Date of assessment 1 to 16 April 2025. The service is a domiciliary care agency providing personal care to people in their own homes. At the time of inspection there were 100 adults and 2 children using the service. The provider had systems and processes in place to assess, monitor and improve the safety and quality of the service. People received their planned care at the times agreed, from a regular staff team. People’s risks were assessed and care plans provided staff with the information they needed to mitigate known risks. People’s care plans were revied regularly or as their needs changed. There were enough trained staff deployed to meet people’s needs. The provider regularly checked staff practice and competencies and ensured staff were supported through regular supervision. Staff were recruited using safe recruitment practices. Staff knew how to seek medical assistance in emergencies and kept people’s families informed. Staff followed infection prevention and control practices. Staff understood how to recognise, and report concerns and the provider had systems in place to report safeguarding issues and carry out any relevant investigations. Staff were encouraged to speak up if they had any concerns about how the service was run. The provider used any incidents and complaints to learn from and improve the service. People were treated with kindness and compassion. Staff sought people’s consent before providing care and encouraged people to maintain their independence. The provider was previously in breach of the legal regulations in relation to assessing, monitoring and mitigating risks and governance, at this inspection the provider had made significant improvements and was no longer in breach of these regulations.
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Empathy Care24 Northampton, a domiciliary care agency serving 68 people, was rated Requires Improvement overall following a focused inspection in March–April 2023, with Well-led downgraded to Inadequate due to continued breaches of Regulations 12 and 17. Critical failures in risk assessment, medicines management, care planning, governance and incident learning persisted from the previous inspection, resulting in enforcement conditions being imposed on the provider's registration.
Concerns (10)
criticalCare planning: “Risk assessments and associated care plans did not consistently include current and correct information and guidance for staff on risk mitigation.”
criticalMedication management: “Medicines were not always managed safely. For one person who received their medication via a PEG, the medicine protocol for 'as needed' (PRN) medicines did not state that the medicine was to be given via the PEG.”
criticalGovernance: “Systems and processes were either not in place or not effective in ensuring the safety and quality of the service. The registered manager had not maintained oversight in this area.”
criticalIncident learning: “3 incident and accident report forms had been completed by staff following acts of aggression or physical violence. This had not prompted the provider or registered manager to update the risk assessments.”
criticalLeadership: “The provider had not implemented an action plan to address the shortfalls identified at the last inspection to ensure they would be compliant in meeting the regulatory requirements.”
moderateStaff competency: “The training and competency checks were not of a standard to ensure staff had the knowledge and skills to carry out their roles effectively.”
moderateMissed or late visits: “They don't phone to say they are going to be late; the visits seem rushed; they fly in and out.”
moderateRecord keeping: “Care records contained high levels of generic information or outdated guidance which in some cases posed a risk to people, including choking and pressure sore deterioration risks.”
moderatePerson-centred care: “Some people's preference around visit times and preferred staff was not always met. One person told us 'I'm not really happy with the management as there is no continuity of carers.'”
moderateSupervision / appraisal: “Senior members of staff who were responsible for auditing and updating people's care records needed further support and training in this role.”
Strengths
· Staff were recruited safely with reference checks and DBS checks completed in line with regulatory requirements.
· Staff understood safeguarding principles, knew signs of abuse and how and where to report concerns.
· People were protected from infection risk; staff used PPE appropriately and understood effective hand washing.
· Enough improvement had been made on MCA compliance; provider was no longer in breach of regulation 11.
· Staff supported people with eating and drinking, respecting choices and ensuring fluids were left at end of visits.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentRequires 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: 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
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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; Working in partnership with othersInadequate
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 staffRequires improvement
Empathy Care24 Northampton received an overall rating of Requires Improvement following a focused inspection in October–November 2022, remaining in breach of Regulations 11, 12 and 17 with warning notices issued for unsafe care and treatment and poor governance. Key failures included inadequate risk assessments, unsafe medicines management, incomplete mental capacity assessments, and ineffective governance systems that had failed to identify or address recurring shortfalls.
