Edith Healthcare Ringwood is a domiciliary care service providing a regulated activity of personal care. The service was providing care and support to people in their own homes. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of our assessment, which took place between 17 July and 18 July 2024, there were 27 people receiving personal care from the service. This assessment was prompted by concerns around safe, effective staffing and the management of the service, therefore we looked at the 3 quality statements related to the concerns. However, following the assessment we did not have concerns and systems operated robustly within the service and people were safe. Staff were recruited safely and had received training, support, and guidance to enable them to carry out their role effectively. Safeguarding was managed within the service; appropriate referrals were made, and staff were aware of reporting procedures. Provider, registered manager, and staff team worked towards enhancing their inclusive culture within the service. They told us people who used their service were ‘family.’ Staff were encouraged to develop, and their individuality and skills were nurtured, they told us they felt included and appreciated. The registered manager and senior team were visible, accessible, and approachable.
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This focused KLOE inspection of Edith Healthcare Ringwood (June 2021) found the service had fully remediated a prior breach of Regulation 19 around recruitment, with both Safe and Well-led improving from Requires Improvement to Good. The service demonstrated safe staffing, robust medicines management, strong safeguarding practice and an open, well-governed culture praised by people, relatives and healthcare professionals.
Strengths
· Safe and robust recruitment practices with appropriate DBS checks, employment references and health screening completed before staff worked with people.
· Consistent, small team of experienced staff who knew people well, with no missed visits reported and suitable travelling times between visits.
· Medicines administered safely by trained staff with competency checks; guidance in place for as-needed medicines.
· Strong safeguarding knowledge among staff and management, with all people spoken to reporting they felt safe.
· Detailed and thorough COVID-19 risk assessments; adequate PPE supply with no clients contracting COVID-19.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infection; Learning lessons when things go wrongGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
Edith Healthcare Ringwood was rated Requires Improvement overall at its first scheduled inspection in April 2019, with one breach of Regulation 19 due to incomplete pre-employment checks, alongside weaknesses in medicines management, care planning, incident recording, and governance systems. The service demonstrated notable strengths in its caring culture, person-centred ethos, staff compassion, continuity of care, and multi-disciplinary working.
Concerns (9)
criticalStaffing levels: “one staff member did not have an enhanced criminal record check...All of the staff records viewed did not contain a full employment history.”
criticalRecord keeping: “References had been obtained but in some cases, these were telephone references that had not been confirmed in writing.”
criticalCare planning: “one person was living with epilepsy. Their seizure escalation plan contained conflicted information...key staff were also not clear about the escalation plan.”
criticalMedication management: “one person was prescribed a medicine to be taken every second day, this had not been happening. The prescribed dose was one or two tablets but staff were not recording how many were actually given.”
moderateIncident learning: “following such events such as falls or medicines errors, staff had not completed an incident form and there was no routine monitoring of incidents and accidents.”
moderateGovernance: “the systems in place had not been fully effective in assessing, monitoring and improving the quality and safety of the service.”
moderateGovernance: “whilst a recruitment audit had been undertaken in December 2018, this had not identified and rectified the concerns our inspection found.”
minorSupervision / appraisal: “we recommend that the registered manager ensure they have access to ongoing and regular clinical or professional supervision and that a suitable programme of mentorship is in place.”
minorEnd-of-life care: “End of life care planning was also an area which could be further developed to ensure these provided a fully person centred record of people's known wishes and preferences.”
Strengths
· People received consistent care workers enabling meaningful relationships and good continuity of care.
· Staff displayed a genuine desire to enhance people's wellbeing and went above and beyond, including staying with anxious clients and obtaining shopping in their own time.
· Strong person-centred culture embedded by the registered manager as a core vision for the service.
· Good safeguarding awareness and positive culture of reporting concerns among staff.
· Infection prevention and control processes followed in line with good practice guidance.
Quality-Statement breakdown (22)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Ensuring consent to care and treatment in line with law and guidance
Good
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
caring: Ensuring people are well treated and supported; 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 meet people's needs, preferences, interests and give them choice and controlGood
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, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Planning and promoting person-centred, high-quality care and support; and how the provider understands and acts on duty of candour responsibilityGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careRequires improvement