Date of assessment: 26 November to 03 December 2025. The assessment was carried out to check whether the breaches of regulation issued at our last inspection had been met. The provider was previously in breach of the legal regulation in relation to safe care and treatment, fit and proper person employed and good governance. Improvements were found at this assessment, and the provider was no longer in breach of regulations. We looked at 9 quality statements in the key questions of safe and well led. Lessons were now being learned and had been embedded to promote good practice. Incidents forms were now comprehensively filled out and followed up with staff. The provider now worked with people to understand and manage risks. Staff knew how to manage people’s risks and care plans, and risk assessments now included appropriate detailed information. Medicines were now managed effectively and fire risks associated with paraffin-based emollient creams were included in risk assessments. Variable dose medicines now contained the required information to support staff in administering PRN “when required” doses safely. Leaders had attended training to strengthen their knowledge, and there was ongoing training scheduled. Governance concerns had been addressed, and audits were now effective in identifying where improvement could be made. The business continuity plan had been updated and contained relevant information for emergency situations. Daily notes were now being comprehensively completed by staff, with daily oversight to ensure accuracy and consistency.
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Date of assessment 20 January 2025 to 11 February 2025. The assessment was carried out to check whether the breaches of regulation issued at our last assessment had been met. We looked at 15 quality statements in safe and well led. We found lessons had still not always been learnt to continually identify and embed good practice. The provider still did not always have clear responsibilities, roles, systems of accountability and good governance. They still did not act on the best information about risk, performance and outcomes. This was in relation to care plans, risk assessments, daily notes, incident reporting, medicines, recruitment practices and audits. However, the provider ensured continuity of care when people moved between services. Staff had the required training, qualifications and worked well to provide safe care that met people’s individual needs. There had now been an improvement on how the risk of infection was assessed and managed. Staff were able to speak up and have their voices heard and there was an inclusive and fair culture for staff. The provider was previously in breach of the legal regulation relating to safeguarding service users from abuse and improper treatment and notification of other incidents. Improvements were now found at this inspection and the provider was no longer in breach in these areas. The provider was also previously in breach of 3 legal regulations in relation to safe and care treatment, fit and proper persons employed and good governance. Sufficient improvements were not found at this assessment, and the provider remained in breach of these regulations. In instances where CQC have decided to take civil or criminal enforcement action against a provider, we will publish this information on our website after any representations and/ or appeals have been concluded. We have also asked the provider for an action plan in response to the concerns relating to safe and care treatment and fit and proper persons employed.
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Care 24/7 Solutions Limited received an overall rating of Requires Improvement following a focused inspection of Safe (rated Inadequate) and Well-Led, with Warning Notices served for breaches of Regulations 12, 13, and 17 covering unsafe medicines management, failure to safeguard people from abuse, and ineffective governance. The service has been rated Requires Improvement for two consecutive inspections and remains in continued breach of multiple regulations despite a prior action plan.
Concerns (14)
criticalSafeguarding: “The service had failed to operate effective systems to identify, investigate and appropriately respond to allegations of abuse. This was a breach of Regulation 13(1).”
criticalMedication management: “MARs did not always represent an accurate record of all prescribed medicines and topical creams administered...1 person's MAR had been used for training/demo purposes.”
criticalCare planning: “Risk assessments were either not present, had not been updated in a timely manner, or lacked sufficient detail to help staff understand and respond to risks.”
criticalInfection control: “The service had not established or effectively implemented robust infection prevention and control procedures to effectively mitigate risk to people.”
criticalGovernance: “Audits had not been fully effective in driving improvement...care plan audits contained repeated actions without evidence of resolution.”
moderateRecord keeping: “Some records were incomplete, outdated, or inaccurate...some information was inaccessible because the service was unable to access emails of a former staff member.”
moderateStaff training: “Staff had completed significant amounts of hours of training of many different subjects in 1 day...1 staff on 9 March 2023 had spent 15 and a half hours training.”
moderateStaff competency: “The medication competency assessment workbook answers we reviewed were populated with internet responses. We were not assured this was an adequate process to assess staff competency.”
moderateIncident learning: “Systems were not operated to analyse accidents/incidents, complaints and safeguarding concerns to identify trends or themes.”
moderateLeadership: “At the time of our inspection there was not a registered manager in post. The nominated individual had submitted an application to be appointed as the registered manager.”
moderateCommunication with families: “Professionals told us they did not always receive a timely response to emails, and a professional noted instances where the service had failed to arrive at planned joint visits.”
moderateStaffing levels: “The rotas we reviewed did not give staff sufficient travel time. One staff had back-to-back visits where no travel time had been allocated, however visit locations were 30 minutes away.”
minorSupervision / appraisal: “The supervision matrix did not always match up with the supervision forms in staff files.”
minorPerson-centred care: “A safeguarding document stated a person 'uses all kinds of tricks' to decline care...records described them as 'little bit tricky' and said they would 'finally play victims of poor care'.”
Strengths
· Most people and relatives felt care was safe and staff were kind, caring and compassionate.
· Provider was responsive to inspection feedback; management completed level 4 safeguarding training after the visit.
· A new electronic care records system was introduced, improving governance and family communication via an app.
· Daily medicines audit checks were being completed regularly and identifying some issues.
· Team meetings were used to promote open culture, good practice and staff communication.
Quality-Statement breakdown (10)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candour; Working in partnership with others
First inspection of a small Swindon-based domiciliary care agency rated Requires Improvement overall, with breaches of Regulation 17 due to absent formal audits, governance and recruitment compliance failings. Care delivery was found to be effective, caring and responsive, with positive feedback about kind staff and a supportive nominated individual.
Concerns (13)
criticalGovernance: “The failure to have effective systems in place to assess, monitor and improve the quality and safety of the service was a breach of regulation 17 (Good Governance)”
criticalGovernance: “No formal audits of care provision, medicines, staff records, or care plans had been carried out.”
moderateMedication management: “Staff completed training to administer medicines but had not had their competence assessed before working unsupervised.”
moderateMedication management: “No documented checks had been carried out to show medicines had been administered as prescribed.”
moderateRecord keeping: “No stock checks of medicines were carried out.”
moderateStaff competency: “The provider's recruitment policy was not being followed.”
moderateRecord keeping: “There were no records of interviews despite the providers policy stating, 'The assessments made by interviewers must be formally recorded on an interview assessment form.'”
moderateStaff training: “There were no documents in place to show that staff had received an induction into the service.”
moderateSupervision / appraisal: “Staff had not had formal supervision sessions. The nominated individual said they had spent one to one time with staff offering support, but this had not been documented.”
moderateCommunication with families: “No formal feedback through reviews was sought from people using the service or their relatives. Informal telephone conversations took place, but these were not documented.”
moderateLeadership: “Staff surveys had been carried out. However, these had not been analysed or used to improve the service.”
minorConsent / capacity: “Although people had signed the initial assessment document, there was no formal consent to care recorded.”
minorInfection control: “The staff don't tend to wear face masks. On arrival they do, but they take them off.”
Strengths
· Staff knew how to keep people safe and protect them from avoidable harm
· Enough staff available to meet people's needs
· Staff received training in safeguarding and infection prevention and control
· Care plans were person-centred and provided detailed guidance
· Relatives gave positive feedback describing staff as kind and caring
Quality-Statement breakdown (24)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
Requires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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: 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 and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
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, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires 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