First inspection of this small domiciliary care service supporting one person with a learning disability or autism rated Requires Improvement overall, with Safe, Effective and Caring rated Good but Responsive and Well-led rated Requires Improvement. Concerns related to inconsistent care planning, lack of person-centred goal monitoring, gaps in mandatory and specialist training, missing supervision records, and absent quality assurance and audit systems.
Concerns (12)
moderateStaff training: “the provider had not ensured all staff had completed mandatory training in line with their own policy or checked staff's competency”
moderateStaff training: “Not all staff had been provided with specialist training relating to working with people with a learning disability or autism, or communication skills.”
moderateSupervision / appraisal: “Staff had not received supervision as outlined in the provider's policy”
moderateCare planning: “Staff did not have one clear support plan to follow, the staff followed various care plans written by different specialist professionals which had not been reviewed regularly and sometimes provided contradictions.”
moderatePerson-centred care: “they did not include person-centred planning tools and approaches to support people to reach their outcomes. Staff were not always aware of people's goals”
moderateGovernance: “there was no audit systems in place. The registered manager told us they reviewed daily records for quality assurance but had no records of this.”
moderateMissed or late visits: “The provider had a record of missed and late care calls but had not considered reviewing this to look for themes and trends to improve the service”
moderateRecord keeping: “documentation relating to recruitment was not always robust”
moderateIncident learning: “Recorded incidents were not always appropriately investigated for learning opportunities to improve the service.”
moderateStaff competency: “When staff had been recruited from previous health and social care backgrounds, we could not be assured suitable checks had taken place to ensure they had the suitable skills.”
moderateCare planning: “Care plans required updating to ensure they reflected staff practice; staff were not trained to use any restraints on people but one care plan referred to 'holds.'”
minorEnd-of-life care: “Care plans outlining people's preferences for end of life care were not in place... Staff had not received any training in end of life care”
Strengths
· Staff supported people to have maximum possible choice, control and independence
· People received kind and compassionate care; staff respected privacy and dignity
· Staff demonstrated good knowledge of safeguarding and how to report abuse
· Effective infection prevention and control measures, including COVID-19 care plans
· MCA was applied correctly with assessments and best interest decisions recorded
Quality-Statement breakdown (21)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
safe: Using medicines safelyGood
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 and access healthcare; working with other agenciesGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires 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; working in partnership with othersRequires improvement
well-led: Continuous learning and improving careRequires improvement