supported and empowered to make informed choices and take calculated risks as safely as possible. We saw that incidents and complaints were reported, recorded and investigated appropriately and changes were made where needed.

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 felt safe with the staff who supported them. People’s relatives said they felt confident that the service would listen to them if they raised any concerns, or experienced a situation which made them feel their loved one was unsafe.

A person’s representative told us, “If there have been any incidents, they [OneCall24 Healthcare] will investigate and provide a response.”

Another person’s relative told us, “There is a sense of caring, unlike other care companies. The company vets people; there are interviews and safeguarding checks, so [Name] is safe.” Another relative said their loved one was safe with the staff who visited and commented, “There’s not one I don’t feel happy with.”

The management team and staff demonstrated a clear understanding of abuse and neglect and knew how to recognise signs that may indicate a person was at risk. Staff worked hard to make sure people were protected from harm and reported any concerns quickly and appropriately.

Staff gave examples of things they looked out for to help make sure people they supported remained safe. A member of staff said, “I look for signs of abuse such as neglect, bruising, emotional distress and a dirty environment.” Another member of staff explained that, although 1 person had a condition which caused them to bruise easily, a body map was completed every day and all bruises were recorded, reported and investigated.

Staff and the management team confirmed that any restrictions on people’s freedom were only used when they were in the best interests of the person. They also had a clear understanding of the processes to follow, if people needed any restrictions for their safety. All the staff we spoke with confirmed they had completed safeguarding training and would report any concerns without hesitation.

A member of staff told us, “I certainly know how to raise concerns. I always think that could be my grandchild.” Other staff explained scenarios which had given them cause to raise safeguarding concerns and confirmed how appropriate action had been taken to ensure people remained safe. For example, a member of staff identified that care staff provided by a different company had not been appropriately trained, which put the client at risk. Another member of staff told us how they had reported a colleague for sleeping during their ‘waking night’ shift.

The provider had effective systems and processes in place to help ensure people were protected from abuse and neglect. We saw the safeguarding policies and procedures followed current and relevant legislation. The systems we looked at showed how concerns about people’s safety were recorded and reported to the Nursing Team Manager or Clinical leads and the Registered Manager, who raised them with other appropriate bodies, such as the local authority safeguarding team and CQC. Where possible, people using the service and their representatives were involved in this process and informed about what action would be taken to keep them safe.

People and their representatives told us the staff helped them to recognise risks in their daily lives and take action to reduce these. People knew about their care plans and risk assessments and had been involved in compiling these as much as possible.

A person’s representative told us that personal risk assessments had been completed and care staff followed them. They gave an example where 2 staff were needed to take the person out. Another person’s relative told us that, although the service identified and mitigated risks, they were not risk averse. This meant their loved one was still able to have ‘life experiences’ but with appropriate safety measures in place.

People and their representatives confirmed that they had regular review meetings, and their care plans and risk assessments were updated whenever needed.

Staff and the management team confirmed that risk assessments were completed with people who used the service and their representatives. This helped them to understand and manage the various risks they encountered in their daily lives. They told us people’s care plans and risk assessments were regularly reviewed and updated as soon as any changes were needed.

A member of staff told us about some of the risk assessments and risk management plans that were in place for a person they supported who had a specific health condition. They explained how the person was able to eat normal food but was at risk of choking if they were not seated correctly. They confirmed that, by following the appropriate safety measures, the person could enjoy a better life experience, with support that was provided in the least restrictive way possible.

Another member of staff told us they knew exactly what support people needed when they visited them. They confirmed that people had clear and detailed care plans and risk assessments, which were accessed via the electronic care system. This member of staff explained, “I always ensure that my care is to a high standard. I request information before commencing a care package, which is promptly forwarded to me by my nurse manager. I then have access to [electronic care system] to enable me to read the client’s care plan, medicines chart and action plans etc.”

The provider had effective systems and processes in place to assess and minimise risks that were identified for people using the service. Risk assessments were person centred and covered all aspects of people’s lives, including personal care, health conditions, clinical observations and procedures, equipment and leisure activities. There were also personalised contingency plans for covering shifts in the event of staff absence or shortage.

