Assured Care Southport

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

Our rating has changed from inadequate to requires improvement. We identified one breach of the legal regulations. Aspects of medicines management were still not fully safe. Staff did not always follow the providers medicines policy, and some medicines records did not correspond accurately against prescriber instructions. Systems had been introduced since our last inspection to ensure accidents and incidents which occurred were recorded, reported and appropriately analysed to demonstrate lessons learnt. However, the improved systems were not being followed consistently which meant some records relating to reporting to other agencies were stored in multiple places, so records were not always complete. There had not been any staff recruitment since our last inspection. Whilst some actions had been taken to respond to our significant concerns at the last inspection relating to safe recruitment, further work was needed to ensure complete records were maintained for all existing staff members. However, there were enough staff to ensure people’s safety and meet their needs and staff received appropriate training. This included training to effectively support people with a learning disability and autistic people. Care plans were now detailed and were underpinned by risk assessments which reflected people’s current needs. Staff understood how to protect people from the risks of infection and how to ensure peoples home environment was safe.

This service scored 53 (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 care they received. One person told us, “I would phone the office or my social worker if I had any concerns.” Family members also told us people felt safe. Comments included, “I have 100% confidence in [staff]. When I leave [Name], I know they are in good hands,” “There have been improved standards recently. [Staff are] more methodical, more willing to listen if any issues” and, “There have been no incidents, but I am confident [Staff] would deal with anything that cropped up.”

Staff were able to describe the process for reporting and recording incidents and accidents and demonstrated an understanding of the processes they needed to follow to ensure peoples safety in an emergency. This included seeking appropriate medical assistance. This process was also confirmed by the office-based staff who explained when they would share concerns with other agencies, such as the local authority safeguarding team or request the external professional advice and guidance following an accident or incident occurring.

At our last inspection, systems to review and learn lessons from accidents and incidents which had occurred were ineffective. During this assessment we found improved systems were now in place however, were not always consistently followed. Detailed actions taken were not always recorded on the correct documentation which had been described to us by staff and the leadership team. For example, some events were only noted in care records which meant we were unable to confirm all appropriate actions had been taken. For example, we could see immediate actions to keep a person safe following a fall, however, we were unable to establish through the providers systems whether appropriate agencies had always been informed. There were a small number of events which the registered manager should have reported to the CQC through a statutory notification which is the system providers must use to inform the CQC of important events which occur. We raised this with the registered manager who told us they had experienced recent technology issues when trying to submit notifications, however agreed systems needed to be more robust.

People told us the provider had worked with them to establish safe systems of care and worked effectively with other agencies to ensure their needs were met. One person told us, “There is very good communication between [the provider], my mental health team and my [family member].” Another person described a recent health emergency when a staff member supported them through a hospital admission and then back home. They told us “[Staff member’s name] saved my life”. They continue to describe how the staff member was flexible around their needs at that time which offered the person relief and reassurance.

Staff were able to describe how they supported people through periods of transition. This included when new people started a package of support as well as when people were supported to and home from hospital admissions.

We received mixed feedback on how the provider worked effectively with other agencies through periods of transition. One professional told us they felt the provider did work well regarding the direct delivery of care to people. Since our last inspection several people had moved from receiving care from Assured Care Southport to other care providers within the local area. Some professionals told us the provider had failed to demonstrate effective partnership working through this process through not sharing information in a timely manner and missing deadlines. This had created difficulties for example to the local authority and the new providers.

Systems were in place to ensure appropriate care records were maintained by staff when people moved between services. This included when referrals to other agencies had been made, for example, if the person returning home needed additional equipment, or adaptations made to their home. However, we raised with the provider the feedback we had received from some partners about effective partnership working through the recent period of transition of people.

People told us they were happy with the support they received from Assured Care Southport. Comments included, “I’ve never been so happy because of the care I have received from Assured Care” and, “[Staff] absolutely treat me amazing.” Family members also told us they felt people were protected from the risk of abuse. One said, “I trust them with my family member.”

Staff told us they had access to safeguarding policies and knew where they were kept. Staff also told us they received relevant training and understood the actions they must take. A staff member told us, “I have completed safeguarding training online- what is safeguarding and what to do with safeguarding information. If there was a safeguarding incident, I would ring the office and speak to a manager who does reviews and risk assessments.” Staff were confident that appropriate action would be taken by the management team if they did raise a concern.

Systems to ensure safeguarding concerns were promptly identified and addressed were not fully robust. A safeguarding policy was in place and safeguarding logs were completed routinely. However, records of any external reporting, actions taken, or investigations undertaken were not consistently stored in the same place. We were unable to review some safeguarding records from the point of the registered manager being made aware of concerns to concluding any investigations which had been undertaken. Some people received support to manage day to day financial expenditure. Although people had given consent for this, there was a lack of auditing systems in place to ensure people’s finances were not being mismanaged. We discussed this with the registered manager and explained this system needed to be more robust in order to protect people from the risk of financial abuse.

People felt they received safe care and were supported effectively to manage risk. We were told, “[Staff] watch what I am doing when they are here to avoid me falling” and, “My needs are ever changing, and [Assured Care Southport] adapt to it.” Family members also felt informed and involved about risk to their loved ones. Comments included, “[Name] is very wobbly at the moment and carers are very aware. They report back to me every day” and, “[Name] had a panic attack. [Staff] immediately called me and an ambulance and stayed with [them] until I could get there.”