Concerns (9)
criticalCare planning: “People's care plans and risk assessments did not always reflect people's current needs or provide information to staff to manage and mitigate risks to provide safe care.”
criticalMedication management: “There was no guidance or protocol in place for staff to follow on administering transdermal patch medicine as per best practice.”
criticalConsent / capacity: “Mental capacity assessments were not always completed for decisions relating to people's care or treatment.”
criticalGovernance: “Systems were either not in place or robust enough to demonstrate the safety and quality of the service was effectively managed. This placed people at risk of harm.”
moderateIncident learning: “Trends and patterns were not always identified to improve safety across the service. There had been a number of incidents involving people's catheter care.”
moderateMissed or late visits: “Records showed that staff did not always stay for the duration of people's care calls. There was no audit in place to review staff compliance with care call duration.”
moderateInfection control: “We could not be assured that all staff followed current COVID-19 Government guidance. We observed staff supporting a person in their home without wearing a face mask.”
moderateRecord keeping: “Missing information in people's care and support plans. This included information on mental capacity and pressure care support.”
minorCommunication with families: “One person told us, 'I did phone up and [staff] snapped my head off so I hung up. I avoid ringing them.'”
Strengths
· Staff were recruited safely with pre-employment checks including references and DBS checks.
· Staff had received training in safeguarding, moving and handling, first aid, food hygiene, MCA and infection prevention and control.
· People and relatives reported feeling safe, with continuity of carers.
· The provider worked in partnership with other healthcare professionals including GPs, district nurses and occupational therapists.
· People were provided with enough to eat and drink, and staff kept records of nutritional support.
Quality-Statement breakdown (13)
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
Empathy Care24 Northampton was rated Requires Improvement overall, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to missed/late calls, medication timing risks, and weak managerial oversight. Staff were described as kind and care planning was thorough, but scheduling, supervision, specialist training, audits and statutory notifications all required improvement.
Concerns (16)
criticalMissed or late visits: “They [staff] are supposed to arrive at 10am but sometimes don't come till 11:30am”
criticalMissed or late visits: “Where one person had a missed call for the planned time of 08:25am they were found later that day to have fallen on the floor and had been on the floor for a number of hours.”
criticalMedication management: “Records showed the time they received their care meant these medicines were given significantly earlier than the prescribed recommendation. This meant there was a risk of harm”
criticalGovernance: “audits were not in place to maintain oversight of accidents and incidents, staff timekeeping, staff supervision or spot checks.”
criticalLeadership: “The registered manager had not fully understood the regulatory requirements. For example, there had been three significant events which the Care Quality Commission (CQC) had not been notified of.”
moderateStaffing levels: “Staff travel time between calls was very limited and set at five minutes for all calls. This did not account for busier times of the day for traffic”
moderateSupervision / appraisal: “Records showed inconsistency in the frequency of staff supervision.”
moderateStaff training: “Specialist training for people's individualised needs such as, people with Parkinson's, catheter/convene care needs or percutaneous endoscopic gastrostomy (PEG) feeds was inconsistent.”
moderateStaff competency: “We identified one person who's needs could not fully be met due to staff not having the right skills and experience and family had continued to support where required.”
moderateCare planning: “Some of the carers don't read the care plan so they do not know the routine and what is involved.”
moderateInfection control: “We found a small number of staff had not attended testing but had continued to work. This meant people had been exposed to increased risk of infection.”
moderateRecord keeping: “Staff files were found to be missing full work history as per the regulatory requirement.”
moderateConsent / capacity: “Some family members had signed on behalf of their relative on some records... We recommend that where people have the capacity to consent, their consent and agreement is clearly recorded.”
moderateIncident learning: “The records had not always been reviewed for any remedial actions required or lessons learned.”
minorComplaints handling: “a brief overview of each complaint was not included to monitor for trends and patterns and support improving the quality of the service.”
minorCommunication with families: “Communication with the office is not always good and they don't always reply to their emails and I find it annoying that some of the office staff don't understand me.”
Strengths
· Staff trained in safeguarding and understood how to report concerns; people reported feeling safe
· Adequate PPE stock and staff trained in infection control
· Thorough initial assessment and person-centred care plans developed with people and families
· People and relatives described staff as kind, caring and respectful of dignity and independence
· Communication needs assessed; information available in alternative formats (large print, easy read)
Quality-Statement breakdown (21)
safe: Staffing and recruitment; Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires 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
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff working with other agencies; supporting access to healthcare services
effective: Staff working with other agencies to provide consistent, effective, timely care; Supporting people to live healthier lives
Requires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with othersGood
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Assessing people's needs and choices; delivering care in line with standardsGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
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 concernsRequires improvement
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
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 othersRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood