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

Inspection report · 2021-10-30

Framework: KLOE · 17 pages · 83 KB · PDF

Inadequate

safe: Inadequateeffective: Inadequatecaring: Inadequateresponsive: Inadequatewell-led: Inadequate

The Care Bureau Domiciliary and Nursing Agency Kettering was rated Inadequate across all five key questions following an unannounced inspection in September 2016, with nine regulatory breaches identified including failures in medicines management, safeguarding, missed care calls, staff supervision, care planning, complaints handling, and governance. The service was placed in special measures due to a systematic leadership failure that left over 200 people exposed to ongoing risk of harm.

Concerns (13)

criticalMedication management: “We reviewed the MAR charts for 12 people and found that each of these charts had omissions in the recording of what medicines had been administered. We found gaps for critical medicines such as Morphine and medicines for Parkinson Disease.”
criticalMissed or late visits: “People did not always receive their care and support at their planned call times. People experienced inconsistent call times from care staff which impacted upon their well-being.”
criticalSafeguarding: “Staff had failed to recognise incidents which should be reported to the safeguarding team, investigate incidents or to take appropriate action to mitigate the risks to people.”
criticalStaff training: “Staff were not required to refresh or update their training. There was no requirement for this training to be updated or refreshed.”
criticalSupervision / appraisal: “A number of staff had not had a formal supervision in over two years. When staff had received supervision this was not consistently completed appropriately.”
criticalCare planning: “People's plans of care had not been reviewed in over 12 months and for a number of people their plans of care were not reflective of their current care and support needs.”
criticalGovernance: “There was a systematic failure to implement any of the provider's procedures for quality monitoring. The provider had not completed any audits of care plans, medicines or people's call times.”
criticalStaffing levels: “The care and support for over 200 people was being coordinated by three people including the manager. This resource was not sufficient to safely coordinate people's care and support.”
criticalLeadership: “There was a systematic failure in the leadership and governance of the service which had resulted in safe systems of care failing to be implemented consistently.”
criticalIncident learning: “Where people had contacted the office to report medicines errors the provider had not taken sufficient action to prevent these from occurring again in the future.”
criticalRecord keeping: “Staff had not recorded in the daily notes that they had administered the medicines to people and no-one could be sure if people had received their prescribed medicines.”
moderateComplaints handling: “Systems were not being operated to manage, respond to and resolve people's complaints. We saw numerous examples of people having contacted the office to make complaints however, these were not recorded.”
moderatePerson-centred care: “Staff were focussed upon the task of delivering care rather than delivering care in a person centred manner according to people's individual preferences.”

Strengths

· Staff respected people's preferences in relation to the gender of carer providing support.
· People had a recruitment process in place including criminal conviction checks and references prior to commencing employment.
· Where people had the same regular carers, positive relationships had developed and people expressed satisfaction with those carers.
· People's ability to consent to their care and support was assessed and staff sought consent prior to delivering care on a day-to-day basis.

Quality-Statement breakdown (20)

safe: Medicines managementInadequate
safe: Safeguarding people from abuse and improper treatmentInadequate
safe: Missed and late care callsInadequate
safe: Risk assessment and mitigationInadequate
safe: Staffing resources to coordinate careInadequate
effective: Staff skills, knowledge and competencyInadequate
effective: Staff supervision and supportInadequate
effective: Food and nutrition supportInadequate

Inspection report · 2021-01-25

Framework: KLOE · 11 pages · 224 KB · PDF

Good

safe: Goodeffective: Requires improvementcaring: Goodresponsive: Goodwell-led: Good

The Care Bureau Domiciliary and Nursing Agency Kettering was rated Good overall following an unannounced inspection on 28–29 September 2015, with Requires Improvement for Effective due to gaps in moving and handling training, outdated care plans, and delayed competency assessments for some staff. All other key questions were rated Good, reflecting safe medication management, strong safeguarding knowledge, caring staff, responsive leadership, and effective quality assurance systems.

Concerns (5)

moderateStaff training: “Other staff told us that the moving and handling training was not detailed enough because old equipment was used which led to confusion when they were caring for people.”
moderateStaff competency: “Another care staff said that they had not been shown one piece of equipment at all and 'no idea how to use it when I was at the person's house.'”
moderateCare planning: “The majority of staff told us that information in care plans and on the summary sheets were not up to date and the information was not accurate.”
moderateSupervision / appraisal: “Another care staff said 'I have done some specific training and I am waiting for a competency assessment but no-body has done it with me yet, I've been waiting for months.'”
minorRecord keeping: “Staff confirmed that although care plans were not up to date they knew what support each person needed and they worked well together sharing information.”

Strengths

· Robust recruitment systems in place including DBS checks, employment history gaps exploration and written references.
· Medicines were safely managed with annual staff training and appropriate care plans and risk assessments.
· Risk assessments were in place, regularly reviewed, and enabled people to safely pursue their independence.
· Staffing levels were sufficient to meet people's needs with rotas reflecting individual care requirements.
· Staff demonstrated strong knowledge of safeguarding responsibilities and whistleblowing procedures.

Quality-Statement breakdown (19)

safe: Safeguarding people from abuseGood
safe: Risk assessment and managementGood
safe: Staffing levelsGood
safe: Medicines managementGood
safe: Recruitment practicesGood
effective: Staff knowledge, skills and trainingRequires improvement
effective: Communication between care and office staffRequires improvement
effective: Supervision and appraisalGood

Inspection report · 2020-01-29

Framework: KLOE · 17 pages · 80 KB · PDF

Requires improvement

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

The Care Bureau Domiciliary and Nursing Agency Kettering was rated Requires Improvement across all five key questions at its February 2017 inspection, with continued regulatory breaches in safeguarding (Regulation 13) and governance (Regulation 17). While improvements were noted in medicines management, care planning, and staff training since the previous inadequate rating, systemic failings in quality assurance, incomplete safeguarding investigations, and a task-led culture driven by scheduling pressures remained unresolved.

Concerns (6)

criticalSafeguarding: “three investigations had been allocated to the previous acting manager however; there was no evidence of these investigations having been completed.”
criticalGovernance: “Effective quality assurance procedures had not been implemented which had resulted in shortfalls failing to be recognised or acted upon appropriately.”
criticalLeadership: “There was not a registered manager in post although a new manager had recently been appointed who told us that they would apply to become the registered manager.”
moderateComplaints handling: “office staff had not always used the correct code to identify complaints which meant that complaints had not been escalated to the provider or senior staff to respond to formally.”
moderatePerson-centred care: “staff did not understand the expectations placed upon them in relation to people's call times which resulted in them feeling under pressure and rushed.”
moderateIncident learning: “a box of audits had been found in the office after the manager had left however, no action had been taken as a result of the audits that had been completed.”

Strengths

· People received their prescribed medicines safely with improved MAR chart systems and competency-assessed staff.
· Staff received regular supervision and training, including induction and shadowing for new staff.
· People had detailed, personalised plans of care developed in partnership with them and their families.
· People were supported to access healthcare services promptly and received appropriate nutritional support.
· People's dignity and respect were maintained by staff during care delivery.

Quality-Statement breakdown (14)

safe: Safeguarding systemsRequires improvement
safe: Medicines managementGood
safe: Risk assessment and care planningGood
safe: Staffing schedules and call timingRequires improvement
effective: Staff training and supervisionGood
effective: Nutrition and hydration supportGood
effective: Healthcare accessGood
effective: Consent and Mental Capacity ActGood

Inspection reports (6)