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

Inspection report · 2021-10-30

Framework: KLOE · 18 pages · 91 KB · PDF

Requires improvement

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

Boldglen Limited Medway Swale was rated Requires Improvement overall following its June–July 2018 inspection, with three regulatory breaches identified covering person-centred care (Reg 9), safe care and treatment including medicines and risk management (Reg 12), and good governance (Reg 17). Caring was rated Good, reflecting strong staff relationships and positive feedback from people, but significant gaps in care planning, medicines administration records and quality monitoring systems undermined safety and consistency across the service.

Concerns (6)

criticalMedication management: “Gaps were found on some people's medicines administration record (MAR)...MAR for May 2018 showed gaps where staff had not signed...evening medicines had not been signed for at all that month.”
criticalCare planning: “The information in the care plan was basic and did not always provide the level of information needed to ensure care and support was consistent.”
criticalGovernance: “An effective system for monitoring the quality and safety of the service provided was not in use...registered manager confirmed they had no evidence of this.”
moderatePerson-centred care: “Life histories were not included in people's care plans and no information recorded to show what and who was important to them to give a holistic view of the person.”
moderateRecord keeping: “The medical or health related conditions people had been diagnosed with and the health and social care professional staff who supported them was not recorded.”
moderateIncident learning: “No recording documentation was in place for staff to record incidents to enable the registered manager to monitor and check for increased risk and changes in behaviour.”

Strengths

· People consistently reported feeling safe and spoke highly of the caring, kind and consistent staff who supported them.
· Robust and safe recruitment practices were in place including DBS checks, reference verification and photographic ID checks.
· Staff had suitable induction training, regular updates and competency observations including medicines administration checks.
· Sufficient staffing levels with good time-keeping; people reported regular, punctual staff who never missed visits.
· Safeguarding procedures were understood by staff who could describe types of abuse and reporting responsibilities.

Quality-Statement breakdown (17)

safe: Medicines managementRequires improvement
safe: Risk assessment and managementRequires improvement
safe: SafeguardingGood
safe: Infection controlGood
safe: Staffing levels and recruitmentGood
effective: Assessment and care planningRequires improvement
effective: Staff training and supervisionGood
effective: Mental Capacity Act complianceGood

Inspection report · 2021-10-30

Framework: KLOE · 20 pages · 103 KB · PDF

Not rated

safe: Not ratedeffective: Not ratedresponsive: Not ratedwell-led: Not rated

This targeted KLOE inspection of Boldglen Limited Medway Swale found continued and new breaches of regulations across safe care, care planning, recruitment, staffing deployment, and governance, with enforcement conditions imposed for Regulations 12 and 17. While some improvements were noted in training, consent, and oral health documentation, the provider failed to meet warning notices issued at the previous inspection, and the overall rating remains Requires Improvement from the last comprehensive inspection.

Concerns (9)

criticalMedication management: “Staff were not always doing this and records showed they were leaving medicines out for the person to take at a later time...the person went without their prescribed medicines.”
criticalCare planning: “One person lived with epilepsy, COPD, Parkinson's disease, angina and asthma...the care plan did not provide guidance for staff on how to support these needs.”
criticalIncident learning: “One person's records for August 2020 showed that they had fallen or had seizures three times in the month. No accident or incident forms had been completed.”
criticalGovernance: “Audits of care records had not identified areas of concern that had been recorded by staff such as records of falls and seizures.”
criticalStaff competency: “Staff were not recruited safely...All three showed gaps in staff employment history. These gaps had not been addressed and recorded.”
criticalSafeguarding: “CQC had not received a notification of alleged abuse in relation to this incident [missed medicines safeguarding concern].”
moderateStaffing levels: “A staff member had a care call from 08:30 until 09:00 and the next care call was at 09:00...nine care calls in one day with no travel time allocated.”
moderateRecord keeping: “Medicines records were not up to date. One person's care plan stated they self-administered all their medicines. However, daily care records showed staff were administering medicines.”
moderatePerson-centred care: “Assessments undertaken with people before they received a service had not always been used to develop a care plan...staff had no guidance about how to meet people's assessed needs.”

