ReadyCQC, a weekly field guide to CQC home-care regulation

criticalStaffing levels: “50% of calls were either scheduled with no travel time or at the same time as other calls... more than half of people's planned care time was not delivered.”
criticalMissed or late visits: “Sometimes they don't turn up at all, usually on a Friday when it's not the regular carer... A few times recently they haven't turned up at night.”
criticalMedication management: “Medicine names where spelt incorrectly, and wrong doses were handwritten. People's allergies were not recorded on the MARs we reviewed.”
criticalSafeguarding: “We made a safeguarding referral to the local authority regarding a concern for a person's safety during the inspection.”
criticalCare planning: “Care plans contained contradictory and inaccurate information and lacked enough detail for staff to provide person-centred, safe and effective care.”
criticalGovernance: “The provider had not established robust systems and processes to assess, monitor and improve the quality and safety of the service.”
criticalLeadership: “The registered manager had little oversight of the day to day running of the service and worked at the providers other location based in Yorkshire and stated they just visited the service twice a month.”
criticalConsent / capacity: “Where people's capacity was in doubt, the provider had failed to ensure decision specific capacity assessments were carried out.”
criticalStaff competency: “Professional references were not always obtained when a candidate had previously worked in care, and gaps in employment history were not explored.”
moderateStaff training: “New staff received a 1-day induction prior to starting work at the service... staff were not provided with enough time to develop their learning.”
moderatePerson-centred care: “There was little or no background information about people or their choices, likes and dislikes. Care records did not contain any detail about people's cultural or religious needs.”
moderateRecord keeping: “Record keeping in relation to people's daily care was at time illegible to read, lacked detail and completeness.”
moderateIncident learning: “The provider did not learn from complaints raised about the service. We found similar themes of complaints reoccurred.”
minorCommunication with families: “We have never been asked for any feedback on the service. Some feedback opportunity or other involvement with how things are going would be good.”

Inspection report · 2023-11-14

Framework: KLOE · 18 pages · 99 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Goodresponsive: Goodwell-led: Requires improvement

Elmar Home Care Manchester improved from Inadequate to Requires Improvement overall, exiting Special Measures, with ongoing regulatory breaches in medicines management (Reg 12/17), consent and mental capacity (Reg 11), and staff training/competency (Reg 18). Caring and Responsive domains achieved Good ratings, reflecting meaningful progress in call scheduling, care planning, safeguarding, and staff culture since the previous inspection.

Concerns (9)

criticalMedication management: “eMARs viewed did not always record how and when to take medication, including frequency of medicines.”
criticalMedication management: “For 1 person we found their pain relief was not being administered safely. This person was administered paracetamol too closely together.”
criticalConsent / capacity: “consent to care were signed by relatives even if the person had a capacity. In 1 person's care plan it said, 'I have full capacity', however, the consent to care was signed by a relative.”
criticalConsent / capacity: “The provider did not carry out mental capacity assessments when they were required to do so.”
criticalStaff training: “2 staff members delivered support to a person with Percutaneous Endoscopic Gastrostomy (PEG) 6 times in 1 month without having appropriate training in place.”
criticalGovernance: “system of checks had not been consistently effective as it had not identified and addressed the issues we found during this inspection.”
moderateStaff competency: “a person who delivered stoma and catheter training did not have the appropriate trainer's qualifications in place to deliver this training.”
moderateRecord keeping: “Not all of the training was recorded on the training matrix. For example, there was no records regarding PEG, stoma or catheter training.”
minorCare planning: “further work was still required to ensure people's long-term conditions provided person centred detail on how their condition impacted them, rather than generic statements.”

Strengths

· Call monitoring vastly improved with electronic call monitoring (ECM) fully embedded, reducing missed calls and call cramming.
· Safe recruitment processes in place including DBS checks and references obtained before staff started work.
· People and relatives spoke positively about care, describing staff as kind and friendly.
· Complaints significantly reduced since last inspection; monthly trends analysis undertaken.
· Safeguarding systems improved with a reduction in allegations; staff demonstrated good understanding of responsibilities.

Quality-Statement breakdown (19)

safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
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 law

Inspection reports (2)