Positive Care Quality Commission assessments of Transform Homecare services

27 July 2020

During the coronavirus pandemic, the Care Quality Commission (CQC) is not routinely inspecting care services. What it is doing, however, is carrying out engagement and support calls covering four assessment areas: safe care and treatment; staffing arrangements; protection from abuse and assurance processes; and monitoring and risk management.

The CQC recently carried out such calls at Transform’s East Surrey, Mid Surrey and North West Surrey Homecare services. It concluded that Transform is managing the impact of the Covid-19 pandemic effectively at these services and is fully meeting all CQC requirements against the four assessment areas. Summaries of the reports can be seen below.

Assessment against the four assessment measures for the three Transform Homecare services

Safe care and treatment

  1. Infection risks to people using the services are being thoroughly assessed and managed.
  2. The services have reliable access to the right personal protective equipment (PPE) and Covid-19 testing for both colleagues and clients who use the services.
  3. The location’s environment supports preventing and containing the transmission of infection.
  4. Working arrangements and procedures are clear and accessible to colleagues, clients, their supporters, and visitors to the services.
  5. Medicines are being managed safely and effectively.
  6. Risks to the health of clients are being properly assessed, monitored and managed.

Staffing arrangements

  1. There are enough suitable colleagues to provide people with safe care in a respectful and dignified way.
  2. There are realistic and workable plans for managing any staffing shortfalls and emergencies.

Protection from abuse

  1. People are being protected from abuse, neglect, discrimination, and loss of their human rights.
  2. Safeguarding and other policies and practice, together with local systems, are properly managing any concerns about abuse and protecting people’s human rights.

Assurance processes, monitoring and risk management

  1. Transform is monitoring and protecting the health, safety and well-being of staff.
  2. Transform’s systems and methods for monitoring the overall quality of the services and for responding to business risks and issues as they arise are effective.
  3. Colleagues are supported to raise concerns and give feedback about the services.
  4. Care and treatment to clients is being properly recorded.
  5. Transform is able to work effectively with system partners when care and treatment is being commissioned, shared or transferred.

Overall summary ­– Homecare East Surrey

Covid-19 symptoms and tests – no clients or colleagues currently have Covid-19 symptoms. Where colleagues have been exposed to the virus, they have been tested prior to working with other people.

PPE/Infection Control – PPE was initially an area of concern as supplies were difficult to obtain. Stocks are now in place and a system for ordering them has been implemented. Colleagues have received training in using PPE.

Safety information – Government guidance has been brought together in a useable format. Office spaces are cleaned regularly and risk management plans are in place.

Staffing – [The East Surrey Registered Operations Manager’s] pride in the team was clear. Examples were shared of how colleagues had shown compassion and commitment to ensure people were safe and well-cared for. No calls have been cancelled or times reduced as colleagues have continued to work flexibly to ensure the rota was covered.

Risk assessments have been completed for all colleagues and where additional risks were noted colleagues have been furloughed. Risk assessments also take into account additional risks to BAME staff members. Contingency plans are in place should there be significant shortages.

Care and treatment/safeguarding – the most significant impact on people’s care has been due to the closure of day services for those living with dementia. Staff training has continued including safeguarding. [The East Surrey Registered Operations Manager] stated she believes safeguarding processes remain effective.

Management – [The East Surrey Registered Operations Manager] said she has felt very supported in her role. Although times have been difficult, the support from colleagues and the Nominated Individual has been ‘phenomenal’. Guidance has been available from a variety of sources and systems set up to ensure good communication with colleagues.

Staff well-being has been taken seriously by Transform with a number of avenues available to support them. Partner agencies have been responsive and quality assurance processes remain in place.

Overall summary ­– Homecare Mid Surrey

Current situation/testing – no people or staff currently have symptoms and staff are aware of how to access testing should this be needed. [The Mid Surrey Registered Operations Manager] said the testing process had proved valuable in enabling staff showing symptoms to return to work quickly. Whilst no one directly involved in the service has contracted Covid-19, a family living with a person receiving support tested positive.

PPE/Infection Control – PPE was difficult to obtain early in the crisis which [The Mid Surrey Registered Operations Manager] feels is a learning point going forward. Rolling orders are now in place with sufficient stock to cover in case of a second spike or similar. The option to order through the PPE Portal has been reassuring. Staff have guidance regarding donning, doffing and disposal of PPE and have had the opportunity to practice this with colleagues. Guidance has also been provided on infection control measures within people’s homes.

