Just ONE Recruitment and Training Limited was rated Good overall at its September 2018 inspection, having remedied previous breaches of Regulation 17 relating to governance and staff training. The service was rated Requires Improvement for safe due to ongoing gaps in medicines stock recording and monitoring, though all other domains were Good.
Concerns (6)
moderate
Medication management
: “The amount of medicines received from the pharmacy was not always recorded on people's medicine records. This meant that it was difficult to audit the stock balance.”
moderateMedication management: “One person's medicine record stated that a medicine should be taken three times per day. However, records showed that it had only been administered once per day for a number of weeks.”
minorMedication management: “One person had three tubes of the same cream in their cupboard without dates on to show when they had been opened or which should be used first.”
minorSupervision / appraisal: “Annual appraisals had not been completed for most staff in the past twelve months. The registered manager was aware of this and told us they had not had the opportunity to complete these since being in post.”
minorPerson-centred care: “We did however observe two staff members entering a person's flat without knocking or explaining to the person why they were there.”
minorGovernance: “We found that the previous rating was not displayed on the provider's website. We raised this during the inspection and it was actioned straight away.”
Strengths
· People told us they felt the support they received helped to keep them safe and staff always arrived when expected.
· Staff completed training relevant to their role and the needs of the people they supported, including person-specific training for conditions such as epilepsy and autism.
· Staff were supported through a comprehensive four-day induction and regular supervision sessions.
· People using the service were involved in staff recruitment, including setting interview questions and discussing candidates with the registered manager.
· Care plans were person-centred, detailed, and regularly reviewed, with copies in people's homes kept up to date.
Quality-Statement breakdown (21)
safe: Medicines managementRequires improvement
safe: Risk assessmentGood
safe: Staffing and recruitmentGood
safe: SafeguardingGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Needs assessment and care planningGood
effective: Nutrition and health supportGood
effective: Mental Capacity Act complianceGood
caring: Kindness and respectful treatmentGood
caring: Involvement in care decisionsGood
caring: Promoting independence and dignityGood
caring: Communication supportGood
responsive: Person-centred care planningGood
responsive: Activities and community involvementGood
responsive: Complaints handlingGood
well-led: Quality monitoring systemsGood
well-led: Leadership and managementGood
well-led: Feedback and engagementGood
well-led: Regulatory compliance and notificationsGood
12 Tapton Way received an overall rating of Requires Improvement, with breaches of Regulation 17 identified across medication administration recording, incident management, and staff training oversight. Strengths were noted in caring and responsive domains, with person-centred care planning, reliable staffing, and a positive organisational culture.
Concerns (8)
criticalMedication management: “On one person's MAR there were eight blanks for a medicated cream over the previous four weeks. The codes to identify the reasons for this were not used.”
criticalRecord keeping: “Medication that was not blister packed was not being counted and stocks recorded. Therefore, it was impossible to know if the stocks held were correct.”
criticalIncident learning: “One team there was a pattern of physical incidents against members of staff. The team had documented 23 physical incidents between January and May 2017.”
criticalGovernance: “Systems and processes had not enabled the registered person to assess, monitor and improve the quality and safety of the services provided to people.”
moderateStaff training: “Some training that people's care plans identified as necessary did not appear on the training matrix; for example dysphagia, mental health awareness and specific syndromes.”
moderateSupervision / appraisal: “We looked at the supervision notes for these staff and saw that the incidents had not been explored with members of staff during these meetings.”
moderateLeadership: “The agency does not have a registered manager. There is a manager in post who has not yet registered with the CQC.”
minorCare planning: “In one person's file it indicated the person had capacity to consent to their care and an assessment had concluded that they did not.”
Strengths
· Person-centred care plans reflecting people's preferences, interests and lifestyle choices, with sections on what makes people happy and their favourite things.
· Robust and well-documented staff recruitment process including four verified references, DBS checks and risk assessments for any records.
· Improvements to rota reliability with stable, familiar staff teams built around individuals, providing continuity of support.
· Staff received safeguarding training on day one of induction with periodic refreshers, and were knowledgeable about types of abuse and actions to take.
· Complaints recorded, investigated and responded to, with evidence of responsive changes made following feedback.
12 Tapton Way, a Liverpool domiciliary care agency, was rated Requires Improvement across all five key questions following an unannounced inspection in September 2015, with breaches identified in safeguarding (Reg 13), consent and Mental Capacity Act compliance (Reg 11), and governance and record-keeping (Reg 17). While staff were praised for their caring relationships and safe recruitment was evidenced, systemic failures in late or missed visits, out-of-date care plans and medication records, and absent staff training records placed people at risk of harm.
Concerns (11)
criticalSafeguarding: “The agency did not report these incidents under safeguarding adult's procedures.”
criticalMissed or late visits: “staff had arrived at a person's house at 11 am instead of 8 am. On arrival staff found the person had fallen and been unable to get up.”
criticalConsent / capacity: “No written assessment of the person's capacity to make this decision was recorded and no 'best interest meeting' had been held.”
criticalRecord keeping: “Records were out of date and inaccurate. This included medication records, care plans, staff training and supervision records and policies.”
criticalGovernance: “Systems and processes did not operate effectively to assess, monitor and improve the quality and safety of the service provided.”
moderateMedication management: “Care records for a third person contained a list of medication they took which was incorrect.”
moderateStaff training: “One member of staff told us training had often been cancelled and not re-arranged. They said this included training on how to meet people's health care needs.”
moderateCare planning: “A third person's care plan had been written in December 2013 and had not been reviewed.”
moderateComplaints handling: “We asked to see the complaints log but one was not produced...There was not a clear audit trail of the complaints and the action being taken.”
moderateSupervision / appraisal: “records relating to staff supervision were not maintained.”
moderateCommunication with families: “Several relatives and people using the service told us that they had not always been able to speak to someone senior in the office when they had concerns.”
Strengths
· Staff were knowledgeable about the people they supported and had built warm relationships with people based on respect.
· Sufficient staff were recruited safely with all required DBS checks and references completed.
· Staff monitored and clearly recorded health observations which were used to provide GPs with information needed to prescribe new treatment.
· A new call monitoring system was being introduced to track staff arrival and departure times.
· Senior staff had commenced visiting people using the service to gain their views and discuss care.
Quality-Statement breakdown (16)
safe: Safeguarding incidents identified and reportedRequires improvement
safe: Care delivered as planned and on timeRequires improvement
safe: Medication records accurate and up to dateRequires improvement
safe: Safe recruitment practicesGood
safe: Sufficient staffing levelsGood
effective: Staff training provided consistentlyRequires improvement
effective: Consent and Mental Capacity Act complianceRequires improvement