Revelation Social Care Ltd

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

Robust recruitment practices were now followed. Systems to support and develop staff now ensured they had the knowledge and skills needed to support people safely and effectively. Visits were effectively managed, and staff safely deployed. People said they felt safe and well supported by consistent staff who knew them. One person said, “They are reliable and definitely safe in their practice.” Areas of risk were now effectively assessed and planned for. Additional advice and support were sought where necessary. People's medicines were now managed and administered as prescribed. Medication training and assessments of competency had been completed ensuring practice was safe. Lessons had been learnt from previous safeguarding concerns. Learning had been shared with staff to help improve practice. Staff understood their responsibilities to safeguard people and were confident any issues or concerns raised would be dealt with as a matter of priority.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Managers felt they had been proactive in addressing the breaches of regulation found at the last inspection. They had and continued to spend time reevaluating the service and implementing the changes required to improve the experiences of people and staff. Staff said opportunities for learning and developed were provided, enabling them to learn new skills and improve their practice.

Systems had been introduced to help managers identify and act on areas of learning and improvement. A monthly report was produced, following review of any complaints and concerns, staffing and accidents and incidents, which informed the organisations business improvement plan. A newsletters ‘High Risk Friday’ was distributed to staff each week. This provided an easy read version of different topics relevant to their work, helping enhance staff knowledge and understanding in key areas. Bespoke team meetings were held to discuss the individual needs of people, helping to promote consistent support.

The relative of one person spoke about the prompt action taken by staff when their family member became unwell. This had resulted in them receiving treatment in a timely following admission to hospital. People said they had been referred to other agencies where it had been identified they had additional support needs.

The registered manager spoke about learning from the last inspection in relation to new referrals. Managers spoke about a slow managed approach so a thorough assessment and care plan could be completed along with any additional training required for staff. This would ensure they were confident in meeting people’s needs. Managers spoke about other agencies they worked in partnership with, so people’s needs were met. Specialist healthcare support was also sought, for example, advice was being sought to assist staff in delivering personalised support when caring for someone diagnosed with Huntington’s disease.

Electronic records were maintained where managers liaised with relevant agencies when people moved between service, for example, admission or discharge from hospital. Managers were introducing a ‘hospital passport’ to help formalise communication systems between agencies. Care plans and risk assessments had been improved, incorporating guidance from other professionals so that continuity in care is delivered.

No issues or concerns raised by those people we spoke with. People felt they were safe and well cared for. We were told, “I always feel completely safe in their care” and “They are reliable and definitely safe in their practice.”

Managers were aware of their responsibilities to report and respond to any concerns raised. We were told issues raised following our previous inspection had been acted upon and were now resolved. Managers gave an example of current work with the family of one person, who lacks mental capacity, so decisions were made in their best interests. Staff were fully aware of the process to follow to raise concerns. All staff we spoke with would raise concerns with the manager and were confident this would be dealt with as a matter of priority. Staff were aware how to keep people safe. They told us how people were supported with both existing and new life skills, so they were better equipped to look after themselves.

Systems were in place to guide and support managers and staff ensuring people were kept safe. Staff received training in safeguarding adults, mental capacity and deprivation of liberty and duty of candour, reinforcing the importance of transparency so people’s rights were upheld.

People told us they felt their care and support was delivered safely. People said managers had supported them to access any equipment they needed to aid them. People and their relatives told us, “I walk indoors with a frame and need a wheelchair for going outside. They understand how to support me either way” and “They [staff] always come in twos as they have to use a hoist for getting [relative] up in the morning and putting to bed at night. [Relative] seems very comfortable with how they use the hoist.”

We were told risk management was overseen by those staff with the relevant knowledge and experience. Managers felt this was working well and provided good oversight of the needs of people and any actions required. Staff felt fully confident in their caring roles. The electronic application on their phones outlined the risks posed to people. Staff told us they were provided with lots of detail on how to mitigate risks, such as falls, choking and smoking. Staff told us they got to know people and built-up valuable relationships, which also helped to keep people safe. Staff members explained the steps they took to reduce the risk of people falling in their own homes. Environments were checked and cleared of any hazards and clutter, rugs were removed, good lighting was used, and carers made sure things were left within people’s reach when leaving the property. Staff also promoted the wearing of any emergency pendants people had so that they could summon help quickly in the event of an accident or fall.

Systems to help identify and manage areas of risk posed to people had been improved. Prior to commencing new packages of care managers worked with people, relatives, and other stakeholders to gather relevant information relating to risk. This information was incorporated in people's individuals support plans and directed staff in the safe delivery of people's care. Environmental and fire risk assessments were also completed to ensure a safe working environment and staff knew what to do in the event of an emergency/ accident or incident. On-call support was provided. Any issues or concerns were recorded and monitored for patterns or themes so that appropriate and timely action could be taken to minimise potential risks to people. Staff completed relevant training in areas of risk such as, moving and handling, falls, infection control and risk of choking.

People felt staff knew what equipment they needed and how to use it, so they were kept safe, both in and away from home. People said staff ensured they had what they needed prior to them leaving. One person told us, “I walk indoors with a frame and need a wheelchair for going outside. They understand how to support me either way. When they leave me, they ensure I have my phone and remote to hand, a hot drink and plenty of water.”

