safe:Insufficient evidence to rateeffective:Insufficient evidence to ratecaring:Insufficient evidence to rateresponsive:Insufficient evidence to ratewell-led:Insufficient evidence to rate
First inspection of a newly registered domiciliary care service supporting only one person, leaving insufficient evidence to rate any key question. Improvements were identified and started immediately around recruitment reference checks and mandatory induction/medicines training.
Concerns (5)
moderate
Staffing levels
: “The service did not have enough staff at the time of the inspection to take on new people.”
moderateStaff training: “Staff did not complete the Care Certificate... The service's induction did not include mandatory training.”
moderateStaff training: “Staff had not yet had medicines administration training from this provider but had received it via their other employer.”
moderateOther: “Although the provider had sought references from previous employment this was not always the manager or the employer so the referee may not have been authorised”
minorMedication management: “We did not have enough information to make a judgement about whether medicines were managed safely.”
Strengths
· Relatives described the service as 'very professional' and were happy with the standard of care.
· Registered manager carried out comprehensive holistic assessments of people's needs.
· Risk assessments were comprehensive with guidance for staff to minimise risks.
· Person-centred and culturally aware approach, including making communication cards in the person's first language.
· Registered manager available on-call 24 hours a day; well-organised policies, procedures and records.
Quality-Statement breakdown (24)
safe: Staffing and recruitmentInsufficient evidence to rate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuseInsufficient evidence to rate
safe: Using medicines safelyInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawInsufficient evidence to rate
effective: Supporting people to live healthier lives, access healthcare services and supportInsufficient evidence to rate
effective: Staff support: induction, training, skills and experienceInsufficient evidence to rate
effective: Supporting people to eat and drink enough to maintain a balanced dietInsufficient evidence to rate
effective: Staff working with other agencies to provide consistent, effective, timely careInsufficient evidence to rate
effective: Ensuring consent to care and treatment in line with law and guidanceInsufficient evidence to rate
caring: Ensuring people are well treated and supported; respecting equality and diversityInsufficient evidence to rate
caring: Supporting people to express their views and be involved in making decisions about their careInsufficient evidence to rate
caring: Respecting and promoting people's privacy, dignity and independenceInsufficient evidence to rate
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesInsufficient evidence to rate
responsive: Meeting people's communication needsInsufficient evidence to rate
responsive: Supporting people to develop and maintain relationships to avoid social isolationInsufficient evidence to rate
responsive: Improving care quality in response to complaints or concernsInsufficient evidence to rate
responsive: End of life care and supportInsufficient evidence to rate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInsufficient evidence to rate
well-led: Engaging and involving people using the service, the public and staffInsufficient evidence to rate
well-led: Continuous learning and improving care; Working in partnership with othersInsufficient evidence to rate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInsufficient evidence to rate
well-led: How the provider understands and acts on the duty of candourInsufficient evidence to rate