Empowerment Care Ltd, a domiciliary care agency serving 19 people, remained in breach of Regulations 12 and 17 at this focused inspection, with persistent failures in risk assessment, care planning, consent/capacity processes, staffing rotas and governance oversight. Strengths included a responsive registered manager, positive staff relationships, improved medicines administration and effective infection control.
Concerns (11)
criticalCare planning: “People did not always have risks to their safety assessed and planned for. For example, there were no risks assessment in place for specific health conditions people experienced such as motor neurone disease, autism and epilepsy.”
criticalGovernance: “Systems were either not in place or robust enough to demonstrate effective management to ensure quality and manage risk. This was continued breach of Regulation 17.”
criticalRecord keeping: “Care plans and risk assessments contained conflicting information...the information we reviewed in 1 person's care plan did not reflect the care plan in the person's home.”
criticalStaffing levels: “Staff rotas we looked at recorded some staff were attending 2 or more calls at the same time or no staff were assigned to calls at all.”
criticalSafeguarding: “People were not always kept safe from avoidable harm as measures identified by the safeguarding team had not all been implemented.”
criticalIncident learning: “The provider had received recommendations from the safeguarding team to improve their practice, but these had not been implemented and we found continued concerns during our inspection.”
moderateConsent / capacity: “We found mental capacity assessments and best interest decisions were not carried out for people who may lack capacity. Relatives choices were followed instead.”
moderateStaff training: “No staff had received learning disability training, which is now a requirement for all services who support people with a learning disability.”
moderateSupervision / appraisal: “Staff had not received support through supervisions or appraisals. However, staff attended team meetings so they could share their views.”
moderateMedication management: “Medicines audits did not identify some people's medicines and Medication Administration records (MARS) had not been reviewed for 3 months.”
moderateMissed or late visits: “One person said, 'They aren't usually on time, they can be 30 minutes late.'”
Strengths
· Staff knew people well and understood how to meet their needs, with no evidence anyone had come to harm.
· Improvements had been made to medicines management since the last inspection, with accurate records and trained staff.
· Effective infection prevention and control practices, including appropriate PPE use.
· Registered manager was responsive, open and transparent; people, relatives and staff spoke positively about them.
· Staff recruitment was safe, with relevant pre-employment checks including DBS carried out.
Quality-Statement breakdown (12)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyGood
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
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
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
Empowerment Care Ltd was rated Requires Improvement overall, with breaches of Regulation 12 (safe care and treatment) for unsafe medicines management and Regulation 17 (good governance) for inconsistent audits and ineffective monitoring systems. Effective, caring and responsive domains were rated Good, with positive feedback from people and relatives about competent, kind staff and personalised care planning.
Concerns (8)
criticalMedication management: “for two people we reviewed, we found there were blank gaps on the medicines administration records (MAR)... There were no stock checks of medicines taking place”
criticalMedication management: “One person was prescribed a medicine two times a day. The MAR we reviewed showed that for 24 days they had received this medicine three times a day.”
criticalGovernance: “Audit completion was inconsistent... This meant these were not effective in identifying all areas of improvement as they were not consistently completed.”
criticalSafeguarding: “There was an ongoing safeguarding... where one person had received twice the amount of medicines they had required... the provider had not identified this or raised as a safeguarding to the local authority.”
moderateMedication management: “When people were prescribed as required medicines there was no guidance in place for staff to follow.”
moderateIncident learning: “there were several incidents where concerns had been raised about staff. Although action had been taken these incidents had continued to reoccur.”
moderateRecord keeping: “When people were prescribed patches to be administered on their skin, there were no records in place confirming where these patches had been administered.”
moderateLeadership: “the service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
Strengths
· Staff received pre-employment checks and there were enough staff available to support people
· Staff received induction, ongoing training and competency assessments for specific needs such as oxygen therapy and epilepsy
· People and relatives praised staff as caring, sensitive and competent
· People's privacy, dignity and independence were promoted
· Care plans reflected personal preferences, choices and communication needs
Quality-Statement breakdown (23)
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff support: induction, training, skills and experience
Good
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcareGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Working in partnership with othersNot rated