Flames Healthcare Ltd remains rated Requires Improvement following a focused inspection, with continued breaches of Regulations 17 and 19 relating to unsafe recruitment practices and ineffective governance and quality monitoring systems. The service demonstrates strengths in infection control, staff training, safeguarding and person-centred relationships, but leadership oversight remains insufficient to ensure consistent safe care.
Concerns (6)
criticalStaffing levels: “Staff did not consistently have Disclosure and Barring Service (DBS) checks completed before they started to work at the service.”
critical
Governance
: “Audits completed did not always analyse the information fully. For example, call times were audited but did not detail how many missed or late calls had occurred or if there were any trends.”
criticalStaff competency: “Not all staff had references sought prior to staff commencing their employment. The provider was therefore not assured of staff conduct in their previous employment.”
moderateRecord keeping: “Systems and processes had not identified when there was missing information in care plans, risk assessments or tasks requiring staff support.”
moderateCare planning: “Not all care files contained the tasks staff were required to support a person with for each call.”
moderateLeadership: “The provider had not completed any actions plans to identify when improvements were needed or who was responsible.”
Strengths
· Staff wore appropriate PPE effectively and all staff completed infection prevention and control training.
· All staff completed the Care Certificate and received induction including shadow shifts before lone working.
· People felt safe with staff and staff understood individual risks and knew people well.
· Staff identified when people were unwell and supported timely access to healthcare professionals.
· Staff felt supported by the registered manager and had regular supervisions and team meetings.
Quality-Statement breakdown (14)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safely; Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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 eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; Supporting people to live healthier lives and access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Managers and staff being clear about their roles; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
Flames Healthcare Ltd received a Requires Improvement rating across all five key questions at its first inspection in April 2022, with Warning Notices issued for breaches of Regulations 17, 18, and 19 relating to governance, staffing, and safe recruitment. While people reported positive experiences of kind and caring staff, significant systemic failures were identified in recruitment checks, staff training, medicines management, infection control, care planning accuracy, and governance oversight.
Concerns (9)
criticalStaffing levels: “Staff files did not contain evidence of Disclosure and Barring Service (DBS) checks being completed before staff started to work at the service.”
criticalStaff training: “Not all staff were trained in specific care tasks which people they supported had an assessed need for. For example, catheter care, medication administration and moving and handling.”
criticalGovernance: “Audits which were in place were ineffective at identifying shortfalls and were not meaningful.”
moderateMedication management: “When people had 'as required' (PRN) medicines prescribed, records were not always completed to evidence the reason the medicine was administered.”
moderateInfection control: “Staff were not following government guidance on testing for COVID-19...Staff were only testing if they were symptomatic.”
moderateCare planning: “Some care plans had not been updated to reflect people's current needs...the person was no longer mobile and was cared for in bed.”
moderateRecord keeping: “Records about people using the service were not consistent. There were multiple discrepancies between written care plans and what was happening in practice.”
moderatePerson-centred care: “Some care plans lacked information to guide staff on how to complete care related tasks...one care plan stated 'needs help with personal care tasks'.”
minorConsent / capacity: “When a person lacked the capacity to make a decision, a best interest meeting was not held.”
Strengths
· People and relatives consistently reported staff were kind, caring, punctual and respectful of privacy and dignity.
· Staff wore appropriate PPE when delivering care, confirmed by people and relatives.
· Staff worked effectively with other health professionals such as occupational therapists and physiotherapists.
· Provider understood duty of candour responsibilities and remained open and transparent throughout inspection.
· People's care plans included details of religion, culture and gender preferences for personal care.
Quality-Statement breakdown (21)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards
Requires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportGood
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Duty of candourGood
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Continuous learning and improving care; Working in partnership with othersGood