Amber Valley Total Care received an overall Inadequate rating at this focused inspection, remaining in special measures due to continued breaches of Regulations 12, 17 and 19, with persistent failures in risk assessment, medicines management, unsafe recruitment, and ineffective governance. Enforcement action included conditions imposed on registration and a Warning Notice, as the provider failed to make sufficient improvement since the previous inspection in January 2023.
Concerns (10)
criticalCare planning: “One person's care plan stated they were at risk of choking, however there was no guidance in place for staff to inform them how to respond if this person exhibited symptoms of choking.”
critical
Medication management
: “There was no guidance in place for people who were prescribed 'as and when required' medicines and staff did not record the dose administered.”
criticalStaffing levels: “We found 8 recruitment files of staff employed at the service that did not include checks with the Barring Service. This meant people were at risk of receiving care from unsuitable staff.”
criticalGovernance: “The provider's auditing processes were ineffective and did not identify any of the shortfalls found during our inspection. Care plan audits did not identify the lack of information recorded in 9 different care plans.”
criticalConsent / capacity: “People had mental capacity assessments but they were not completed in line with the Mental Capacity Act Code of Practice. There were no best interest decisions in place for people who lacked capacity.”
criticalIncident learning: “There was a lack of evidence to show the provider had processes in place to learn from events. The issues identified at the previous inspection were still not addressed at this inspection.”
moderateLeadership: “One staff member said, 'The [registered] manager is rough with us. The management style is very outdated, they don't listen to staff'.”
moderateRecord keeping: “Staff used a communication portal to share concerns about people's health and wellbeing, however we saw no evidence that the provider took any actions to follow up on the concerns.”
moderatePerson-centred care: “One person requested to be supported by female staff only, but this was not recorded in their care plan. We saw that on one occasion this person's request was not accommodated.”
minorSupervision / appraisal: “Some staff felt supervisions were helpful and a safe space to discuss any concerns. Others felt they were not well supported by the manager and did not feel comfortable raising issues.”
Strengths
· Staff completed safeguarding training and had awareness and understanding of abuse, knowing how to report safeguarding concerns.
· People felt safe receiving support from care staff and spoke highly of carers.
· Staff received appropriate training, induction and felt confident working independently.
· Staff followed infection control policies and used PPE effectively.
· There were enough staff to meet people's needs, with cover available for missed calls.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongInadequate
safe: Staffing and recruitmentInadequate
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Preventing and controlling infectionGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Staff support: induction, training, skills and experienceGood
well-led: Managers and staff being clear about their roles, quality performance, risks and regulatory requirementsInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate
well-led: How the provider understands and acts on the duty of candourGood
Amber Valley Total Care was rated Inadequate overall following a January 2023 inspection, with breaches of Regulations 12, 17, and 19 identified in relation to unsafe medicines management, absent risk assessments, unsafe recruitment, and a complete absence of governance audits and statutory notifications. The service was placed in special measures, with warning notices issued across all three breached regulations.
Concerns (14)
criticalGovernance: “There were no systems in place to audit any aspect of the service, this meant there was no evidence of learning, reflective practice or service improvement.”
criticalIncident learning: “There were no statutory notifications submitted in the last 12 months to inform us of significant events that happened at the service.”
criticalSafeguarding: “There were no systems in place to analyse accidents or incidents... people were at risk of harm due to no analysis or identification of trends.”
criticalMedication management: “We found missing signatures on the 3 medicine administration records (MAR) viewed. This meant people did not always receive their prescribed medication.”
criticalMedication management: “MAR were handwritten and were not completed in line with best practice, for example the strength, dose or route of medicines had not been recorded for 3 people.”
criticalCare planning: “Risks were not assessed, monitored or managed appropriately. There was no written guidance or control measures in place to mitigate risks.”
criticalLeadership: “The provider who worked as the registered manager did not fully understand their responsibilities of their registration with us.”
criticalRecord keeping: “We found 2 recruitment files of staff employed that did not include references or full employment history. One person employed did not have a completed criminal record check.”
moderateStaff competency: “The provider could not evidence staff competency checks had been undertaken to ensure staff remained safe to administer medicines.”
moderateCare planning: “Care plans did not include individual likes, dislikes and preferences... no evidence to demonstrate people's care was personalised.”
moderateStaff training: “Not all staff had received infection prevention control (IPC) training. This posed a risk in relation to managing and minimising the risk of infection.”
moderateSupervision / appraisal: “Staff supervision and support was not consistent... supervision records we saw were a short checklist not detailing specific discussion or progress.”
moderatePerson-centred care: “Care plans did not consistently include people's preferences, choices or social history. This meant people or their relatives were not fully involved to inform care planning.”
minorInfection control: “The policy did not refer to procedures in relation to COVID-19. This meant there was a risk that procedures in relation to COVID-19 may not have been embedded.”
Strengths
· People told us staff were kind, caring and reliable, with one person stating 'They are very caring, I can't speak highly enough of them to be honest'.
· There were enough staff to meet the needs of people using the service; people received their care within 30 minutes of their allocated time.
· Complaints were investigated and actions taken to improve people's outcomes in a timely manner.
· The service worked within the principles of the Mental Capacity Act 2005 with completed mental capacity assessments in care plans.
· The provider worked with other healthcare professionals, including referrals to district nursing and social work teams.
Quality-Statement breakdown (20)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongInadequate
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Using medicines safelyInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
effective: Staff support: induction, training, skills and experience
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Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careInadequate
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringInadequate