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

Inspection report · 2021-10-30

Framework: KLOE · 18 pages · 89 KB · PDF

Requires improvement

safe: Goodeffective: Goodcaring: Goodresponsive: Goodwell-led: Requires improvement

Wealden Community Care Limited was rated Requires Improvement overall at this March 2018 inspection, with four of five key questions rated Good following significant improvements since the previous Requires Improvement rating in December 2016. The sole remaining breach concerned the registered manager's failure to submit a statutory CQC notification for a safeguarding incident in a timely manner, constituting a breach of Regulation 18 of the Registration Regulations 2009.

Concerns (2)

criticalGovernance: “The registered manager had failed to notify CQC of a notifiable event in a timely manner. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.”
moderateIncident learning: “The registered manager had not submitted one notification to us relating to a safeguarding incident.”

Strengths

· People were protected from abuse; staff could identify types of abuse and were confident in reporting concerns.
· Sufficient staffing levels planned around people's needs with consistent rotas and travel time built in.
· Medicines management improved significantly since last inspection; monthly audits implemented with accurate MARs.
· Safe recruitment procedures now in place with DBS checks completed before staff work alone with people.
· Risk assessments reviewed and updated comprehensively since previous inspection.

Quality-Statement breakdown (20)

safe: People are protected from abuse and improper treatmentGood
safe: Risks to people are assessed, monitored and managedGood
safe: Safe recruitment procedures are followedGood
safe: Medicines are managed safelyGood
safe: Infection prevention and controlGood
safe: Lessons are learned when things go wrongGood
effective: People's needs are assessed and care delivered in line with current legislationGood
effective: Staff have the skills and training to deliver effective careGood

Inspection report · 2021-10-30

Framework: KLOE · 20 pages · 97 KB · PDF

Requires improvement

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

Wealden Community Care Limited was rated Requires Improvement overall following a December 2016 inspection, with multiple regulatory breaches identified including unsafe medicines management, inadequate risk assessments, failure to follow safe recruitment procedures, non-compliance with the Mental Capacity Act, poor care planning, and ineffective quality monitoring systems. The service was rated Good for caring, with staff demonstrating genuine kindness, dignity, and strong relationships with the people they supported.

Concerns (12)

criticalMedication management: “MAR sheets did not list individual medicines, prescribing instructions and were not signed in.”
criticalRecord keeping: “One person had been assessed by a speech and language therapist as needing a special soft diet...the person's care plan was not updated to reflect these changes”
criticalSafeguarding: “codes for key safes attached to people's properties were sent out in rotas to staff members via staff members' own private email addresses”
criticalConsent / capacity: “two people had bed rails...the registered provider hadn't identified that the use of bed rails could potentially amount to a restrictive practice”
criticalGovernance: “Monthly reports...were completed up to August 2016 but none had been completed between August and December 2016.”
criticalStaff competency: “one staff member had started working at the service before it had been established that they were suitable...A DBS was issued later that was not clear and which indicated a risk to others”
criticalStaffing levels: “out of 10 days' records we examined there were nine care calls (out of 40) where only one carer had delivered care”
moderateCare planning: “care plan failed to reflect that the person had mental health needs and a learning disability. This information was only seen in an older NHS document”
moderatePerson-centred care: “Care plans were not always person centred and did not contain important personal information, such as diagnoses.”
moderateMissed or late visits: “The bed time call should have been made between 19.30 and 20.30 and there was evidence of that call being delivered as late as 23.00.”
moderateComplaints handling: “responses to complaints that were not person centred or receptive to the concerns raised meaning that opportunities for improving the quality of service...were missed”
minorSupervision / appraisal: “appraisals did not highlight areas for improvement, set goals for the coming appraisal period or assess the overall performance of staff”

Strengths

· Staff were kind and caring, treated people with dignity and respect, and fostered good caring relationships.
· Staff were well trained with appropriate skills and knowledge, including specialist training for complex needs.
· Staff received regular supervision, team meetings, and had access to one-to-one support from management.
· Complaints were logged and responded to within the timescales set out in the provider's policy.
· The culture of the service was open and supportive with an approachable acting manager.

Quality-Statement breakdown (19)

safe: Safe care and treatment (risk assessments)Requires improvement
safe: Safeguarding people from abuse and improper treatmentRequires improvement
safe: StaffingRequires improvement
safe: Medicines managementRequires improvement
safe: Recruitment practicesRequires improvement
effective: Healthcare access and record currencyRequires improvement
effective: Consent and Mental Capacity Act complianceRequires improvement
effective: Staff training and skillsGood

Inspection report · 2021-10-30

Framework: KLOE · 18 pages · 98 KB · PDF

Requires improvement

safe: Requires improvementeffective: Requires improvementcaring: Requires improvementresponsive: Requires improvementwell-led: Requires improvement

Wealden Community Care Limited received a third consecutive 'Requires Improvement' rating following its December 2020 inspection, with Warning Notices issued for continued breaches of Regulations 12 and 17 relating to safe care and governance. Key failures included inadequate risk assessments and medication guidance, incomplete staff training and recruitment checks, unreported safeguarding incidents, and poor-quality person-centred care planning.

