Date of Assessment: 19 February to 27 February 2025. The service is a care at home service. The provider was previously in breach of the legal regulations in relation to safe care and treatment and good governance. Improvements were found at this inspection and the provider was no longer in breach of these regulations. Staff understood their safeguarding responsibilities and were confident if they raised any concerns they would be dealt with promptly. Systems were in place to ensure any accidents or incidents were recorded and appropriate action was taken. Risks to individuals and staff were identified and well managed. All required checks had been undertaken prior to people commencing employment at the service. Staff received the induction, training and support they needed to carry out their roles effectively. There were sufficient staff deployed to meet people’s needs. Medicines were managed and administered safely. People’s needs were assessed and person-centred support plans and risk assessments were in place to guide staff. People’s health conditions were well documented and their capacity to consent was identified, documented and respected. Managers and staff knew people well, and respected and treated people as individuals. Staff placed great importance on ensuring people’s independence was promoted and maintained. Staff told us they felt valued and listened to. A staff member said, “If I have a problem they [managers] are always there.” Staff involved people in decisions about their care. There was an appropriate system in place to manage any complaints or concerns. The provider and registered manager worked closely together. They had a shared commitment to providing responsive person-centred care and support. There was a range of quality monitoring, auditing and oversight in place. Staff spoke very positively about the registered manager and provider and told us they were approachable and easy to contact.
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Buttercup Home Care T/A Visiting Angels was rated Requires Improvement overall at its first inspection, with breaches of Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) due to inadequate risk assessment, unsafe medicines management, unrecorded incidents and ineffective audits. Caring and Responsive were rated Good, with positive feedback about staff kindness, dignity, flexibility and the registered manager's approachable, person-centred ethos.
Concerns (10)
criticalCare planning: “Risk assessments were not in place for people at higher risk to falls and for people with medical conditions which increased their risk of harm.”
criticalMedication management: “The management of medicines was not always safe. The responsibilities of the care team and relatives when managing medicines had not been clearly defined”
criticalIncident learning: “Accidents and incidents had not been appropriately recorded and investigated. Incident forms were available but not in use at the time of the inspection.”
criticalGovernance: “Effective quality assurance processes were not in place and systems had not been developed for all relevant areas of the service.”
moderateMedication management: “Protocols for 'when required' (PRN) medicines, were not in place and body maps were not used to plot the location of patch medication.”
moderateRecord keeping: “People's care records were not reviewed regularly and risk assessments were not updated where increased risk was indicated.”
moderateConsent / capacity: “Mental capacity assessments had been developed for all people receiving care however the outcome or need for these assessments was not always clear.”
moderateOther: “Fire safety of the office location had not been monitored. Fire evacuation drills were not taking place.”
moderateCommunication with families: “Some people may have benefitted from external input but this was not requested or recorded. For example, district nurse input in relation to diabetes management”
moderateLeadership: “A registered manager was in post at the time of the inspection however the support they had received from the franchise was minimal.”
Strengths
· Positive feedback from people and relatives, with staff described as caring, respectful and flexible
· Staff treated people with dignity, privacy and respect, promoting independence
· Safe recruitment practices were followed and staffing levels were sufficient to meet needs
· Staff were appropriately trained with a training matrix and competency checks overseen by the registered manager
· Strong communication systems with families, building positive relationships
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and management, learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
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, guidance and the lawRequires improvement
effective: Supporting people to live healthier lives, access healthcare services and supportRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff support: induction, training, skills and experienceGood
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: 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 supportNot rated
responsive: Meeting people's communication needsGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
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