Focused inspection downgraded the service from Good to Requires Improvement, with breaches of Regulations 12, 17 and 19 covering unsafe medicines management, ineffective governance and inadequate recruitment procedures. Despite positive feedback from people and partners, quality assurance systems failed to identify shortcomings in risk assessments, MARs, COVID-19 controls and employment history checks.
Concerns (9)
criticalMedication management: “People's medicines were not always managed safely. Care plans contained conflicting information about the level of support people required to take their medicines.”
criticalStaff competency: “The provider did not follow safe recruitment processes to ensure staff were suitable to work with people with health and social care needs.”
criticalRecord keeping: “The provider did not obtain a full employment history when recruiting staff and gaps in employment were not explained.”
criticalGovernance: “There were quality assurance processes in place but these were not always effective as they had not identified the issues we found with risk assessments, medicines support and recruitment files.”
moderateMedication management: “Staff received training in the administration of medicines, however, their competency had not been assessed in line with best practice guidance.”
moderateRecord keeping: “References from previous employers were not always obtained before people started work.”
moderateInfection control: “The provider was not doing all they could to prevent and control infections as staff were not carrying out regular COVID-19 tests according to current government guidelines.”
moderateInfection control: “The provider had also not assessed the risk of COVID-19 for people receiving care or staff.”
moderateCare planning: “staff were no longer supporting this person with medicines, but the care plan had not been updated to reflect this change.”
Strengths
· People and relatives gave positive feedback about the care received, including staff going 'the extra mile'.
· ECM analysis showed people received their care visits on time and staff communicated when running late.
· DBS checks were conducted before new staff started working.
· Staff had access to appropriate PPE and followed safe hygiene practices.
· Staff demonstrated good understanding of safeguarding and whistleblowing procedures.
Quality-Statement breakdown (10)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infection; Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk from abuseGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood