A50 Ltd improved from Requires Improvement to Good overall at this March 2023 inspection, having addressed previous breaches of regulations 12, 17 and 18 relating to medicines management, governance and staff support. Residual concerns remain around staff understanding of the Mental Capacity Act, incomplete risk assessments and outstanding mandatory learning disability and autism training, all flagged for follow-up at the next inspection.
Concerns (4)
moderate
Consent / capacity
— “not all staff knew what the MCA was in relation to but provided us with examples of how they sought people's consent and supported them in the decision-making process.”
moderateCare planning — “some risks identified had not been fully assessed to guide staff on how it can affect people. Fire risk assessments did not always include information regarding the support people required.”
minorMedication management — “there wasn't a protocol in place to indicate the dose and what the 'as required' medicines should be given for, to the person.”
minorStaff training — “the registered manager told us they were in the process of arranging the recently introduced mandatory training for staff working with people with a learning disability and people with autism.”
Strengths
· Medicine administration records were fully completed, accurate and regularly audited, with prompt action taken on errors.
· Safe recruitment procedures followed including employment history, DBS checks, references and visa expiry monitoring.
· Strong continuity of care with punctual, consistent staff attendance monitored via electronic call monitoring.
· Close partnership working with healthcare professionals including weekly calls with hospital staff and specialist training up to 3 months.
· Hugely improved governance and leadership since the last inspection; provider no longer in breach of regulations 12, 17 or 18.
Quality-Statement breakdown (20)
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support; induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to live healthier lives and working with other agenciesGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA)Good
caring: Ensuring people are well treated and supported; equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control; meeting communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles; understanding quality, performance, risks and regulatory requirementsGood
well-led: Continuous learning and improving care; Duty of CandourGood
well-led: Engaging and involving people, the public and staff; working in partnership with othersGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
First inspection of A50 Ltd identified breaches of Regulation 12 (safe care) and Regulation 17 (good governance), with medication recording, risk assessments, recruitment checks, supervision and audit systems all found lacking. Despite caring staff and positive relative feedback, the absence of effective oversight by the registered manager resulted in an Inadequate rating for well-led and an overall rating of Requires Improvement.
Concerns (14)
criticalMedication management — “MAR for one person showed they were being administered PRN pain relief. However, this was not detailed on the list of prescribed medicines on the person's MAR.”
criticalMedication management — “no clear indication of what medicine, dose, route and frequency the medicines should be administered and in what circumstance. This placed people at risk of potential overdose.”
criticalGovernance — “registered manager who told us they had not undertaken any audits of the service. We were not assured that quality assurance systems were effective”
criticalLeadership — “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalRecord keeping — “Records were not easily accessible nor always in place for us to review. For example, there were no supervisions records, staff induction records”
moderateStaff training — “registered manager told us they could not access any records in relation to staff training as the subcontracted external agency that held records were unable to provide”
moderateSupervision / appraisal — “no records of staff supervision or induction. The registered manager told us staff did not have formal supervisions.”
moderateCare planning — “one persons' risk assessment did not contain clear guidance for staff to support them to mobilise safely.”
moderateCare planning — “care plans and found these did not contain any preadmission assessments”
moderatePerson-centred care — “care records clearly identified people's clinical needs, however made no mention of people's preferences in relation to the care and support they received and lacked personalisation.”
moderateCommunication with families — “People's communication needs and guidance for staff were not always robustly recorded in their care plans.”
moderateIncident learning — “People did not always receive care from a service that learned lessons when things went wrong... provider had identified some of the issues found during this inspection however failed to act in a timely manner.”
moderateOther — “registered manager failed to ensure robust pre-employment checks were undertaken prior to staff working at the service.”
moderateMissed or late visits — “we were not assured the registered manager monitored staff arrival and departure times. This meant we were not confident people received care and support on time”
Strengths
· Staff treated people with compassion, kindness and respect with strong rapport built with people using the service
· People's privacy and dignity were maintained and independence was encouraged where possible
· Effective COVID-19 infection prevention protocols were in place with PPE access and lateral flow testing
· Staff had clear understanding of safeguarding and how to identify, report and escalate suspected abuse
· Relatives praised staff punctuality and reliability in attending visits
Quality-Statement breakdown (20)
safe: Using medicines safely and Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced diet
Requires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving care and Working in partnership with othersInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: How the provider understands and acts on the duty of candourGood