First inspection of a small domiciliary care service supporting one person, rated Requires Improvement overall due to a breach of Regulation 17 (Good Governance) with no formalised quality assurance, audits, supervision records or competency checks. Caring and responsive aspects were rated Good, with relatives describing staff as kind, respectful and meeting communication and cultural preferences.
Concerns (8)
critical
Governance
: “There were no formalised quality assurance systems in place to demonstrate how the provider was maintaining oversight of the service”
criticalRecord keeping: “There were no recorded audits of the care records, daily records, recruitment files or staff support systems to check the quality”
moderateSupervision / appraisal: “there were no records of staff supervisions, competency assessments or spot checks that had been undertaken to ensure staff were supported and competent”
moderateStaff competency: “There was a lack of formal processes to support the shadowing opportunities for new staff and to demonstrate how their competencies had been assessed”
moderateOther: “Robust recruitment checks were not completed when staff commenced employment. We reviewed three staff files and found gaps in their employment history”
moderateCare planning: “Although a care plan was formed from the assessment it was not clear from the information what tasks staff should support the person with.”
moderateOther: “Risk assessments had been completed but these required more detail to ensure they covered all required risks and actions for staff to take”
moderateLeadership: “At the time of our inspection there was not a registered manager in post.”
Strengths
· Staff trained in safeguarding and understood how to protect people from abuse
· Relatives described staff as caring, friendly, kind and respectful
· Staff supported communication preferences including primary language other than English
· Infection control practices followed including appropriate use of PPE in line with COVID-19 guidance
· Care plans reflected protected characteristics and personal preferences
Quality-Statement breakdown (21)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Supporting people to express their views and be involved in making decisions about their careNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care to meet needs and preferencesNot rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirements; continuous learningNot rated
well-led: Promoting a positive, person-centred culture; engaging people, public and staff; partnership workingNot rated
well-led: How the provider understands and acts on the duty of candourNot rated