My Homecare Slough South Bucks improved its overall rating from Requires Improvement to Good at this focused July 2023 inspection, having remedied all prior regulatory breaches in safe recruitment, risk assessment, safeguarding, medicines, infection control, care planning, complaints and governance. Safe remains Requires Improvement due to ongoing concerns about staff rotas not providing sufficient travel time, causing rushed visits, and risk assessments that are not fully personalised to individuals.
Concerns (8)
moderateMissed or late visits: “The carers are very nice, some are a bit rough and they seem to be in a rush and a hurry to get to the next call”
moderate
Care planning
: “information within some risk assessments was not fully personalised, which meant standardised statements could be potentially misleading for staff”
moderateCare planning: “1 person's care plan contained information about 3 different types of epileptic seizures without specifying which type of seizures the person normally experienced”
moderateIncident learning: “not all incidents had been logged on the system. This meant we could not be assured this data available to the registered manager was fully accurate”
minorMedication management: “1 person's risk assessment did not include the storage location for their prescribed creams or include the potential fire risk associated with the use of emollient creams”
minorRecord keeping: “1 staff member's file contained 3 documents relating to another staff member…the service had failed to display its rating at the office location and on its webpage”
minorSafeguarding: “We identified one incident witnessed by care staff where the service had not sought guidance from the local authority as to whether the threshold was met for a safeguarding referral”
minorPerson-centred care: “there was limited and variable information gathered about people's wider social needs, such as their culture and interests”
Strengths
· Staff were safely recruited with full pre-employment checks including overseas criminal record checks where applicable
· Safe medicines administration practices improved with monthly audits and daily stock checks successfully identifying a recent error
· Effective infection prevention and control measures promoted, including staff training and PPE provision
· Continuity of care promoted through small staff 'routes' with route leaders providing oversight
· Governance systems significantly improved since last inspection with electronic quality assurance system and regular audits
Quality-Statement breakdown (14)
safe: Staffing and recruitmentGood
safe: Staff rotas and travel timeRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Safeguarding and learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
responsive: Planning personalised care and person-centred care plansGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Roles, quality performance, risks and regulatory requirements; continuous learningGood
well-led: Engaging people, public and staff; working in partnershipGood
well-led: Promoting a positive, person-centred and open cultureGood
Focused inspection downgraded the service from Good to Requires Improvement overall, with Well-led rated Inadequate due to ineffective audits, poor records, unreported safeguarding allegations and missed CQC notifications. Seven regulatory breaches were identified (Regs 9, 12, 13, 16, 17, 19 and Reg 18 Registration) with warning notices served for safeguarding and good governance failures.
Concerns (16)
criticalSafeguarding: “The registered manager failed to report any of these allegations to the local authority...placed at risk of harm because the registered manager failed to recognise what was a safeguarding incident”
criticalMedication management: “Records did not evidence safe medicines administration had consistently taken place. This was a breach of Regulation 12”
criticalGovernance: “Quality assurance systems and processes used to assess and monitor the service were ineffective. This was because audits were either not undertaken regularly or in some instances were not completed at all.”
criticalLeadership: “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalComplaints handling: “Systems were not effectively operated and accessible for identifying, handling and responding to complaints. This was a breach of Regulation 16”
criticalInfection control: “Systems were not operated effectively to ensure appropriate infection control measures in response to the COVID-19 pandemic.”
criticalOther: “Systems were not consistently operated for the safe recruitment of staff. This was a breach of Regulation 19”
moderateCare planning: “Some care plans contained incomplete or unclear information, meaning staff did not have full information to inform them about relevant risks.”
moderatePerson-centred care: “The assessment, review and delivery of care was not always personalised to people's needs and preferences. This was a breach of Regulation 9”
moderateStaff training: “only four staff had received training in relation to supporting 'challenging' behaviour. A relative expressed concern about whether all staff were competent”
moderateSupervision / appraisal: “supervision policy stated staff should receive six formal supervisions a year but supervision records viewed showed this did not happen.”
moderateRecord keeping: “Records maintained were not always complete, accurate and kept up to date, as seen in staff recruitment files, quality assurance audits, safeguarding records”
moderateIncident learning: “There was no evidence the service had undertaken an audit or wider analysis of accidents and incidents to identify themes, trends, or where further action may be required”
moderateMissed or late visits: “Visit records showed evening visits were regularly carried out around one hour later, with some visits recorded after 10.30pm, and two recent visits commencing after 11pm.”
moderateCommunication with families: “The communication needs of people with disability or sensory loss were not always met. This was a breach of Regulation 9”
minorCultural competency: “Another person had a cultural preference for female staff, and experienced episodes of distress, but received some care from male staff”
Strengths
· Staff knowledgeable about people they regularly supported and their preferred routines
· Positive feedback regarding end of life care provision
· Staff demonstrated awareness of cultural needs and assigned matching staff where possible
· Most people reported feeling safe with care staff
· Staff understood signs of abuse and how to escalate concerns internally
Quality-Statement breakdown (13)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Planning personalised care to ensure people have choice and controlRequires improvement