ICRIT Healthcare improved from Requires Improvement to Good overall, having resolved a previous breach of Regulation 17 relating to governance, with all five key questions rated Good. Minor issues remain around timeliness of visits, MCA documentation accuracy, and staff communication with English-speaking service users.
Concerns (4)
moderate
Consent / capacity
: “There was documentation to record people's capacity within the care files, but this was not always completed as required.”
moderateConsent / capacity: “Some of these were signed by the person and others by their representative. It was not always clear why a representative had signed.”
minorMissed or late visits: “They sometimes turn up late, but they always get here. Timings have been erratic, but we didn't know about the half hour bandings, we now understand.”
minorCommunication with families: “Sometimes staff are difficult to understand. Sometimes they speak loudly and it sounds like shouting.”
Strengths
· Robust safeguarding systems with all staff trained and confident in reporting procedures
· Safe recruitment practices with appropriate DBS checks and thorough staff files
· Medicines managed safely with competency assessment before staff administer medicines
· Care plans included thorough, person-centred assessments reviewed and updated regularly
· Governance significantly improved since previous inspection; no longer in breach of Regulation 17
ICRIT Healthcare was rated Requires Improvement overall at this October 2018 inspection, with ongoing breaches of Regulation 17 (good governance) due to audit systems failing to detect unsafe moving and handling practice and repeated delays in CQC notifications. Effective, Caring and Responsive domains were all rated Good, reflecting significant improvements in staff training, personalised care and medicines management since the previous inspection.
Concerns (7)
criticalSafeguarding: “One person had been assessed as needing two carers to support them with all transfers but told us, that until recently, transfers had regularly been performed by one carer.”
criticalGovernance: “The provider had failed to maintain good governance. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalMissed or late visits: “Another safeguarding concern had been raised in relation to missed visits which had resulted in harm.”
moderateIncident learning: “There had been a long delay in notifying CQC of this incident... a notification had not been submitted as soon as the registered manager had been aware of an incident.”
minorCare planning: “The registered manager had not always recorded these phone calls in the person's daily records but had begun a log of calls in the office.”
minorRecord keeping: “We did not see any records in the daily records of any referrals. Staff told us they informed the manager who would make the necessary referral.”
minorComplaints handling: “Not everyone we spoke with felt confident their complaint or concern had been listened to, one person told us they had to raise a matter a few times before it was addressed.”
Strengths
· Significant improvements in staff training since last inspection; service no longer in breach of staffing regulations.
· Medicines managed safely with no gaps in MAR charts and timely audit follow-up.
· Staff recruited safely with all pre-employment checks completed before starting work.
· Risk assessments completed and regularly reviewed across all care plan areas.
· People felt safe and reported staff were caring, kind, and not rushed.
Quality-Statement breakdown (18)
safe: Moving and handling practice not always followed agreed risk assessmentsRequires improvement
safe: Medicines managementGood
safe: Staffing levels and recruitmentGood
safe: Safeguarding knowledge and proceduresGood
safe: Infection controlGood
effective: Staff training and inductionGood
effective: Supervision and appraisalGood
effective: Mental Capacity Act compliance and consentGood
ICRIT Healthcare received an overall rating of Requires Improvement at its first CQC inspection, with breaches of Regulations 17 and 18 identified for inadequate governance systems and failure to ensure staff received appropriate training in key areas including mental capacity, safeguarding and dementia care. The service demonstrated genuine strengths in the caring attitude of staff, reliable visit delivery, safe medicines management and responsive care planning, with people and relatives consistently praising the quality of direct care.
Concerns (8)
criticalStaff training: “not all care staff who had been employed at the service had completed training in a number of areas...challenging behaviours, emergency awareness, dementia awareness, mental capacity, equality and diversity”
criticalGovernance: “The provider had failed to maintain good governance. This was a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations, 2014.”
moderateRecord keeping: “quality of care records and the recording was not consistent and robust especially in respect of ensuring details about consent to care and risk assessments had been clearly documented”
moderateConsent / capacity: “the provider had not provided staff with training in this area and records for mental capacity had not been consistently completed across the service”
moderateSafeguarding: “six care staff had not received safeguarding awareness training”
moderateCare planning: “systems and processes for assessing the quality of the service were not robust to ensure audits were taken for the quality of the care records, staff recruitment files and staff training needs”
minorSupervision / appraisal: “not all supervision records had been signed by the registered manager and staff”
minorCommunication with families: “I just wish the office would ring if they are caught up in emergencies or delayed to let me know they are running late”
Strengths
· People and relatives spoke overwhelmingly positively about the caring nature and compassion of care staff
· Medicines management was robust with MAR audits, competency checks and staff re-training where errors identified
· Safe recruitment procedures followed including DBS checks and character references for all reviewed staff files
· Safeguarding incidents were investigated, disciplinary measures applied and lessons learnt documented
· Care plans were person-centred, detailed and regularly reviewed with involvement of people and relatives
Quality-Statement breakdown (16)
safe: Safeguarding systems and risk managementRequires improvement
safe: Medicines managementGood
safe: Safe recruitmentGood
safe: Staffing levels and visit reliabilityGood
effective: Staff training and developmentRequires improvement
effective: Mental capacity and consentRequires improvement
effective: Supervision and inductionGood
effective: Nutrition and healthcare needsGood
effective: Assessment and care planningGood
caring: Dignity, respect and person-centred approachGood
caring: Communication and involvement in decisionsGood
caring: Cultural and religious needsGood
responsive: Personalised care planning and reviewGood
responsive: Complaints handlingGood
responsive: End of life careNot rated
well-led: Governance and audit systemsRequires improvement