Date of assessment 30 May to 10 September 2024. At our last inspection the provider had breached the regulations relating to staffing and good governance. The provider was no longer in breach. The provider had enough staff and recruited new staff safely. Medicines administration records (MARs) were accurate and evidenced the medicines people had received from care staff. However, no MARs were available for topical medicines, such as creams. This was also an issue at the last inspection. Following our visit to the service the registered manager confirmed these were in place. Medicines competency assessments were also out of date. There were systems to record and review incidents. Although care staff had completed safeguarding training as part of the Care Certificate, they had not completed specific safeguarding training. Partners also felt the service could engage more proactively with safeguarding. Care plans usually contained person-specific risk assessments. Professionals had input into risk management. However, care plans were not always available for some people with specific health needs. The provider confirmed they would act on this immediately. The management structure and on-call arrangements were unclear in relation to conflicting information about some staff roles, oversight arrangements in the registered manager's absence staff access to some records. The provider’s website was not showing the current rating and advertising for services which the provider was not registered for. This has since been addressed. The provider had quality assurance processes, comprising of audits and checks on the service. The completed audits lacked detailed information about the findings, as well as containing little reflection about areas for improvement and lessons learnt. The provider’s service improvement plan identified future development plans for the service. However, it lacked specific timescales for delivering the improvements.
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E2E Homecare received a 'Requires Improvement' rating across all five key questions at its first rated inspection, with breaches of Regulation 17 (Good Governance) and Regulation 18 (Staffing) identified. Key failures included inconsistent staffing and missed or late visits, incomplete medicines records, insufficient staff training and supervision, and ineffective quality monitoring systems.
Concerns (12)
criticalStaffing levels: “The provider failed to maintain sufficient numbers of suitably qualified, competent, skilled, and experienced staff to make sure that they can meet people's care and treatment needs.”
criticalMedication management: “Application of topical medicines and transdermal patches were not routinely recorded on Topical Medicines Application Records (TMARS) and body maps.”
criticalStaff training: “Staff also lacked specialist training related to people's specific conditions, such as peg feeding, oral health and stoma care. One professional told us, 'Staff are not always competent to provide the care and support required.'”
criticalGovernance: “The provider's quality monitoring systems were not always effective. Regular audits were not conducted to improve service delivery.”
criticalRecord keeping: “The provider failed to maintain accurate, and complete records. Some people's daily notes contained unexplained gaps.”
moderateMissed or late visits: “A morning call, due at 8am, was provided at almost 10am, with no explanation as to why or an apology for being late.”
moderateSupervision / appraisal: “Staff supervisions were not routinely planned. The provider's systems did not contain the information to assure us staff received ongoing or periodic supervision.”
moderateCare planning: “Not all care plans provided concise guidance for staff about how to deliver people's care and support requirements, for example, in relation to accessing people's property.”
moderateCommunication with families: “English is not their first language, and they don't understand everything I say. The carers can't pronounce the names of my tablets, so they identify them by colour.”
moderatePerson-centred care: “A neighbour told me, (Name) had an incontinence accident and the carer started to vomit when going to clean it up and the neighbour had to help clean (Name).”
moderateLeadership: “The registered manager and staff lacked a clear understanding about their roles and did not always have an effective oversight of the service.”
minorComplaints handling: “Procedures were in place to investigate and respond to complaints. However, we found these were not always recorded.”
Strengths
· Staff were recruited safely with appropriate immigration, sponsorship and pre-employment checks including DBS.
· Safeguarding systems were in place; concerns were reported and actioned, and most people felt safe with staff.
· Effective infection prevention and control systems in place; staff wore PPE and followed good practices.
· People's end of life decisions were respected, with care plans containing details of end of life considerations.
· Staff worked in partnership with external professionals such as GPs and District Nurses to ensure timely care.
Quality-Statement breakdown (23)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: Working in partnership with othersRequires improvement