We saw that people’s care plans contained up to date information and guidance for staff about the action they should take to manage identified risks and keep people safe. There were clear processes, which staff followed when they needed to report concerns, incidents and accidents. These processes helped enable the provider to have oversight of risks and ensure they were mitigated as much as possible. The management team completed regular audits and people’s care plans were updated as soon as there were any changes or new risks were identified.

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

Most people or their representatives, told us they were happy with the care staff allocated to their individual care packages and believed they were skilled and appropriately trained. Most people said that staff were reliable and always completed all the tasks they were required to do.

A person’s representative told us, “They [OneCall24 Healthcare] are supportive when issues arise. For example, putting in an emergency 2nd carer support at very short notice, to maintain consistency of care for [name] during a recent crisis period.”

Another person’s representative explained, “The care team have to be in the heart of our family, as they are here from 8am to 7pm daily. The nurse manager promised they would find the right lovely people to care, and they have worked hard to get the care team right.”

Some people told us they had issues with the quality and availability of staff for their family members’ care package. However, on reviewing these comments, we identified that some issues or concerns raised by clients or their representatives, were due to funding or the commissioning of hours and qualifications, rather than the service not meeting people’s needs. There were difficulties in some areas with recruitment but there were also instances where family members refused to accept certain staff for personal reasons.

Staff told us their work schedules were achievable and most said they felt there were enough staff recruited for people’s individual care packages. Most staff said they felt well supported and had very good training opportunities.

Staff confirmed they completed an induction, shadow shifts and mandatory training, as well as person and health specific training. Staff gave examples of the training they had completed, which included learning disabilities and autism, paediatric first aid and a range of training to meet people’s specific health needs.

A registered nurse told us how they cared for 1 particular person in their own home and said they had completed an induction and were sent information about the client prior to meeting them. The nurse also explained, “This client requires 2 staff at any one time and there are 2 x 12 hours shifts a day. The shift lengths are enough to complete most of what is required to be done and anything pending is handed over to the next shift. If one staff fails to turn up for work, which rarely happens, one staff from the previous shift will stay until the agency gets replacement cover.”

The provider had safe and effective systems and processes for recruiting, deploying and managing staff. We saw records that demonstrated how the provider followed a thorough staff recruitment process. Staff disciplinary and capability processes were fair and regularly reviewed. This helped ensure staff were not disadvantaged because of any protected equality characteristics they may have. Staff completed comprehensive training that was appropriate and relevant to their role. They were also supported to deliver safe care by receiving regular supervisions, appraisals and development support and by being encouraged to be actively involved in improving the service.

We noted that recruitment in some areas was more difficult than others. However, we also found there had been a number of situations where new staff had been introduced, but the person using the service or their family had refused to accept them onto the care package team for personal reasons.

We reviewed and cross-referenced a large amount of evidence, which included correspondence and communication. Overall, we were assured that the service was doing everything possible to ensure sufficient staff were safely employed and deployed. We saw the service worked closely with family members and each person had a contingency plan in place in case of a staff shortage. In some cases, we saw the service had provided qualified nurses, at their own expense, to cover where there had been shortages of care workers.

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 told us they were happy with the way the service and care staff managed their medicines. A person’s representative told us that medicines were always administered properly and on time and there had never been any problems with carers supporting their relative with their medicines.

Staff and the management team told us that some people required support to manage and administer their medicines. They confirmed that regular monitoring and audits were completed by way of checking people’s medicines administration records (MAR), spot checks and feedback from clients and their representatives.

All the staff we spoke with confirmed they had completed training for medicines management and administration and were confident with this area of responsibility. Staff also understood their responsibility for reporting problems or errors with people’s medicines.

A member of staff told us, “Errors and missing medications are reported to the office and the office always addresses issues promptly.” Another member of staff said, “If I was ever unsure about any medication, I would question it rather than give it. My client isn’t on any medication that can’t wait until confirmation could be sought.”

The service had effective systems and processes in place to ensure people’s medicines were managed and administered in a safe way. The service’s medicines management processes reflected current and relevant best practice and professional guidance. The systems used for auditing medicines were reliable and robust.

We saw the service closely monitored people’s medicines and kept detailed records of all anomalies regarding these. This included recording instances where family members or staff from other agencies had been responsible for managing and administering medicines but had made an error or not signed the MAR sheets. This extra oversight helped provide people with a safer service.