K2 Care Limited, a Peterborough domiciliary care agency, was rated Requires Improvement overall at its May/June 2019 inspection, down from Good in 2016, due to shortfalls in medicines record-keeping, inadequate incident investigations, and insufficiently robust governance audits. Care delivery, staffing, safeguarding, and person-centred practice were all rated Good, with people and families consistently positive about staff compassion and responsiveness.
Concerns (7)
moderateMedication management: “the dose to be given a person as guidance for staff, had not been recorded on the MAR.”
moderateMedication management: “no guidance was in place for staff to follow regarding these triggers, the maximum dose they could administer in 24hour period”
moderateIncident learning: “Concerns raised by an external care professional regarding staff practice had not been thoroughly investigated.”
moderateIncident learning: “staff did not receive this training until two months later.”
moderateGovernance: “these were not sufficiently robust and had not identified the shortfalls we found during this inspection in relation to medicine records and investigations.”
moderateGovernance: “the registered manager had not sent us all the required notifications...information about important events that the provider or registered manager is required by law to notify us about.”
moderateRecord keeping: “staff sometimes helped them with to take their medicines from the container. This was not reflected in their care plan and put the person at risk of receiving the wrong medicine.”
Strengths
· People felt safe with staff and were protected from avoidable harm by a trained staff team who understood how to recognise and report concerns.
· Staff knew people well and delivered continuity of care, often matching carers by culture, language and gender.
· Staff were compassionate, went 'the extra mile', and were described by people and relatives as patient, caring and respectful.
· Care plans were detailed and personalised, with external professionals praising the clarity of guidance provided to care workers.
· Sufficient staffing levels were maintained with travel time built into rotas; people reported staff arrived on time.
Quality-Statement breakdown (22)
safe: Using medicines safelyRequires improvement
safe: Learning lessons when things go wrongRequires improvement
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
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
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff work with other agencies to provide consistent, effective careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; 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: 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, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staffGood
K2 Care Limited received an overall rating of Requires Improvement following a January 2016 inspection, with three regulatory breaches identified relating to unsafe risk assessment, unlawful restraint of a child without MCA authorisation, and incomplete care plans. The service was rated Good for caring, with staff demonstrating kindness and respect, but failed to ensure accurate care records, appropriate safeguarding referrals, or staff competency in Mental Capacity Act principles.
Concerns (8)
criticalCare planning: “staff were providing food and medicines via special methods through the stomach, and this was not recorded as part of the care plan”
criticalSafeguarding: “People were controlled and restrained without the required authorisation under the Mental Capacity Act 2005 Deprivation of Liberty Safeguards”
criticalConsent / capacity: “People's capacity under the Mental Capacity Act 2005 had not been assessed to ensure decisions that were taken were in their best interest”
criticalIncident learning: “we found two issues that had not been appropriately reported to the safeguarding team. We raised these as safeguarding issues with the local authority.”
moderateMedication management: “Some medicines recorded within peoples care plans were spelt incorrectly. The same medicine was spelt differently several times within one person's care plan.”
moderateRecord keeping: “Where people's needs changed staff were able to tell us about the changes. However the changes had not been updated and recorded in the care plan”
moderateGovernance: “no additional quality audits in relation to areas such as care plans and risk assessments had been completed”
moderateStaff training: “Staff were not trained in the principles of the Mental Capacity Act 2005 (MCA) although some could describe how people were supported to make decisions.”
Strengths
· People's privacy and dignity was respected by staff and staff treated them with kindness
· There was a sufficient number of staff to meet the needs of people receiving a service
· Staff meetings and individual staff supervision were completed regularly
· Over a seven day period in November 2015, 595 visits were made with no missed calls
· People and their relatives said they felt confident using the complaints procedure
Quality-Statement breakdown (18)
safe: Risk assessment and managementRequires improvement
K2 Care Limited achieved a Good rating across all five key questions at this announced inspection, having successfully remediated all breaches identified at the previous January 2016 inspection relating to care plans, risk assessments, and restraint recording. The service demonstrated safe staffing, effective medication management, person-centred care, and robust quality assurance systems, with no missed calls and positive feedback from people using the service.
Concerns (1)
minorRecord keeping: “although risk assessments had been completed there was not always formally recorded information for staff as guidance on what they should do in the event of the risk occurring”
Strengths
· Previous breaches of legal requirements relating to care plans, risk assessments, and restraint recording were fully remediated by the time of this inspection.
· Staff demonstrated clear understanding of safeguarding procedures and there had been no safeguarding concerns since the last inspection.
· Medication administration records for five people showed medicines were administered as prescribed, with staff competency assessed by senior staff.
· No missed calls recorded; a new electronic log-in system provided evidence of visit attendance and duration.
· Regular spot checks (up to six times per year), staff appraisals, and team meetings were in place and confirmed by staff and people using the service.