Mears Care Rotherham improved from Requires Improvement to Good overall, having resolved previous medication management and governance concerns identified at the June 2017 inspection. All five key questions were rated Good, with the service demonstrating safe medication practices, person-centred care, effective auditing, and strong staff support structures.
Strengths
· Medicines managed safely with accurate MARs, monthly audits, and spot checks monitoring administration
· Risk assessments in place covering personal risks and home environments for all reviewed care plans
· Staff received comprehensive mandatory training including safeguarding, infection control, and medicines management
· People's privacy and dignity upheld, monitored through unannounced spot checks by managers
· Care plans detailed and person-centred, including life histories, interests, and individual preferences
Mears Care Rotherham was rated Requires Improvement overall at its first inspection, with a regulatory breach (Regulation 12) identified due to significant shortfalls in medication management including missing records, undocumented administration, and an unreported double-dose incident. The service performed well in caring, effective, and responsive domains, but governance and audit processes were insufficiently robust to detect and address medication failings.
Concerns (6)
criticalMedication management: “there were no records for staff to confirm that they had applied this medication, and there was also a lack of information about where on each person it should be applied.”
criticalMedication management: “we noted an incident where a person was accidentally given a double dose of medicines by staff. We raised this with the registered manager, who had not been made aware of this incident.”
moderateRecord keeping: “Often there was no staff signature to show who had completed this form and at times the form lacked detail. For example, we saw some medicines were recorded to be administered "as directed."”
moderateGovernance: “we identified shortfalls within the management of medicines that this increased auditing had failed to identify, indicating that the audit lacked completeness.”
moderateIncident learning: “When medication issues were reported there was no matter of urgency or anyone contacting us back to see how the patient was or any feedback as to what was happening.”
minorPerson-centred care: “A number of people told us that the provider used to give them a printed rota...but they said that this practice had recently ceased, which they were unhappy about.”
Strengths
· Staff were trained in protecting people from harm and appropriate safeguarding systems were in place.
· Robust recruitment processes including comprehensive DBS checks and two written references for all staff.
· Highly personalised care plans reflecting individual preferences, opinions, and care needs.
· Good staff training including a comprehensive five-day induction with practical and knowledge components.
· Effective complaints handling with written responses and signposting to external remedy.