Dolphin Health Care – Wiltshire is a domiciliary care agency. An on site assessment was conducted on 30 April 2024, following this the assessment continued remotely and concluded on 21 May 2024. At the time of the assessment there were 4 people using the service. The assessment was a planned one following an inspection in January 2024 where the service was rated inadequate. The assessment reviewed key questions relating to the issues identified in the first inspection. We found that not enough improvement had been made by the provider and there were two breaches of the legal regulations in relation to, safe care and treatment and governance and 1 breach in notifications of the absence of the registered manager. Medicines were still not being managed safely. The provider stilldid not have oversight of the service and had not reported information to the Care Quality Commission as required. The provider had introduced a new electronic system and were transferring peoples’ information to it. The information of peoples' care needs was more accessible and more detailed but still did not always contain clear guidance for staff on how best to support people. Staff were did not always clearly understand how to safely support people.
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Dolphin Healthcare Wiltshire, a newly registered domiciliary care agency, was rated Inadequate overall following its first inspection in November 2023, with breaches of Regulations 9, 12 and 17 resulting in three warning notices and the service being placed in special measures. Critical failures spanned unsafe medicines management, absent safeguarding and incident reporting, ineffective governance, incomplete recruitment checks, and poor person-centred care, placing the 24 people using the service at significant risk of avoidable harm.
Concerns (13)
criticalMedication management: “One person was receiving medical support from staff that had not been trained to administer this medical support. This put the person at risk of harm.”
criticalSafeguarding: “The provider had not reported issues of safety to the Care Quality Commission or to their local council. Incidents not reported included a staff member being threatened with violence.”
criticalGovernance: “Reporting systems were not in place to ensure all notifiable incidents were reported to the CQC... medicine errors had not been reported appropriately.”
criticalIncident learning: “The provider did not review incidents and accidents to look at lessons learnt. This meant that people were at risk of the same issues happening again.”
criticalRecord keeping: “There were gaps in the medicine administration record (MAR) that could not be accounted for and had not been identified by the registered manager.”
criticalLeadership: “During the inspection both the registered manager and the assistant manager left their posts.”
moderateCare planning: “Peoples care plans did not contain enough detail to ensure they were supported in line with their needs and wishes.”
moderateStaff training: “Staff told us that if they were recruited with training in health and social care, they did not have any further training from the provider.”
moderateStaff competency: “The provider could not demonstrate that they had assured themselves that the current training their employees had was adequate and that they were competent.”
moderateMissed or late visits: “The registered manager had been made aware by people that there were experiencing several missed appointments which there were no prior warning about.”
moderatePerson-centred care: “One person told us that a member of staff had fallen asleep whilst working with a relative. Another person told us 'There wasn't a massive amount of engagement' from staff.”
moderateSupervision / appraisal: “The registered manager told us they had not received regular supervision. This meant the provider had no oversight of their working practices.”
minorCommunication with families: “People told us that at times communication was difficult with their carers, as English was not always their first language.”
Strengths
· Staff had access to personal protective equipment and the registered manager confirmed it was used during visits.
· People were supported to access health care when needed.
· The registered manager had taken steps to address communication issues by pairing carers with limited English with those who were proficient.
· The registered manager had recently implemented a new system to address missed visits, after which people reported visits were happening regularly.
· People told us that the registered manager had been open and transparent with them.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmInadequate
safe: Assessing risk, safety monitoring and management, learning lessons when things go wrongInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Supporting people to develop and maintain relationships and follow interestsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life careNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Continuous learning and improving careInadequate