ILS24Health Care 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

Breaches of the regulations in respect of safe care and treatment including medicines were found at this assessment. The needs and risks of people were not properly assessed and mitigated. This meant staff did not always have clear information and guidance on how to care for people safely.

People’s records showed staff were supporting people with basic clinical tasks for which they were not registered, properly trained or delegated to complete by an appropriate health care professional. This placed people at significant risk of harm. Staff did not have adequate or safe guidance on how to perform these tasks and records showed the support provided did not always adhere to professional advice or best practice.

The management of medicines was unsafe. Records about medicines were not accurate, up to date or properly maintained. This meant medicines could not be properly accounted for. There was a lack of safe systems in place to ensure medicines were administered as agreed and as prescribed. This increased the risk of medicine errors being made. Staff lacked appropriate guidance for the application of prescribed topical creams or homely remedies to be given effectively. Some medicines were administered with no guidance or records made about their administration.

Staff were not always recruited safely. There was a lack of a robust learning culture or adequate investment in ensuring staff were trained and competent to do some of the tasks expected of them.

Staff told us they liked working for the provider and felt supported by the registered manager. There were policies, procedures and checks in place to ensure good standards of infection control and staff demonstrated they knew how to prevent the spread of infection when providing care.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The relatives we spoke with did not give any direct feedback in this area. They did feedback however, the registered manager and staff were responsive to any concerns or queries they had about people’s care.

We found a robust learning and safety culture was not fostered within service with staff providing support outside of their skills and experience. This was not safe practice. Continuous learning and supervision in these areas was not undertaken.

Staff told us meetings took place to share learning. However, staff meetings did not reflect this. Records showed not all staff attended staff meetings regularly.

The provider had not recognised staff were providing support of a clinical nature without an embedded culture of clinical safety or learning. This meant staff had not received appropriate training, development or supervision in these areas to mitigate risks in the delivery of care.

There were processes in place to support a learning culture, but these were not consistently or effectively applied across the service.

The provider had a training programme in place for staff with regards to personal care. However, staff were expected to complete tasks of a clinical nature. There was no adequate training, learning or development or supervision framework in place for the provision of these tasks. This lack of a proactive, positive safety and learning culture placed people at significant risk of avoidable harm.

People’s relatives did not provide any feedback in this area. However, we found that people’s needs were not always fully assessed or accurately described to promote a safe and positive transition to other services, should this be required. This increased the risk of a poor pathway or transition being experienced by people using the service.

The registered manager told us once a referral was received an assessment was undertaken prior to the start of the service to ensure the service could meet the person’s needs.

We found the assessment process however failed to identify that some people using the service required a level of support that was outside of the scope of the service and staff skills and competencies.

During our assessment we made contact with the Local Authority and NHS partners to discuss our concerns about the service providing support to people with complex clinical needs without the appropriate safety frameworks and pathways, such as the Nursing and Midwifery Council and Skills for Care Scheme of delegation being in place. These safety frameworks provide guidance on how to ensure risks associated with the delegation of basic clinical tasks to non clinically qualified staff is safe.

Partners took the necessary action to mitigate risks to people receiving clinical support from the service.

There were processes in place to promote safe systems, pathways and transitions but they were not used effectively to ensure positive outcomes.

Assessment and care planning processes were not always thorough or consistent. People’s medical and physical health conditions were not properly assessed or described and information in people’s care plans was not always properly updated when their needs had changed. This increased the risk of incorrect or out of date information being shared with other medical and health and social care professionals involved in the person’s care.

The relatives we spoke with felt their loved ones were safe with the staff who supported them. They told us regular staff supported the person and positive, warm relationships had developed between the person in receipt of support and staff.

Staff members told us they had completed safeguarding training. Staff knew what action to take should they suspect or witness potential abuse.

The registered manager and provider however, had failed to understand the potential impact of staff providing people with support for clinical tasks for which they were not adequately trained or supported. This placed people at risk of improper treatment and avoidable harm.

There were safeguarding and whistleblowing policies and procedures in place to guide staff on how to respond and report allegations of abuse.

There were processes in place to record safeguarding events, accidents and incidents however, we were not assured about their accuracy. For example, staff meeting minutes indicated that concerns had been raised with regards to rushed visits, lack of communication and late visits but these concerns were not documented on the provider’s incident register or complaints tracker.

The processes in place however, did not recognise that people were placed at risk of avoidable harm and improper treatment due to staff providing elements of clinical support they were not trained, or legally authorised to provide.

People did not provide any direct feedback in this area.

People’s records showed they did not always experience care that mitigated risks or supported them to move safely between services.

For example, some people required regular repositioning to the mitigate risk of pressure sore development. Records showed this was not always provided effectively or health care professionals contacted appropriately for advice on how to manage potential risks when changes in the health of people’s skin had declined.

Medicine records were not accurate or up to date which meant should a person have to move between services, for example be admitted to hospital, there was a risk the person would not receive the right medicines or the medicine they needed.

During our discussions, when asked the registered manager was unable to explain why people’s risks had not been assessed using standardised or recognised tools. They were unable to explain why people’s medicine records were not up to date or accurate.

Staff members did not provide any feedback in this area.

People’s needs and risks were not adequately assessed or described, and staff had insufficient guidance on how to care for people safely. Some people had complex medical needs which had not been assessed or adequately care planned.

People’s care plans and risk assessments did not always contain consistent or enough information to guide staff on how to mitigate risks specific to them. For example, some people did not have adequate risk assessments or management plans in place for their mobility, moving and handling, nutrition or skin integrity needs.

Where people’s needs had changed care plans had not always been updated appropriately and where this related to clinical care, formal confirmation of any changes had not been sought. For example, the formal PEG (percutaneous endoscopic gastrostomy) regime from the NHS outlining how people’s PEG nutrition should be managed, was not dated. The PEG regime in people’s care plans did not match the PEG regime specified by the NHS. It was unclear which was the latest PEG advice as no formal confirmation of any changes had been sought from the NHS PEG Team.

People’s care was not always monitored appropriately to mitigate the risk of avoidable harm.

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

People’s relatives felt there were enough staff, as visits were completed on time, for the duration agreed and most people had regular staff. One relative told us, “Yes, very regular (Staff). Carers are very good. At the moment he has 5 regular carers and we have a regular rota.”

People’s relative’s felt staff were trained and knew what to do.

Staff felt there were enough staff to meet people’s needs. Staff told us prior to working unsupervised with people, they completed an induction with included opportunities to work alongside more experienced staff, at the start of their employment.

When asked the registered manager was unable to provide CQC with satisfactory assurance about the quality of the complex care training provided to staff and how this equipped them with the skills and competencies to provide basic clinical care safely.

The process in place to ensure safe recruitment was robust, had not identified the gaps and discrepancies in the recruitment information obtained for some staff members. This meant the provider and registered manager could not be fully assured people employed were safe and suitable to work with vulnerable people.

There was a training programme in place to provide staff with relevant training appropriate to the delivery of personal care. The processes in place however, failed to identify the training programme in place to equip staff with the skills and knowledge to provide basic clinical care was inadequate. The provider and registered manager referred to this training as ‘complex care training’. The complex care training was in-house and delivered by trainers not qualified, sufficiently trained or experienced in providing complex care to vulnerable people in the community.

There were processes in place to ensure staff received supervision on a 1:1 basis with the registered manager. The processes in place however, failed to identify the clinical tasks staff were expected to complete required formal delegation and monitoring by a qualified health care professional registered to provide clinical care, which CQC refers to a ‘Treatment of Disorder, Disease and Injury” activities. For example, delegation and monitoring by a health care professional employed by an NHS Trust. This failure to identify staff were not sufficiently trained, supervised or legally authorised to provide these clinical tasks was a serious concern.

There was a process in place to identify how many staff members were needed to support each individual person. Staff rotas were planned in advance with consideration given to ensuring the person had a regular staff team.

People’s relatives told us they had no concerns about infection prevention and control. They confirmed staff wore appropriate personal protective equipment (PPE) when delivering personal care.

Staff completed appropriate training in infection prevention and control, food hygiene and were aware of safe hygiene practices. Personal protective equipment (PPE) was available for staff to wear when providing support. Staff were able to explain how they protected people from the risk of infection through good hand hygiene and the use of PPE.

There were policies and procedures in place to guide staff in infection prevention and control. Staff had access sufficient supplies of PPE.

People’s relatives did not report any concerns with medicines. However, we identified serious concerns with the administration and management of people’s medicines which placed people at significant risk of medicinal harm.

The registered manager was not able to explain why people’s medicine records were not up to date or accurate. They did not demonstrate an awareness of this poor record keeping or an awareness of best practice with regards to safe medicines management.

Staff confirmed they administered people’s medicines and told us they had had their competency to do so checked.

The process staff followed when administering medicines did not follow best practice issued by the Royal Pharmaceutical Society, the Nursing and Midwifery Council or CQC. The process followed did not comply with the provider’s own medicines policy. Medicines records were not maintained correctly and were not up to date. Some medicines were not listed as a prescribed medicine on the person’s medicine administration record (MAR) but were administered by staff. This meant staff had no guidance on how to administer these medicines and made no records as to how and when they were administered. This placed people at significant risk of avoidable medicine related harm.

The times some medicines were administered were not recorded. This meant it was impossible to tell if medicines with a specific time interval between doses such as paracetamol had been given safely. It also meant it was impossible to tell if time specific medicines such as medicines to treat Parkinson’s disease or Epilepsy had been given at the right time to prevent unwanted symptoms. Guidance in relation how to administer medicines was sometimes unclear and care plans referred to some medicines no longer prescribed.

Staff lacked suitable guidance to follow when administering when ‘as required’ medicines such as prescribed creams, painkillers or medicines with a variable dose.

There was a lack of clarity over who was responsible for administering medicines. For example, one person’s care plan stated the person’s family were responsible for administering morning medicines, yet records showed staff were administering these medicines. This lack of clarity increased the risk of medicine errors and people being given the same medicine twice.

The medicine audits in place to check the safety of medicine administration were not robust. They lacked sufficient detail of what had been audited and failed to identify the serious concerns with medicines management found at this assessment.