Charisma Services was rated Good across all five key questions at this August 2017 inspection, demonstrating sustained improvement following breaches identified in December 2015 related to staffing deployment and governance. Minor concerns were noted around incomplete diabetes training for one person and an omission of the health ombudsman contact details in the complaints policy, both of which were being promptly addressed.
Concerns (2)
moderate
Staff training
— “training for staff in support of people who needed help to manage their diabetes safely was not fully up to date”
minorComplaints handling — “when we looked at the information we saw it did not include the contact details for the health service ombudsman”
Strengths
· Staff knew how to recognise and report abuse and could contact external agencies such as the local authority and CQC
· Safe recruitment processes in place including DBS checks and reference checks from previous employers
· No missed calls in July 2017 and only one in August 2017, which was followed up with action
· People were treated with kindness and compassion; staff recognised people's right to privacy and dignity
· People were involved in planning and delivery of their care with written care plans kept in their homes
Charisma Services was rated Requires Improvement overall following a December 2015 inspection, with two regulatory breaches found: unsafe staffing deployment causing frequent late and missed visits (including missed medicines administration), and ineffective quality governance that failed to identify and resolve these recurring shortfalls. The service demonstrated genuine strengths in the caring and responsive domains, with staff praised for kindness, dignity, person-centred practice and effective complaints handling.
Concerns (9)
criticalMissed or late visits — “Out of a total of 33 visits there were 16 occasions when staff were either early or late...four occasions when the visit missed its correct start time by more than one hour.”
criticalStaffing levels — “Shortages of staff had resulted in an increased number of visits being included in each round and that this had resulted in a greater likelihood of visit times becoming unreliable.”
criticalMedication management — “Two occasions when staff had not completed a visit at all...people had been placed at risk of harm because they had not been supported to take their medicines at the correct time.”
criticalGovernance — “Shortfalls in completing quality checks and in receiving feedback about the service had increased the risk that people would not reliably receive care that met their needs.”
moderateStaff training — “Established staff had not always been provided with the refresher training that the registered person had planned...including training in how to provide basic first aid and how to achieve good standards of food hygiene.”
moderateSupervision / appraisal — “Staff had not met with someone senior as frequently as the registered person said was necessary in order to review their work.”
moderateRecord keeping — “Quality checks had not been recorded and so we could not be confident about whether they had been comprehensive.”
moderateOther — “Background checks had not always been completed before new staff had been employed...including obtaining references from previous employers.”
minorLeadership — “The registered person had not engaged with initiatives such as the 'Social Care Commitment' and 'Dementia Champions'...reducing opportunities staff had to reflect upon and develop their professional practice.”
Strengths
· Staff were caring, kind and compassionate; people and relatives were consistently positive about the quality of care provided.
· People were treated with respect and dignity; staff recognised people's right to privacy and managed confidential information appropriately.
· Staff followed the Mental Capacity Act 2005, supporting people to make decisions for themselves and acting in best interests when needed.
· People were supported to eat and drink enough and had access to healthcare services; staff proactively contacted relatives and health professionals.
· People received all agreed care tasks; staff effectively supported those with special communication needs and those at risk of distress.
Quality-Statement breakdown (21)
safe: Staffing levels and deploymentRequires improvement
safe: Recruitment and background checksRequires improvement
safe: Safeguarding and abuse recognitionGood
safe: Medicines managementRequires improvement
safe: Risk assessment and accident preventionGood
effective: Staff knowledge and skillsGood
effective: Training and refresher trainingRequires improvement
effective: Supervision and appraisalRequires improvement
Charisma Services, a small domiciliary care agency supporting 28 older people in Lincolnshire, was rated Good across all five key questions at its March 2020 inspection. The service demonstrated consistent, person-centred care with strong leadership, timely visits, robust care planning, and effective partnership working.
Strengths
· Staff arrived on time and people did not feel rushed; calls grouped into rounds to minimise travel between visits
· Personalised care plans regularly reviewed with people involved in their development
· Strong safeguarding awareness; staff confident to raise concerns internally and to external agencies
· Medicines administration training in place with accurate records kept
· Registered manager accessible and well-known to people, fostering an open person-centred culture
This focused follow-up inspection of Charisma Services found that most required improvements from the December 2015 inspection had been implemented, meeting the previously breached Regulations 17 and 18. However, residual shortfalls in timely visit completion and incomplete staff training meant both 'Safe' and 'Well-led' remained at Requires Improvement.
Concerns (3)
moderateMissed or late visits — “19 of the visits had been completed at the right time with the remaining visit having been late by a small amount of time.”
moderateGovernance — “further improvements still needed to be made in the way some quality checks were completed... had not always effectively and quickly resolved problems.”
minorStaff training — “quality checks completed by the registered person had still not resulted in all staff receiving all of the training they were considered to need.”
Strengths
· Improved staff deployment with clearer individual work rosters enabling more organised visit planning
· No missed visits in the six months preceding the inspection, compared to two missed visits in the prior period
· Strengthened recruitment checks ensuring robust employment history verification for new staff
· More regular supervision meetings between staff and the registered person to discuss work and resolve problems
· Courtesy telephone calls introduced to notify people promptly when staff are delayed
effective: Mental Capacity Act complianceGood
effective: Nutrition and hydration supportGood
effective: Access to healthcareGood
caring: Kindness, compassion and respectGood
caring: Privacy, dignity and confidentialityGood
responsive: Person-centred care planningGood
responsive: Support for communication needsGood
responsive: Promoting independence and interestsGood
responsive: Complaints handlingGood
well-led: Quality assurance and monitoringRequires improvement
well-led: Feedback and engagement with peopleRequires improvement
well-led: Engagement with good practice guidanceRequires improvement