UK Top Care Ltd was rated Requires Improvement overall following breaches of Regulation 12 (medication management) and Regulation 17 (good governance), with unsafe medicines practices and an ineffective quality assurance system identified. Strengths included culturally competent, consistent staffing, positive family relationships, and good personalised care delivery.
Concerns (8)
critical
Medication management
: “People's records did not always provide information as to the medicine people were prescribed, including the name of the medicine, the dosage and times of administration.”
criticalMedication management: “Staff had received training in the safe administration of medicine, however staff were not observed administering medicine to ensure they were competent to do so.”
criticalGovernance: “The provider did not have an effective system in place to assess, monitor and improve the quality and safety of the service. This was a breach of Regulation 17.”
moderateSupervision / appraisal: “The provider did not have an effective system to support staff through supervision. Group supervisions were held by the trainer. However, there was no planned schedule.”
moderateSafeguarding: “Staff told us they would report any concerns regarding abuse to the registered manager. However, staff were unclear as to other organisations they could contact.”
moderateRecord keeping: “Care plans and risk assessments for medicines did not provide clear information, and sometimes had contradictory information as to the role of staff and family members.”
moderateLeadership: “The registered manager had not kept up to date with changes in legislation. The provider was not aware of the Health and Social Care Act 2008 and the Key Lines Of Enquiry (KLOE's).”
minorCare planning: “People's care plans were not consistently clear as to who was responsible for the provision of care...care plans for medication and the provision of meal times, sometimes stated both family members and staff were responsible.”
Strengths
· People were supported by a core group of staff, many of whom having provided care over several years, developing trusting relationships.
· Staff reflected the cultural diversity of those using the service, able to converse in people's preferred language including Gujarati.
· Robust recruitment process with appropriate checks undertaken for new staff.
· Comprehensive risk assessments undertaken including people's living environment, regularly reviewed.
· People and family members were involved in the development of care plans.
Quality-Statement breakdown (23)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
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 dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: End of life care and supportNot rated
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
safe:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This targeted inspection of UK Top Care Ltd (a 5-person domiciliary care agency) found that improvements had been made against Warning Notices issued for breaches of Regulation 18 (Staffing) and Regulation 17 (Good Governance), with staff now trained, risk assessments in place, and governance systems strengthened. The overall rating remains Requires Improvement as targeted inspections do not reassess the full key questions, and only Safe and Well-led were reviewed.
Concerns (3)
criticalStaff training: “failure to ensure that people who use the service were not at risk of receiving unsafe care and support because staff were not trained, competent and qualified”
criticalGovernance: “provider had failed to ensure that the provider's oversight systems and processes were effective. The lack of leadership and management oversight of people's care placed increased the risk of harm.”
moderateLeadership: “There were limited opportunities for people and staff to give feedback on the service.”
Strengths
· Staff had been trained to administer medicines since the last inspection
· Risk assessments were in place for a range of issues including supporting people to walk safely and environmental risks
· Audits and checks were introduced to verify care was meeting assessed needs
· Spot checks on staff implemented to assess competence and quality of care
· Registered manager understood duty of candour and statutory notification requirements
Quality-Statement breakdown (5)
safe: Staffing and recruitment (Regulation 18)Insufficient evidence to rate
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuseInsufficient evidence to rate
well-led: Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirements (Regulation 17)Insufficient evidence to rate
well-led: Duty of candour and information sharingInsufficient evidence to rate
UK Top Care Ltd, a small domiciliary care agency serving 6 adults, received a Requires Improvement rating at its May 2023 focused inspection, with two Warning Notices issued for continued breaches of Regulation 17 (governance) and Regulation 18 (staffing). Key failures included staff operating without completed induction or essential training, absent incident and supervision systems, and ineffective management oversight, representing a continuation of breaches identified at the previous 2019 inspection.
Concerns (11)
criticalStaff training: “Staff had not received induction and essential training in all key areas of care provision to help ensure they had the skills and knowledge to fulfil their roles.”
criticalStaff competency: “one staff member with no experience of working in social care had supported a person for 5 months without completing induction training.”
criticalGovernance: “The provider's oversight systems and processes remained ineffective. The lack of leadership and management oversight of people's care placed increased the risk of harm.”
criticalLeadership: “There was a continued lack of effective leadership. The service was managed by the administrative staff member with limited relevant management experience.”
moderateIncident learning: “The provider did not have a system to record all incidents and accidents such as falls. Staff were not able to tell us if lessons were learnt as staff meetings were not consistent.”
moderateSupervision / appraisal: “There was no system to support and supervise staff and to ensure staff were kept up to date about changes to people's needs or practices.”
moderateMedication management: “Staff who supported some people with their medicines were not always trained to do so.”
moderateCare planning: “care plans were not kept up to date to reflect people's current needs, support required and clear guidance for staff to follow to meet those needs.”
moderateSafeguarding: “The provider understood their role to act on abuse and report it to relevant external agencies but further action was needed to ensure all staff were trained in this area.”
minorConsent / capacity: “the registered manager was not fully aware of the process for best interest decisions when a person lacked capacity or had fluctuating capacity.”
minorRecord keeping: “The registered manager told us some staff practices in the safe moving and handling of people had been assessed by a community nurse, but no record was found to confirm this.”
Strengths
· Risks to people's safety were assessed and measures were put in place to reduce any risks.
· Staff were recruited safely, including references and DBS checks.
· People and relatives reported feeling safe with staff and care provided.
· Sufficient numbers of staff to meet people's needs; people reported regular, reliable and punctual carers.
· PPE was available and used by staff; infection control procedures were in place and spot-checked.
Quality-Statement breakdown (10)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive, person-centred, open and inclusive culture