Managers told us designated staff completed environmental risk assessment, exploring environmental safety both in and outside the home and fire safety. We were told assessments explored what control measures were in place and action taken to minimise risk to people and staff. Staff outlined the steps they would take to ensure people remained safe, especially when staff weren’t there. One staff member described how a large rug had become a hazard, due to the person’s decline in mobility. This had been discussed with the person and their family and removed from the house, so it no longer posed a risk.

Policies and procedures were in place to support and guide staff in the safe management of environmental risk. Additional training was also provided in health and safety, fire safety in care and the safe use of equipment in people’s homes. Health and safety checks were carried out to make sure people’s home environment and equipment remained safe for them and staff. Systems were also in place to monitor any accidents or incidents so that timely action could be taken where necessary.

People told us they had consistent support from staff who knew them, any changes were communicated to them. People and their relatives told us, “I have mostly regular care staff and we know each other well. Their time off is covered by others, but they are always ones I’ve met before and the care doesn’t change, they are all brilliant” and “Time keeping is good. They send consistent care staff, even the relief staff usually know her very well.” Staff were said to have the skills to meet people needs. People told us, “The staff seem very confident in what they do, and some have told me about having changed rotas to be able to attend training sessions.”

Managers told us they had been working hard to formalise the induction, training and support systems for staff, so they were equipped to carry out their role safely and effectively. Managers were exploring secure chat systems providing an effective method of communicating and informing staff of relevant information. Staff we spoke with told us there were no staffing issues. People were supported by carers who struck up good relationships with them and got to know them. One member of staff told us, “We have more than enough staff; we need more customers.” Staff considered they were well-trained and fully prepared them for the caring role. A suite of on-line training courses was available to staff, consisting of elements of mandatory training such as safeguarding, medication, health, and safety, first aid and food hygiene. Some elements of training were face to face and staff had accessed training resources organised by the local authority and other health professionals. Mandatory training was supported by elements of more specialised training, such as dementia, autism, and diabetes. Staff told us they had the facility to request additional training around different health conditions, if this would help to meet people’s needs.

Improvements had been made to ensure staff were safely recruited, trained and supported in carrying out their role and responsibilities. Recruitment records were paper based, but plans were in place to move these to electronic records. We found the required checks were in place to ensure staff were of the right character to work with vulnerable people. There was a thorough induction process in place, with a template guide to record an on-going induction. This detailed aspects of the induction from starting employment, covering health & safety, training, and development, and also outlined aspects of the caring role, such as medication, care plans and providing appropriate personal care. We saw examples of completed induction records on staff files, including employee signatures and sign offs by management. Competencies were checked and there was regular supervision with staff throughout the induction process. There was a review of performance with new staff after 3 and 6 months. There was the option to extend the 6 months probationary period if it was identified staff needed any additional training or support. A review meeting checklist outlined elements to discuss with new staff, such as feedback about the role, performance, training and development and well-being. Minutes from team meetings showed a range of subjects discussed around safe and effective care practices, record keeping, meeting the individual needs of people and training and development.

People spoken with said staff wore protective clothing when assisting them with their care and that items were cleaned away and disposed of properly. We were told, “They all use PPE, many still choose to wear masks. I have a special bin, where they dispose of incontinence pads after bagging them” and “There are two further hygiene calls during the day. Items are bagged separately from other refuse.”

There were no issues with this aspect on speaking with staff. They had access to equipment and supplies that they collected from the main office. Staff also observed people’s different faiths and any additional requirements in relation to infection prevention.

Systems were in place to promote good hygiene standards. Staff had access to information and training to guide them in areas such as Control of Substances Hazardous to Health, Health and safety, Food hygiene and Infection control. Appropriate personal protective equipment (PPE) was made available. Care plans clearly outlined the practice to be followed by staff when providing personal care or with meal preparation to help minimise the spread of infection.

People told us they received the support they needed in managing their prescribed medicines. People were aware that administration records were completed to show items were given at the agreed time. One person said, “I have creams applied, which they monitor and record, and they tell me when it’s time to re-order.” Peoples relatives also felt medication was appropriately monitored and managed safely. We were told, “They [staff] administer all medicines, they are given on time and well recorded” and “Revelation prompted a medicine review, so [relative] is no longer on any medication. They also monitor their skin condition, which includes recording all positional changes and the creams they use on their skin.”

Managers told us the medication policy had been reviewed and staff had undertaken further medication training to help improve practice. Work had also been undertaken to improve people’s records detailing the medicines support they needed. Staff told us they were provided with the appropriate information in relation to the administration of medicines. Staff ensured people received the right dosage in the right way. For example, one staff member used a syringe to administer medication for a person with dementia. It was important to use the syringe so that the person did not receive too much medication. Staff were provided with information to ensure topical creams were applied in the right places and at the right time. For those people that chose to self-medicate the registered manager carried out checks to make sure they were safe to do so. Staff also received checks on their practice; management were assured staff were competent to administer medication.

Systems and process had been improved to ensure people received their prescribed medicines safely. The service had a clear policy and procedures in place for the safe management and administration of people’s medicines. Staff also completed annual training and assessment of competency were undertaken by managers to check staff practice was safe. Medication administration records were audited to check people had received their medicines as prescribed. Where people received support with their prescribed medicines, detailed care plans and assessments had been developed to guide staff. These were kept under review and updated where needs changed. Written confirmation had been received from the GP regarding the administration of crushed medicines and directions from the speech and language therapists in relation to the use of thickener.