First inspection of a newly registered domiciliary care service rated Requires Improvement overall, with breaches of Regulation 12 (safe care and treatment) due to insufficient risk assessments and Regulation 17 (good governance) due to ineffective audits and incomplete records. Staff were caring, well-trained, safely recruited and worked well with health professionals, but management oversight and record-keeping needed strengthening.
Concerns (9)
criticalCare planning: “risk assessments... were not detailed enough and did not identify individual risks or mitigating actions required for staff to take to help keep people safe”
criticalCare planning: “for one person who had a pressure sore, there was no information recorded to identify risks associated with repositioning, personal care and what the signs staff needed to be aware of”
criticalRecord keeping: “Not all records had been completed or kept up to date. Staff did not always have accurate records they could rely on to provide good quality care.”
criticalGovernance: “Audits were not effective. Not all records had been completed and there were missed opportunities to improve the quality of care.”
moderateCare planning: “Care plans just stated to use a slide sheet or other equipment but not how this was done.”
moderateStaff training: “the registered manager checked that staff were competent to use equipment, but they had not had formal training to assess that staff used this correctly”
moderateMedication management: “where the position of skin pain patches needed to be recorded, staff had not recorded this. Relatives told us staff varied where they applied the skin pain patches.”
moderateGovernance: “care plan audits did not review if there was sufficient detail in care plans or if risks assessments were suitable and sufficient to help keep people safe”
moderateLeadership: “the registered manager provided care to people where a female member of staff was requested. This detracted from the governance and oversight of the day to day running of the service.”
Strengths
· Staff knew how to safeguard and support people to keep them safe
· Enough suitably skilled staff had been safely recruited through a robust process including DBS checks
· People were supported by a consistent staff team they felt comfortable with
· Staff adhered to good infection prevention and control guidance and used PPE correctly
· Staff received required training, regular supervisions and competency assessments; new staff completed the Care Certificate
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires 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
safe: Learning lessons when things go wrongRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies; supporting people to access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisionsGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure choice and controlGood
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 roles, understanding quality, risks and regulatory requirements; continuous learningRequires improvement
well-led: Promoting a positive, person-centred, open culture; duty of candourGood
well-led: Engaging and involving people, public and staffGood