The assessment began on 26 June 2024 and concluded on 18 July 2024. Revelations Social Care provides personal and complex care and support for people living in the Borough of Bury. The service currently supports 7 people. Only 4 people received a regulated activity. We looked at all 34 quality statements across the 5 key questions. This include those areas where breaches in regulation were identified at our last inspection in relation to safe care and treatment, good governance, staffing and fit and proper person. At this assessment, we found the service had made improvements and was no longer in breach of regulations. Recruitment of staff was now safe. Staff now received the training and support needed to carry out their roles safely and effectively. Areas of risk were now effectively assessed and planned for ensuring the safety of people. Records also now reflected people’s capacity and consent or where decisions were made in the [persons nest interest, ensuring their rights were upheld. The management and administration of people’s prescribed medicines was now safe. Effective governance systems had been implemented. These need embedding to help identify and drive continuous improvements. This service has been in Special Measures since 30 May 2023. The provider has demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.
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Revelation Social Care Ltd was rated Inadequate overall following a focused inspection in April 2023, with regulatory breaches identified across safe care and treatment, recruitment, staffing, consent, and governance. Multiple critical failures were found including unsafe medicines management, incomplete risk assessments, ineffective staff training, and disorganised governance systems, resulting in a Warning Notice for Regulation 17 and placement of the service into special measures.
Concerns (9)
criticalMedication management: “one person required topical cream applied twice daily, records showed this was applied 4 times each day. Records did not provide any direction for staff on where creams were to be applied.”
criticalStaff competency: “Medication competency assessments were completed for staff as part of the induction programme. Records seen showed assessments of staff had been carried out with people who did not receive support with the medicines.”
criticalGovernance: “The service did not have systems in place to monitor and review the service provided. The office environment was disorganised and did not provide an effective working environment.”
criticalConsent / capacity: “Where people were said to lack capacity to make their own decisions, an MCA assessment had not been completed. Information was not sufficiently detailed where decisions had been made in their 'best interest'.”
criticalCare planning: “Specific areas of concern, such as behaviours that challenge and self-harm had not been thoroughly assessed and planned to provide clear guidance for staff.”
moderateStaffing levels: “Some staff were rostered to work an excessive number of hours with appropriate breaks.”
moderateStaff training: “Training records showed a number of staff had completed multiple courses in 1 day. This did not demonstrate training was appropriately planned to promoted staff learning.”
moderateRecord keeping: “Both electronic and paper records were inaccurate and incomplete.”
moderateSupervision / appraisal: “Self assessments and observed competency assessments had been completed with some staff. Where additional learning had been identified there was no evidence this had been acted upon.”
Strengths
· People and relatives gave very positive feedback about care staff, with comments such as 'I can't praise them enough' and 'Couldn't ask for a better team.'
· Suitable infection control arrangements were in place; staff had access to PPE and training in infection control.
· The registered manager liaised with the local authority safeguarding team where issues and concerns had been raised.
· The service worked in partnership with healthcare professionals and was responsive to people's healthcare needs.
· Nutritional and hydration needs were assessed and planned for; the service joined the Greater Manchester Nutrition and Hydration programme.
Quality-Statement breakdown (14)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Systems and processes to safeguard people; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills, and experienceInadequate
effective: Assessing people's needs and choices; consent and MCA complianceRequires improvement
effective: Supporting people to eat and drink enoughGood
effective: Staff working with other agencies; supporting people to access healthcareGood
well-led: Continuous learning and improving careInadequate
well-led: Managers and staff being clear about roles; understanding quality, performance and risksRequires improvement
well-led: Duty of candourGood
well-led: Promoting a positive, person-centred culture; engaging people and staffGood
well-led: Working in partnership with othersRequires improvement