Blossom Care For You LTD

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• 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 this assessment we looked at 4 quality statements in the key question of safe. The overall rating for this key question combines scoring from quality statements we looked at during this assessment and quality statements scores in line with findings from our last inspection. At our last inspection this key question was rated good. At this assessment the quality of care had declined and the key question of safe is now rated requires improvement. We found breaches in regulation related to medicines optimisation and safeguarding. There were not effective systems in place to oversee the safe management of medicines. This included shortfalls in care planning, risk assessment and record keeping. Safeguarding concerns and incidents were not always robustly investigated, and actions were not always recorded or reported to demonstrate how people were kept safe. People received support from consistent staff, who had a good understanding of their care needs. The provider had identified issues related to their staff recruitment processes. They had started work to retrospectively obtain required recruitment documentation for all staff. The provider had recognised where handovers of care to alternative providers could be improved and where improvements were needed, and lessons could be learnt for future transitions. We have asked the provider for an action plan in response to the concerns found at this assessment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

We spoke to 1 person and 5 relatives as part of this assessment. They told us they were supported to access healthcare services and raised no concerns about the support they received. Comments included, “When my relative needed to access any health professionals, the staff have been very amiable in assisting every process” and, “We have a care plan and I’m happy with how it stands at the moment"

Staff had a good knowledge of people’s needs and the support they needed when accessing healthcare services, such as hospital admission and discharge. They had a good understanding of how to communicate information to professionals upon admission and checking for changes to care plans once care recommenced post discharge.

We received feedback from the local authority quality and commissioners about Blossom Care For You LTD. They had raised a number of concerns about the quality of the service. This included concerns around how the transition of care was handled when people were supported to find an alternative provider. Specifically, communication with professionals during the transition of services and how concerns that the provider did not always follow agreed safeguarding procedures when concerns arose about people.

The provider did not always follow agreed procedures with stakeholders during the transition of people’s care to alternative providers. In some instances, they did not promptly report concerns to local safeguarding teams around incoming providers or arrangements around transfers of care. There were situations where there was confusion around end dates of care packages, with examples where the provider had continued to provide care outside of agreed timescales. The provider acknowledged that they had not always followed agreed procedures but had done so with the with people’s welfare in mind.

We spoke with 1 person and 5 relatives as part of this assessment. They told us they felt safe receiving care from staff. They felt comfortable raising any safeguarding issues with the provider’s senior staff and were confident their concerns would be addressed. Comments included, “I have full control over the care and the carers [staff] do exactly what I want”, “I think my relative is very safe with this agency”, and “Our opinions are well respected [by the provider] and I can voice anything, and they will take it on board”.

Staff we spoke with knew what constituted a safeguarding concern and the appropriate channels to report these to. They also knew people well and what was needed to keep them safe. The provider had made training available for staff to complete in safeguarding adults. However, we could not find evidence that 3 staff had completed this training. Therefore, we were not fully assured all staff had received all the safeguarding training relevant to their role.

The systems and processes to report, investigate and oversee incidents was not effective. Incidents relating to concerns and safeguarding were not always followed up robustly. This included examples where investigations into incidents were incomplete and related documentation was missing. We found missing records of actions taken to safeguard people in response or reduce the risk of recurrence. The provider did not have a robust system to ensure oversight of incidents, with no evidence that incidents were analysed to identify trends, causes or potential actions in response to help prevent future incidents. We found evidence of incidents which were not reported to CQC, which met the threshold of statutory notification. Reporting specific types of incidents to CQC is a requirement in regulation providers must adhere to. We brought this to the manager’s attention, who agreed to review previous incidents and submit any missing statuary notifications to CQC.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for 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.

We spoke with 1 person who used the service and 5 relatives to gain feedback about staffing at the service. People and relatives with were positive about staff. They told us staff were friendly, reliable and were competent in their role. Comments included, “I think they [staff] have the relevant training and know their duties very well indeed” and, “Overall the quality and attitude are very professional”.

We spoke with 4 staff and obtained written feedback from 1 member of staff as part of the assessment. Staff were happy with the training and ongoing support they received in their role. They told us their working patterns were consistent and that they had sufficient time with each person scheduled in. However, they did comment that they had previously felt rushed and under pressure during the period when the provider supported a greater number of people.

Staff received training via an online training platform. Mandatory training covered subjects relevant to staff’s role, including specific training around the use of equipment, such as catheters. Training was set to be reviewed each year to help ensure staff followed current best practice. However, the system for senior staff to oversee staff training updates needed development. During the assessment, the provider was unable to provide a full list of training for all staff or some dates that individual staff had completed previous training updates. Therefore, we were not fully assured that all staff had completed up to date training. There were shortfalls in the provider’s staff recruitment processes. They had not always completed all required pre-employment checks when recruiting new staff. We checked 5 staff recruitment files and found that 3 files had missing information including, full employment histories, reasons for leaving previous employment roles and missing references from previous employers in the health and social care sector. The provider had previously recognised where there were shortfalls in staff recruitment records and had started to retrospectively collect this information. However, we were not assured that their systems and processes were robust.

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 received positive feedback from the 1 person and 5 relatives we spoke to about the support they received in managing their medicines. Comments included, “[My relative] has two carers [staff] a day who are instructed to provide their medication which they do very safely” and, “The carers [staff] do [apply] the creams safely to [my relative’s] skin.”

Staff told us they had received sufficient training in medicines administration. The manager told us they had completed a training course enabling them to assess staff’s medicines administration competence. However, we were unable verify evidence that this had been completed. Staff told us people had information around their medicines needs in their care plans. They fed back that since the provider had introduced an electronic care planning system, medicines administration was easier to record and guidance for staff was much clearer than under the previous paper-based system.

Systems to support people to manage their medicines were not safe. We identified significant shortfalls in care planning. For example, there was a lack of detail and required information around the use of topical creams, time specific and ‘when required’ medicines. Risk assessments were not sufficiently robust when medicines administration was shared between multiple providers. There were shortfalls in the detail included on medicines administration records. This included guidance around administration when people were prescribed a short course does of medicines. Medicines related incidents were not always followed up appropriately. We found 1 example where the provider did not seek timely medical advice after a person missed a dose of the medicines. This put the person at increased risk of coming to harm.