Staff confirmed they had read risk assessments and care plans for people. Copies were available for staff to refer to within peoples home and at the registered office location. Staff told us they felt care plans contained sufficient information to support people safely and they were kept updated with any changes. One staff member said, “I usually have the same people. If I have new people, I read [their care plan]. If there were any changes, the office would let us know, then I would read again.” Staff were able to explain how they responded to risk situations, such as supporting a period through a period of upset, or distress. The registered manager described how they ensured care plans were updated as peoples needs changed. One example shared was a person who had recently received new equipment in the home to assist with mobility.

At our last inspection, we had multiple concerns about the lack of appropriate risk assessment and care plans in place to identify, respond to and mitigate risks to people’s health and wellbeing. At this assessment we found significant improvements had been made. Each persons care plan had been fully reviewed and risk was now managed safely. Records demonstrated people had been involved in this process. However, we did identify some improvements were still needed to ensure risks to one person were more explicit. In two other people’s care plans, information about intimate personal care need was spread across several documents. This needed to be simplified to ensure staff did not miss important information. We raised these shortfalls with the registered manager who took immediate action to address.

People told us they were supported to maintain a safe home environment. Staff would raise concerns and acted when needed. One family member told us, “[Staff] contacted me and made me aware of a rug in front of the fire that was a falls risk, and they removed it.”

Staff confirmed they received training for their role which included fire safety. The registered manger described the systems followed to review safety and suitability of people’s home environment to ensure people who used the service, and staff were safe.

Processes were in place to ensure people were supported in a safe environment. People had access to appropriate equipment and home adaptations to meet their needs. Appropriate training was provided and guidance to use equipment was detailed in care plans.

Most people told us they received a safe and reliable service from staff who knew them well. They added they were kept informed if there were changes to planned visits, for example if a staff member was running late. Comments included, “[Staff are] reliable and stay the right amount of time,” “Time keeping is very good” and, “[Staff] turn up on time and stay the duration.” People also told us they felt staff had the right skills and knowledge to support them. We were told, “[Staff] are well trained and knowledgeable I think,” “All staff are confident and compliant” and, “[Staff] are all trained, and they all know what they are doing.” However, one person we spoke with did not share this view. They told us, “Some do what I want, some don’t. Don’t do the job. I am looking to finish with them. They are always in a hurry. I want a proper cleaner not a Carer.” Another person commented staff do leave occasionally early to visit other people. We shared this feedback with the registered manager.

During this assessment, staff told us they had undergone a series of updated training courses since our last inspection to update their skills and knowledge which included a mixture of e-learning and recent face to face moving and handling training. Staff confirmed they had received an induction when they commenced employment with Assured Care Southport. Staff generally spoke positively about staffing levels and told us they worked as a team when short. One staff member said, “Like any service, staffing can sometimes be challenging with sickness, annual leave etc. but everyone on the team pulls together and will pick up extra shifts to cover. Never been a situation when anybody has gone without significant care. Care needs always been met.” The management team were able to describe systems in place to monitor the reliability of calls to people and plan to improve this further through the implementation of a new electronic system.

At our last inspection multiple failings were identified which demonstrated unsafe staffing. At this assessment, we found whilst significant progress had been made, some improvements were still needed. Action had been taken to ensure every member of staff now had a Disclosure and Barring Service (DBS) check. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Risk assessments had been put into place to address any recruitment gaps; however, these were not fully robust. We raised this and the registered manager took action to address the remaining shortfalls. Systems were in place to ensure staff received supervision. However, this was not yet fully embedded into practice. Whilst some staff received regular supervision and observation of practice, this was not yet consistent across the team. At our last inspection we had significant concerns about the skills and knowledge of some staff who were performing a particular intimate care task. During this assessment staff told us, and records confirmed they received refreshed training which included an assessment of their competency to undertake the care task. Records demonstrated all staff had recently received refreshed training in all aspects of their role. This included training to support people who lived with dementia and people with a learning disability or autistic people. Systems demonstrated people were receiving their care as planned. The registered manager had oversight of any missed calls. We were told improved processes were planned with regard to this.

People told us they were protected from the risk of infection and staff wore appropriate protective personal equipment (PPE) when providing care. One person commented, “I make sure they do wear gloves and aprons we have a joke about it.”

Staff told us they received training regarding infection prevention and control and had access to adequate supplies of PPE. Staff were also able to describe how they promoted good hygiene through regular handwashing. The registered manager told us how they check staff compliance through spot checks of practice when working in people’s homes.

Systems were in place to protect people from the risks associated with poor infection prevention and control techniques. There were policies and procedures for staff to follow and staff received training. Specific care needs were identified through peoples care plans. Spot checks were undertaken by the management team on staff practice.

People told us they received their medicines as prescribed. Comments included, “Staff support with gel, and I self-medicate all tablets. They pass the medication to me” and, “I don’t expect [Staff] to have medical knowledge like a doctor or nurse. They always check the Warfarin book.” People describe how staff supported their independence, and one person told us about their personal risks around safe administration of medication and explained how staff kept them safe with this aspect of their care.

Staff told us they had received training in safe administration of medicines. Since our last inspection several staff had received face to face training. All staff had received a recent check of their competency. Staff understood the actions they must take if they were concerns about a person’s medicines.

At our last inspection, we identified a lack of effective systems to ensure medicines were managed safely. At this assessment we found significant progress had been made, however some aspect of medicines management needed further improvements. We found one person was prescribed medicines for pain which was needed on an as required basis. However, staff were administering this medicine as a regular dose. There was a risk the person was receiving medicines when they were not required. A staff member had not followed safe practices when decanting a person’s medicine into alternative packaging for future administration. There was no way to ensure the tablets were in date due to a lack of original packaging. Medication administration records (MAR) did not record if a person had allergies. We raised this with the registered manager who told us they would address.