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

criticalCare planning: “Where people were at risk of pressure ulcers, there was not a clear assessment of this level of risk...the risk of pressure ulcers had not been assessed using a reliable tool”
criticalIncident learning: “Records showed there had been 11 missed visits to this person within 26 days leading up to the hospital admission...The provider had not reviewed the person's risk management plan”
criticalMissed or late visits: “The most recent data showed 60% of care calls took place within 15 minutes of the scheduled time. However, this meant two fifths of calls still deviated significantly”
criticalStaffing levels: “staff rushing or leaving early because they did not have enough time to complete their tasks, and unreliable staffing at weekends with late and missed calls”
moderateMedication management: “Where people received medicines within blister packs, staff signed MARs to show all tablets had been administered rather than signing for each individual medicine”
moderateSupervision / appraisal: “for almost half of the staff it was not clear in the provider's records whether appraisals were taking place when due”
moderateComplaints handling: “In one case, the relative complaining had sent three emails asking for a response but there was no evidence that the provider had responded at all”
moderateGovernance: “two people's records had not been checked for five months and another had no records on file from the last six months”
moderateConsent / capacity: “there was not always evidence of appropriate procedures being followed to ensure decisions about their care were made in their best interests, in line with the MCA Code of Practice”
moderateRecord keeping: “On some occasions, when only one carer instead of two have visited, the log book is signed as if both did attend”
moderateSafeguarding: “Safeguarding investigations did not always have a clear outcome recorded and it was not always clear whether investigations were still under way or what the next steps were”
moderatePerson-centred care: “care plans did not contain information about the support people needed to manage their health conditions, including symptom control and pain management”
minorCultural competency: “there was information about people's religious beliefs but not about how this might impact on how their care was delivered, such as whether they needed to receive support from staff of the same gender”

Inspection report · 2025-03-29

Framework: KLOE · 18 pages · 102 KB · PDF

Requires improvement

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

Medacs Healthcare Croydon, a domiciliary care agency supporting 311 people, improved significantly from its previous inadequate rating and exited Special Measures, with all prior regulatory breaches remediated. Remaining weaknesses centre on inconsistent staff punctuality, poor office-to-care-staff communication, incomplete risk assessment linkage, and absence of recorded end-of-life care preferences.

Concerns (6)

moderateCare planning: “one person's pressure ulcer risk assessment had looked at factors such as the person's age and skin condition, but had not considered the person's reduced mobility or history of malnutrition”
moderateMissed or late visits: “another relative said, 'I've had to chase a couple of times when they've been really late. It's happened a few times and it would be nice to be informed.'”
moderateCommunication with families: “People told us they often did not know in advance which staff would be visiting them and were not always told when staff were running late.”
moderateRecord keeping: “the office had failed to replace medicines administration record sheets when the supply ran out, meaning staff had to record medicines using daily log sheets instead.”
moderateGovernance: “although we found some shortfalls in the quality of care including the above issues with communication, the registered manager had identified these and had plans in place to address them.”
minorEnd-of-life care: “there was very little evidence in care plans that the service had explored people's individual preferences about the care they wished to receive at the end of their lives.”

Strengths

· Risk assessments were improved and more comprehensive, covering mental and physical health issues, medicines, home environment and self-neglect risks.
· Staff were now receiving yearly appraisals and regular one-to-one supervision, with staff reporting satisfaction with support received.
· Safeguarding systems improved; provider responded appropriately to alleged or suspected abuse, involving people, staff and reporting to the local authority and CQC.
· Medicines administration was safe, with detailed care plans including body maps for topical medicines and improved record keeping.
· Complaints handling significantly improved; registered manager responded within suitable timescales and resolved complaints to people's satisfaction.

Quality-Statement breakdown (24)

safe: Assessing risk, safety monitoring and managementRequires 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: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood

Inspection report · 2025-03-29

Framework: KLOE · 22 pages · 95 KB · PDF

Inadequate

safe: Inadequateeffective: Inadequatecaring: Requires improvementresponsive: Inadequatewell-led: Inadequate

Medacs Healthcare - Croydon was rated Inadequate overall and placed in special measures following an October 2018 inspection that identified multiple regulatory breaches spanning unsafe medicines management, widespread late or missed visits, inadequate care planning, and a systemic failure of governance. Enforcement action including conditions on registration was taken across Regulations 9, 12, 17 and 18, with improvements promised after a March 2018 inspection having largely not been delivered.

Concerns (16)

criticalMissed or late visits: “Overall only 45% of visits took place within 15 minutes of their scheduled time. One member of staff attended visits outside of the schedule 77% of the time.”
criticalMedication management: “Staff had recorded administering both paracetamol and co-codamol to one person on 17 occasions... risk of liver damage if too much paracetamol is taken.”
criticalCare planning: “Care files did not contain information about which medicines people had been prescribed, the support they needed to take them, or any side effects.”
criticalStaff training: “More staff were now out of date in their safeguarding adults, health and safety and food hygiene training.”
criticalGovernance: “The provider's systems to check and audit care had not identified or addressed the significant concerns that we raised during this inspection.”
criticalSafeguarding: “Records showed that recent safeguarding concerns raised by the local authority had been shared with the provider. Records showed CQC had not been notified.”
criticalComplaints handling: “A relative said, 'Yes, we did make a complaint, but it fell on deaf ears.' Records did not always show what was done in response to complaints.”
criticalPerson-centred care: “One person's care plan stated, 'support with personal care' with no information about what elements of personal care this person required support with.”
criticalStaffing levels: “Records showed there were occasions when only one care worker attended when two were required to deliver safe care.”
moderateSupervision / appraisal: “Half of the staff files contained regular supervisions in line with the provider's policy, but the remainder didn't contain any supervisions.”
moderateEnd-of-life care: “These care plans lacked information about people's wishes and what was important to them at this stage of their lives.”
moderateRecord keeping: “There was no tracker for this and we identified multiple instances where people's daily notes and medicines records were not available.”
moderateConsent / capacity: “Several files where relatives had signed to indicate consent on their family member's behalf... provider had no records to demonstrate that relatives providing consent were lawfully authorised.”
moderateIncident learning: “A care worker had recorded a person had suffered an injury during their visit in the daily logs, but this was not captured in the incident recording systems.”
moderateCommunication with families: “Another relative said, 'Complaints take a long time from Medacs. They don't communicate by phone or email.'”
minorCultural competency: “The service did not consider the impact people's religious beliefs, cultural background, sexual and gender identity had on their care preferences.”

Strengths

· The provider followed robust recruitment processes including reference checks, employment history verification and DBS checks.
· Staff were provided with personal protective equipment (gloves) to protect against infection, confirmed by relatives.
· Where safeguarding concerns were identified by other organisations, the provider completed investigations as instructed by local authority safeguarding teams.
· New care workers completed an induction programme including Care Certificate training.
· The provider was meeting regularly with local authorities to address concerns raised by people and relatives.

Quality-Statement breakdown (26)

safe: Visit punctuality and staff deploymentInadequate
safe: Medicines managementInadequate
safe: Risk assessment and mitigationInadequate
safe: SafeguardingRequires improvement
safe: Incident reporting and learningRequires improvement
safe: Infection controlGood
safe: RecruitmentGood
effective: Staff trainingInadequate

Medacs Healthcare - London

Inspection reports (5)