Focused inspection of a domiciliary care service supporting 140 people downgraded the overall rating from Good to Requires Improvement, with a breach of Regulation 17 (good governance) due to ineffective monitoring of care calls, missed visits, lapsed risk assessments and reduced staff supervision/spot checks. Care workers were praised as kind and competent and management were open and committed to a comprehensive improvement plan.
Concerns (10)
criticalMissed or late visits: “Some people told us they experienced late and missed calls where the care worker did not arrive at all.”
critical
Missed or late visits
: “my mum didn't have food for 8 hours. They said we cancelled a call. I know I did not. My mother is not able to call them.”
criticalGovernance: “Systems and process in place to assess, monitor and improve quality and safety of service provided were not sufficiently effective.”
moderateCare planning: “For several months the service had not been carrying out assessment visits to people before they started providing their care.”
moderateStaffing levels: “The service had been experiencing staffing challenges for several months including recruitment, staff retention and staff sickness due to the COVID-19 pandemic.”
moderateStaff competency: “Spot checks on care workers in people's homes to ensure they were working to required standards had not been taking place.”
moderateSupervision / appraisal: “Some staff had not received regular supervision.”
moderateCommunication with families: “I have tried to ring in last two or three days and no one picks up or gets back to me. I left my phone number”
moderateRecord keeping: “there was no audit trail for when an agreement had been made to cancel a care call or cut the call short or to send one worker when the person required two workers.”
minorPerson-centred care: “Emergency protocols in place for people with diabetes were generic rather than specific guidance for the person.”
Strengths
· People liked their care workers and said the quality of care was generally good
· Staff were recruited following safe practices to minimise the risk of unsuitable people being employed
· People received their medicines safely and as prescribed
· Comprehensive PPE and infection control practices in place
· Care plans included person-centred detail such as likes, dislikes and communication preferences
Quality-Statement breakdown (14)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Supporting people to develop and maintain relationships to avoid social isolationNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Continuous learning and improving care; Working in partnership with othersNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated