Kare Plus Milton Keynes and Bedford was rated Requires Improvement overall following an announced inspection in July–August 2018, with a breach of Regulation 17 (Good Governance) identified due to inadequate oversight of care records, medicines, MCA compliance and complaints. Caring was rated Good, reflecting positive staff–people relationships and person-centred support, but significant gaps in risk assessments, care planning, MCA documentation and medicines recording undermined safety, effectiveness and responsiveness.
Concerns (9)
criticalGovernance: “This constitutes a breach of regulation 17(1): Good governance of the HSCA 2008 (Regulated Activities) Regulations 2014.”
moderateMedication management: “medicine administration record sheets (MAR) were not consistently being completed in line with current guidance...gaps in records of medicines that had been administered”
moderateCare planning: “People did not have appropriate risk assessments and risk management plans in place...one person required a high level of staff support to move; they did not have a moving and handling assessment”
moderateConsent / capacity: “there was no record of mental capacity assessments being undertaken or best interest decisions being made on behalf of people”
moderateComplaints handling: “one complaint investigation had not been concluded nor the outcome provided within the timeframe stated in the provider's complaints policy”
moderateRecord keeping: “Some people had specific health and medical needs that were not identified in their care plan...nutritional assessments and care plans were not in place”
minorSupervision / appraisal: “There were few records of planned one to one supervision and no records of appraisal.”
minorInfection control: “two people told us that although staff wore disposable gloves and washed their hands regularly, they did not wear protective aprons when supporting them with personal care”
minorStaff training: “some staff required training in practical manual handling as they had only undertaken training that covered the theory of manual handling”
Strengths
· Safe recruitment procedures with DBS checks, references and identification verified before staff commenced work.
· Sufficient staffing levels with staff arriving on time and notifying people and management when running late.
· People felt safe and had positive, caring relationships with a consistent team of staff who knew them well.
· Staff understood safeguarding responsibilities and how to report concerns.
· Incidents were reviewed by the registered manager and lessons shared with staff.
Quality-Statement breakdown (13)
safe: Medicines recording and administrationRequires improvement
safe: Risk assessment and risk management planningRequires improvement
safe: Safeguarding and staffingGood
effective: Mental Capacity Act compliance and best interest decisionsRequires improvement
effective: Health and nutritional needs assessment and recordingRequires improvement
effective: Access to healthcare professionalsGood
effective: Staff training and supervisionRequires improvement
caring: Relationships, dignity, respect and involvementGood
responsive: Care plan detail and accuracyRequires improvement
safe:Insufficient evidence to rateeffective:Insufficient evidence to ratecaring:Insufficient evidence to rateresponsive:Insufficient evidence to ratewell-led:Insufficient evidence to rate
Kare Plus Milton Keynes and Bedford was inspected in May 2017 as a newly established service providing personal care to only one person, resulting in an 'Inspected but not rated' outcome across all five key questions. The service demonstrated appropriate foundations including safe recruitment, person-centred care planning, and supportive leadership, but insufficient evidence was available to assess the effectiveness of most systems in practice.
Strengths
· Staff had a clear understanding of safeguarding procedures and appropriate risk assessments were in place promoting independence.
· Robust pre-employment checks including DBS, professional and personal references ensured only suitable staff were employed.
· Staff received induction training, mandatory training, shadowing, and were enrolled in the Care Certificate.
· Regular one-to-one supervisions were in place and annual appraisal procedures existed.
· People's consent was obtained before care was provided and individuality, privacy and dignity were respected.
Quality-Statement breakdown (10)
safe: Safeguarding and risk assessmentInsufficient evidence to rate
safe: Staffing levels and recruitmentInsufficient evidence to rate
safe: Medication managementInsufficient evidence to rate
effective: Staff training and inductionInsufficient evidence to rate
effective: Supervision and appraisalInsufficient evidence to rate
effective: Mental Capacity Act complianceInsufficient evidence to rate
caring: Person-centred care and dignityInsufficient evidence to rate
Kare Plus Milton Keynes and Bedford improved from Requires Improvement to Good across all key questions at this September 2019 inspection, having resolved a prior breach of Regulation 17 around governance and record-keeping. The service of 9 people received personalised, safe and well-managed care supported by effective audits, consistent staffing and an accessible registered manager.
Strengths
· People felt safe and staff demonstrated good understanding of safeguarding responsibilities
· Medication administration records were completed accurately and thorough audits identified minor errors
· Risk assessments documented risks in detail enabling staff to work safely