Strengths

· Staff training had improved since the last inspection, with online training introduced and staff receiving regular courses covering manual handling, safeguarding, health and safety, and first aid.
· Staff spoke knowledgeably about the people they supported and signs of health decline; staff felt well supported by the management team.
· People and relatives gave positive feedback: 'They are all wonderful and see to my needs well'; 'They are excellent'.
· COVID-19 risk assessments were carried out with staff, PPE was provided, and staff were offered tests when required.
· Consent and capacity practice had improved; MCA assessments were being carried out and people had signed their care plan records.

Quality-Statement breakdown (9)

safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferences

Inspection report · 2021-10-30

Framework: KLOE · 28 pages · 130 KB · PDF

Requires improvement

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

Boldglen Limited Medway Swale, a domiciliary care service for approximately 157 people, was rated Requires Improvement overall at its August 2019 inspection, with Safe declining to Inadequate due to continued and new breaches across medicines management, risk assessment, care planning, staff training, recruitment, consent, and governance. Warning notices were served against Regulations 9, 12, 17, and 18; the service had failed to make sufficient improvement following the same ratings at its previous June 2018 inspection.

Concerns (15)

criticalMedication management: “MAR had only been signed for twice in June 2019 which meant that the person had not received medicines twice within the month. The MAR for April 2019 had not been completed at all.”
criticalMedication management: “One person's daily records for 10 May 2019 showed staff administered Paracetamol gel to the person's back. In the same care visit staff also gave the person two Paracetamol.”
criticalCare planning: “Health conditions did not feature in the care plan at all. This meant guidance was not in place to make sure staff knew what to do in certain circumstances where concerns may arise.”
criticalCare planning: “One person had a diagnosis of epilepsy... There was no information for staff on how to meet the person's needs when they had a seizure.”
criticalStaff training: “Staff had not completed epilepsy awareness training, diabetes awareness, stroke awareness or catheter care training despite providing care and support for people with these conditions.”
criticalStaff training: “None of the staff employed by Boldglen Limited Medway and Swale were trained to be able to provide stoma training to others.”
criticalGovernance: “Quality monitoring processes were haphazard and did not provide the information the provider would need to be assured of the quality and safety of the service provided.”
criticalGovernance: “The medicines audit was not adequate to pick up areas of practice that were not safe and take action to address the issues quickly.”
criticalRecord keeping: “Failure to record accidents and incidents means that lessons cannot be learnt, risks to people's safety is not reviewed and assessed in a timely manner.”
criticalSafeguarding: “Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not carried out sufficient checks to explore staff members' employment history.”
criticalConsent / capacity: “Staff responsible for carrying out assessments had no awareness of the MCA process to ensure that decision making was decision specific for each person.”
criticalIncident learning: “An accident did occur at a person's home which resulted in an injury. Staff had not appropriately recorded the accident on an accident form or within the person's daily records.”
moderateRecord keeping: “Records were not accurate, complete or contemporaneous. There had been no robust audits or checks of the service completed since our last inspection.”
moderatePerson-centred care: “Life histories were not in place within many people's care plans and no information was recorded to show what and who was important to them to give a holistic view of the person.”
moderateStaffing levels: “Many care visits did not have travel time between them which meant staff were allocated to start their next care visit at the time the previous visit ended.”

Strengths

· People consistently reported feeling safe with staff and expressed high satisfaction with their regular carers.
· All staff had completed safeguarding adults training and demonstrated knowledge of their responsibilities.
· Infection control training was completed by all staff and PPE was appropriately provided and used.
· Staff were observed carrying out care visits and regular spot checks were undertaken by senior staff.
· Complaints were appropriately responded to and resolved; complaints procedure was accessible to people.

Quality-Statement breakdown (23)

safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentRequires 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 lawRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement

Inspection reports (5)