The Kingsgate improved from Requires Improvement to Good across Safe, Effective and Well-Led following a focused inspection, having resolved prior breaches of Regulations 11 and 12. A minor ongoing issue with dual medication recording systems was noted but people were receiving their medicines safely.
Concerns (2)
minorMedication management: “Due to the two methods of recording, it was not always clear to see what medicines had been given and when.”
minorRecord keeping: “The provider told us that two systems were being used to monitor the giving of medicines as a temporary method.”
Strengths
· People felt safe and expressed confidence in staff providing personal care.
· Robust risk assessments and personalised care plans were in place for each individual.
· Effective and safe recruitment practices including DBS checks and full employment histories.
· Staff received appropriate training including safeguarding, infection control and catheter care.
· Accidents and incidents were recorded, reviewed and actions shared with staff promptly.
Quality-Statement breakdown (14)
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
Maple House, a small domiciliary care agency in Purley, was rated Requires Improvement overall at its first inspection in July 2019, with regulatory breaches found in safe care and treatment (Regulation 12) and need for consent (Regulation 11). While staff were caring, respectful and promoted dignity and independence, significant shortfalls were identified in medicines management, risk assessment, care plan accuracy, and Mental Capacity Act compliance.
Concerns (9)
criticalMedication management: “MAR charts did not always contain details such as what time a medicine should be taken or how many tablets to take. In one case, the name of the medicine was not present.”
criticalConsent / capacity: “None of the three people whose care plans we reviewed had provided a signature or other indication that they consented to their care being provided as planned.”
criticalRecord keeping: “One person whose care plan stated they needed staff to prompt them with medicines did not have a MAR and staff were not recording in daily notes whether they prompted the person.”
moderateCare planning: “Some of the information in care plans was out of date or incomplete...one person's care plan referred to what they would like to happen when they came out of hospital, which had already happened.”
moderateGovernance: “The provider's audits and checks were not always effective in identifying improvements that were required. Their care plan audits had not identified the problems we found.”
moderateSafeguarding: “Staff did not always know the correct procedures to follow when reporting a safeguarding concern. Two staff told us they would discuss the concerns with people or their relatives.”
moderateEnd-of-life care: “One care plan also made reference to a decision not to attempt resuscitation in the event of cardiac arrest but there was no evidence to show this decision had been made by an appropriate medical professional.”
minorCultural competency: “Although the provider asked about people's diverse characteristics such as cultural and religious needs...it was not always clear whether these were considered when planning people's care.”
minorStaff training: “The service did not have a written accident and incident reporting policy in place. This meant there was a risk that the provider's system would become less effective as the service expanded.”
Strengths
· Staff took time to build supportive relationships with people, with people reporting feeling safe, comfortable and treated with dignity and respect.
· Good consistency in staffing due to small team size, enabling strong relationships between staff and people using the service.
· Staff promoted people's privacy, dignity and independence, with care plans reflecting individual preferences.
· The provider worked with other agencies such as the district nursing team to support people's healthcare needs.
· The registered manager carried out regular spot checks and sought feedback regularly from people, relatives and staff.
Quality-Statement breakdown (24)
safe: Assessing risk, safety monitoring and managementRequires improvement
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: Staffing and recruitmentRequires 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 law
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; 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 control and to meet their needs and preferencesRequires improvement
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportNot rated
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candour; Working in partnership with othersGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood