Link Medical Staffing Solutions Ltd Haverhill Branch received an overall rating of Requires Improvement at this focused inspection, with Good for Safe but continued Requires Improvement for Effective and Well-Led. Key concerns include a continued breach of Regulation 17 (Good Governance) due to weak audit systems, lack of staff meetings, a culture where staff feared raising concerns, and failure to implement Oliver McGowan mandatory training.
Concerns (8)
criticalGovernance: “There was no structured system to review service delivery and ensure high quality care was provided.”
critical
Leadership
: “Several staff told us there was a culture within the service where they were not able to speak up for fear of repercussion.”
moderateStaff training: “The provider had not updated their induction training to include the 'Oliver McGowan Mandatory Training on Learning Disability and Autism'.”
moderateIncident learning: “Analysis of themes, trends or patterns were not assessed. Staff were not always informed of the outcome from these incidents.”
moderateCommunication with families: “People shared that they did not always receive their care and support visits from staff they knew. Where changes occurred, these were not always communicated in a timely manner.”
moderatePerson-centred care: “One person told us, 'The [registered] manager has never asked me about how I think my care is going.' Another person commented, 'I have never had any forms to fill in.'”
moderateRecord keeping: “The provider told us they carried out regular 'spot checks' of care staff performance but was unable to locate all of these records.”
minorStaff competency: “The training…well they don't always carry out tasks in the same way. Some carers do things differently than others.”
Strengths
· People's medicines were managed safely with no reported issues and PRN care plans in place.
· Appropriate recruitment safety checks were carried out including DBS checks and references.
· Staff wore and had access to PPE; infection prevention and control training completed by all staff.
· Each person using the service had a care plan in place developed following an assessment of needs.
· Improvements in timely referrals to healthcare professionals since last inspection.
Quality-Statement breakdown (13)
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
well-led: Promoting a positive culture; managers and staff clear on roles; duty of candourRequires improvement
well-led: Continuous learning; engaging people and staff; working in partnershipRequires improvement
This focused follow-up inspection found the provider had met the previous warning notice on infection control and recruitment but remained in breach of Regulations 12 and 17 due to incomplete care plans, weak risk assessments and ineffective governance/auditing. Despite consistently positive feedback from people and relatives, oversight of medicines, MCA compliance and quality assurance required further improvement.
Concerns (9)
criticalGovernance: “Quality assurance and governance arrangements were not effective to identify shortfalls and promote improvements.”
criticalCare planning: “One person's care plan and risk assessment was blank... the person was in receipt of personal care, at risk of pressure ulcers and was diabetic.”
criticalRecord keeping: “Record keeping in areas such as care planning and risk assessing was not robust and did not support the consistent delivery of safe and effective care.”
moderateMedication management: “there were recordings of medicines not being administered but no reasoning why on the MAR chart or in the person's care notes.”
moderateConsent / capacity: “records did not demonstrate that the MCA had been followed... decisions, where a person lacked capacity to consent, were clearly recorded as being in the persons best interests.”
moderateStaff competency: “Recently employed staff told us there had not been a competency assessment of their practice in certain healthcare tasks before working with people on their own.”
moderateIncident learning: “There was not a robust system in place for the provider to evidence how they learned lessons when things go wrong.”
moderateLeadership: “The provider recognised the need to recruit an effective and experienced manager to run the service on a day to day basis.”
moderateSafeguarding: “where one person had a deterioration in their skin health, staff took a photograph, but no referral was made to a healthcare professional for review.”
Strengths
· People and relatives were highly complimentary about the service and care received
· Improvements in safe recruitment, infection prevention and control, and PPE use since last inspection
· Improved oversight of care calls through new electronic system; calls on time and full duration
· Staff received training and were enrolled on health and social care vocational qualifications
· Safeguarding systems in place and staff understood reporting responsibilities
Quality-Statement breakdown (13)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff working with other agencies; Supporting people to access healthcare servicesNot rated
effective: Staff support: induction, training, skills and experience