Concerns (14)

criticalCare planning: “Risk assessments were not always in place and people's specific and complex needs were not fully and effectively recorded.”
criticalMedication management: “There was conflicting and confusing information regarding the application of prescribed topical creams. Care plans did not contain clear guidelines to staff about where cream should be applied.”
criticalSafeguarding: “A recent notifiable incident had not been reported to safeguarding. Therefore, we could not be assured that all incidents and accidents were reported to CQC or safeguarding appropriately.”
criticalStaff training: “Training records showed some staff had not received refresher training about key aspects of care and support, including safeguarding adults, for over a year.”
criticalGovernance: “Systems had not been embedded within the service...risk assessments had not always been completed, care plans lacked person-centred detail, staff supervisions and spot checks had not been consistently carried out.”
criticalIncident learning: “There was no evidence of any analysis to identify trends and themes within the service around accidents and incidents...no analysis of falls or specific incidents to prevent re-occurrence.”
moderateMissed or late visits: “Sometimes they do miss calls and they're not always on time...I don't always get informed when they are running late.”
moderatePerson-centred care: “People were not always involved in creating their care plans...Care was not always person centred, people often had their religion recorded but were not asked about their cultural preferences.”
moderateSupervision / appraisal: “Staff supervisions and spot checks had not been consistently carried out. This placed people at risk of harm due to inconsistent care.”
moderateStaff competency: “Training had not been completed by staff who cared for people with these specific health conditions such as muscular dystrophy and brain injuries.”
moderateCommunication with families: “They don't ring me if they're late, I ring them...I don't know who the staff in the office are. No one rings me from the office.”
moderateConsent / capacity: “Decisions about mental capacity had been made for some people, however, there was no record to show how these decisions were assessed.”
moderateRecord keeping: “One person's risk assessment stated they had a weakness on their right side however, the care plan said it was their left side.”
minorEnd-of-life care: “Care plans did not contain information regarding peoples end of life care. There was a reliance on individual staff knowledge to enable people to receive appropriate support.”

Strengths

· People described care staff as caring, respectful, polite and helpful, with regular staff who understood their needs.
· The provider had recently recruited four members of staff and actively recruited to ensure enough staff to meet commitments.
· Complaints handling had improved; the provider was no longer in breach of regulation 16, with evidence of investigations and follow-up with complainants.
· Staff had access to sufficient PPE including masks, gloves and aprons, and regular Covid bulletins were sent to staff.
· People's care plans identified when care staff should contact district nurses or GPs in relation to specific needs.

Quality-Statement breakdown (15)

safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink; Staff working with other agencies; Supporting people to live healthier livesRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement

Inspection report · 2019-08-09

Framework: KLOE · 17 pages · 99 KB · PDF

Requires improvement

safe: Requires improvementeffective: Goodcaring: Requires improvementresponsive: Requires improvementwell-led: Requires improvement

Wealden Community Care Limited deteriorated from Good to Requires Improvement overall, with four regulatory breaches identified covering unsafe medicines management (40–70 errors per month), missed and late visits, unaddressed complaints, and inadequate recruitment checks. Effective care remained a relative strength, with good staff training, consent practices, and multi-agency working, but persistent governance failures meant recurring issues were not resolved.

Concerns (12)

criticalMedication management: “In May there had been 42 errors and in April there had been 70. We were not assured that people were being assisted to take their medicines safely or as prescribed.”
criticalMissed or late visits: “out of three people's visit records, an average of 8 out of 18 visits were between 20 minutes and 1 ½ hour late. This is just under 50%.”
criticalComplaints handling: “The complaints records showed that none of the complaints had been responded to in writing and no lessons had been learned or recorded.”
criticalGovernance: “Although the audits were being consistently completed and the errors were being recorded, there were no actions taken to prevent re-occurrence.”
criticalStaffing levels: “Recruitment checks were not always completed to ensure staff were suitable. Two out of the four staff files we reviewed did not include two references.”
moderateCare planning: “Care plans did not always include details such as how people liked their hot drinks or what they liked to talk about...staff stated that care plans were not sufficiently detailed.”
moderateStaff training: “one member of staff, who was assessed in March for medicines, proceeded to make four errors in May. Nothing had been done in response to these errors.”
moderateRecord keeping: “hand written medicine administration records (MARs) did not have double signatures to show that staff had checked the medicine list, dosage or frequency.”
moderatePerson-centred care: “the registered manager had failed to promote person-centred care...care plans were not always person centred, people's needs were not always met.”
moderateIncident learning: “There had been eight accidents or incidents since January 2019 and, although they had all been recorded, none of them had outcomes of lessons learned.”
minorEnd-of-life care: “There wasn't a large amount of information available in care plans for staff around person centred end of life care...There was a reliance on individual staff knowledge.”
minorSupervision / appraisal: “At the last two staff meetings the agenda was the same and there were no notes or records of what any staff members had said.”

Strengths

· Staff were up to date with mandatory training and received regular supervision and appraisal.
· People's rights were protected in line with the Mental Capacity Act 2005, with signed consent forms and lasting power of attorney records in place.
· People were supported to maintain good health with effective referrals to healthcare professionals including district nurses and GPs.
· Pre-admission assessments comprehensively considered people's needs including health, mobility, daily routine, food preferences and social interests.
· Staff demonstrated good knowledge of safeguarding processes and infection control practices.

Quality-Statement breakdown (21)

safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and management; Using medicines safelyRequires improvement
safe: 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: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced diet

Wealden community Care Limited

Inspection reports (5)