Care and Treatment/Safeguarding – people are supported by regular staff who are able to identify any risks or safeguarding concerns. [The Mid Surrey Registered Operations Manager] shared examples of where concerns have been responded to and reassurance provided to people in a compassionate way. Examples included requesting additional support for one person who was struggling with not being able to go out and arranging respite for one family due to personal circumstances.

Staff also ensure people have shopping and supplies on a daily basis. Where safeguarding concerns have been identified, these have been reported and investigated. [The Mid Surrey Registered Operations Manager] felt that current safeguarding processes were effective and staff fully understood their responsibilities.

Staffing – despite a third of the team being absent for a variety of reasons, all calls have been met. Some families have chosen to provide care themselves although additional hours have been arranged for both new and existing clients.

[The Mid Surrey Registered Operations Manager] stated the team have been extremely flexible in covering additional hours and had gone above and beyond to ensure that the minimum number of staff were used to support one person at high risk. Contingency plans are in place with people prioritised for care should there be extreme staff shortages. Risk assessments have been completed for staff, and training continues to be completed.

Management – [The Mid Surrey Registered Operations Manager] was highly complimentary regarding her staff team and how they have responded during the crisis. She stated she was immensely proud of the team work and focus on supporting people to remain happy and well.

Support was also available from the organisation for all staff including regular calls and a counselling service. Support for registered managers was implemented quickly with weekly video calls to share information, discuss staffing and different approaches to solving concerns. [The Mid Surrey Registered Operations Manager] described the Nominated Individual as being particularly supportive in ensuring staff have all the guidance and equipment they required. No changes have been made to recording systems and quality assurance checks remain in place.

Overall summary – North West Surrey

From our discussion and other information about this location, we assess that you are managing the impact of the COVID-19 pandemic.

Current situation/testing – no people or staff have displayed any symptoms throughout the pandemic. [The North West Surrey Registered Operations Manager] is aware of how to access testing should anyone need this.

PPE/Infection Control – there are continued issues with the service being able to access the PPE portal. This has been reported and escalated to the DHSC. The reasons for this were discussed and along with queries regarding if the portal will cease in the near future. Gail to request updates on both these areas and recommended ordering additional supplies through the portal from the other registered Transform services in the meantime.

Staff are used to wearing PPE and have not expressed concerns. Information has been shared with staff and people regarding infection control. Signage is displayed within Mitchison Court and PPE provided for visitors.

Staffing – [The North West Surrey Registered Operations Manager] described how hard her team had worked to ensure people were kept safe. She reflected on how proud she was of their willingness to go above and beyond for people, their flexibility and positive approach.

Staff are working with smaller groups of people wherever possible to minimise risks. A contingency plan has been developed alongside the Covid risk assessment to ensure priority calls can be covered in the event of extreme staff shortages. Staff training stats have increased despite the added pressures on the service. This includes online learning regarding the donning and doffing of PPE. Risk assessments have considered specific health needs in addition to the increased risks to BAME colleagues.

Care and treatment/safeguarding – appropriate action was taken following a recent safeguarding concern being identified. Staff are aware of reporting processes and the need to be observant of the increase in scams targeted at those people who are isolating. Staff know people well and promptly report any concerns or changes in people’s needs. Where day services have not been available additional hours have been arranged for people to minimise the risks of isolation and ensure their nutritional needs are supported.

Management – discussed this had been an extremely challenging time for [The North West Surrey Registered Operations Manager] who has taken over the service at Mitchison Court at the height of the pandemic. [The North West Surrey Registered Operations Manager]’s approach was very positive whilst acknowledging the great commitment and effort this had taken from the whole staff team. [The North West Surrey Registered Operations Manager] felt she had received the support she required from her manager and also from the Nominated Individual [Transform’s Compliance Support Officer] in ensuring information was clearly presented and accessible.

Support for staff continued to be available with regular catch-ups, supervisions and access to a counselling service. Records continue to be reviewed and completed by staff as required and QA systems remain in place. This includes regular calls to people and their families to ensure they are happy with the service they receive.

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