Date of Assessment: 10 January 2025 to 24 January 2025. This assessment was completed to identify if the required improvements had been made following a previous inspection. The service is a domiciliary care agency providing personal care to adults of all ages living with physical disabilities, sensory impairments, dementia and mental health conditions. Governance systems were not consistently identifying areas of improvement. The provider had not fully understood reportable incidents and improvements were needed to learning and improvement systems. However, staff safeguarded people from the risk of abuse and were suitably recruited and trained. People were supported to maintain a safe environment including steps taken to minimise the risks from cross infection. Systems were in place to learn and prevent future incidents and provide people with safe care minimising risks to their safety. Medicines were given in line with the providers policy. People’s needs were assessed and plans put in place to meet them by staff who worked as a team to provide evidence-based care, with other health professionals. People using the service experienced an improved quality of life and their consent was sought. Staff were kind and caring treating people as individuals and helping to retain their independence. People made choices about their care and staff were responsive to their needs. Staff understood people’s needs and preferences and provided care taking account of peoples protected characteristics. People made plans for their future and staff provided appropriate information and listened to people. The provider supported staff wellbeing and staff described an open and positive culture. The vision for the service had developed and improved systems, staff were treated equitably, with the freedom to speak up if things went wrong. The provider worked in partnership with staff, other professionals and people using the service and their relatives to continually improve the service.
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Hibiscus Domiciliary Care Agency improved from Inadequate to Requires Improvement overall, but remained in breach of Regulations 11 (consent/MCA) and 17 (good governance), with Warning Notices served on both. The service remains in special measures due to a third consecutive inadequate or requires-improvement rating for well-led, with no registered manager in post at the time of inspection.
Concerns (8)
criticalGovernance: “care plan audits...reflected there were no changes required despite some information being out of date or no longer relevant to the person.”
criticalConsent / capacity: “no record of the assessment of the person's capacity to make this decision, or any record of an associated best interests meeting”
criticalConsent / capacity: “nominated individual and manager were still not clear about their responsibilities to assess people's capacity...relied on local authority social workers”
moderateMedication management: “most recent medicines audit was March 2023...did not reflect that daily administration of medicines had been reviewed”
moderateRecord keeping: “information about people's mental capacity to make specific decisions was not always consistent or up to date”
moderateCare planning: “1 person who was not receiving care in line with their assessed need. Records reflected the person was not always being supported safely with their mobility.”
moderateLeadership: “At the time of our inspection there was not a registered manager in post...third consecutive inspection where this key question has been rated either requires improvement or inadequate.”
minorStaff competency: “gaps in employment history which the provider had not investigated”
Strengths
· Staff were knowledgeable about people's risks and knew them well; people felt safe with familiar staff.
· Staff received relevant training including moving and handling, safeguarding, MCA, and mental health awareness since last inspection.
· Incident review processes now in place with learning shared with staff to reduce reoccurrence.
· Professionals praised personalised, culturally sensitive care: 'Hibiscus go above and beyond...They are like people's extended family.'
· Recruitment checks including DBS now in place for all staff.
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people, continuous learning and improving careRequires improvement
Hibiscus Domiciliary Care Agency was rated Inadequate overall following inspections in September 2022, with breaches across five regulations including unsafe medicines management, absent governance and audit systems, unlawful deprivation of liberty, unsafe recruitment, and insufficient staff training. The service was placed in special measures, having deteriorated since its previous Requires Improvement rating in 2019, with no registered manager in post since July 2020.
Concerns (15)
criticalMedication management: “MARs had multiple unexplained gaps in recording, medicines were recorded as being given at the incorrect time and there was regular recording of people being overdosed.”
criticalGovernance: “There were no audits in place for care plans, daily care records or medicine records. Therefore, concerns and areas to improve had not been identified.”
criticalCare planning: “People had basic care plans in place, but these did not cover all aspect of people's needs or risks. People did not always have individualised care.”
criticalStaff training: “Staff did not receive enough training to be effective in their role. The provider had no way of tracking the training staff had received, such as a training matrix.”
criticalConsent / capacity: “One person was being unlawfully restricted and had been for a prolonged period of time. There had been no applications to the Court of Protection.”
criticalSafeguarding: “We could not be sure concerns would always be identified and reported as there was a lack of systems in place to review people's care.”
criticalIncident learning: “There were no systems in place to review accidents or incidents. No checks were made to see if there were any trends, or anything which could be learned.”
criticalStaff competency: “Staff were not recruited safely. Some staff had no evidence their Disclosure and Barring Service (DBS) records checked.”
criticalLeadership: “The service had been without a registered manager for a significant period of time. The last registered manager had left in July 2020.”
moderateInfection control: “Care staff did not always wear appropriate PPE masks in the presence of people, and we could not be sure masks were always of the appropriate quality.”
moderateSupervision / appraisal: “Staff did not have supervisions so were not given the regular opportunity to discuss their opinions on a private basis.”
moderateEnd-of-life care: “There were no end of life care plans in place and people had not been given the opportunity to discuss their end of life wishes.”
moderateRecord keeping: “Some people's daily notes did not record the times calls took place so there was no audit trail.”
minorPerson-centred care: “Two people had bowel monitoring charts put in place, which were later stopped. The acting manager said they had put them in place for everyone — a lack of individualised care.”
minorComplaints handling: “People and relatives did not always know how they could complain about the service they received.”
Strengths
· There were enough staff to support people and staff had a consistent rota, generally supporting the same people regularly.
· People felt well treated, with staff treating them with dignity and respect; professionals were complimentary of staff interactions.
· People were supported with culturally appropriate food and staff could communicate with people effectively.
· People were supported to avoid social isolation and engage in activities if they wished.
· The nominated individual engaged an external consultant to support the service in establishing systems and processes.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
effective: Staff support: induction, training, skills and experienceInadequate
effective: Ensuring consent to care and treatment in line with law and guidanceInadequate