OASIS Central London Office, a domiciliary care agency supporting 145 people, was rated Requires Improvement overall with breaches of Regulations 12 and 17 relating to unsafe medicines management, inadequate risk assessments and ineffective quality assurance. Staff were found to be caring and well-recruited, but care planning lacked personalisation and some people experienced late visits without being informed.
Concerns (9)
criticalMedication management: “Medicines were not always documented and recorded diligently. For example, we found gaps in a number of medicines administration records (MARs)”
criticalCare planning: “not all risk assessments provided staff with clear and concise information in how to manage and minimise the risk identified in the assessment”
criticalGovernance: “The current quality assurance systems did not highlight the shortfalls we found in relation to people's care plans, risk assessments, medicines management, MAR charts and assessments of needs.”
moderateMedication management: “there were no care plans or 'protocols' in place to inform staff when to administer these [PRN] medicines, or what their intended affect was”
moderateCare planning: “The safety of staff was not assessed for every home visit they might attend. There were not always environmental or lone working risk assessments for some properties”
moderateMissed or late visits: “Most complaints related to staff being late... Some people told us they were not always informed if staff were late.”
moderatePerson-centred care: “The electronic system focussed on a list of daily tasks the person required support with rather than how they would like to be supported.”
moderateConsent / capacity: “we found that some relatives made decisions on people's behalf without having obtained the appropriate permission”
minorCommunication with families: “While most people told us that they were informed if staff would be late, this was however not the case for everyone.”
Strengths
· Staff were caring, kind and treated people with dignity and respect
· Safe and effective recruitment practices including DBS checks and references
· Staff matched with people based on cultural, language and gender preferences
· Staff had a good understanding of safeguarding and how to report concerns
· Regular supervision and induction based on the Care Certificate
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management, using medicines safelyRequires improvement
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: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
caring: Ensuring people are well treated and supportedGood
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 controlRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportNot rated
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 understands and acts on duty of candour responsibilityRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
safe:Goodeffective:Inspected but not ratedresponsive:Goodwell-led:Good
Focused inspection found OCTA had addressed previous breaches of Regulations 12 and 17, with improvements to medicines management, risk assessment, care planning and governance, raising the overall rating from Requires Improvement to Good. Minor concern noted that BAME staff COVID-19 risk discussions were informal and not documented.
Concerns (1)
minorInfection control: “the registered manager told us that they would discuss COVID-19 risks with staff from the Black, Asian and Minority Ethnic (BAME) community. However, this was currently done informally.”
Strengths
· Safe recruitment practices with appropriate pre-employment checks completed before staff were employed
· Electronic MARs introduced enabling immediate monitoring of missed or late medicines administration
· Real-time call monitoring system to track lateness and call duration
· Detailed, person-centred care plans including cultural, religious, communication and sexual preferences
· Effective quality assurance systems including regular audits of medicines and call monitoring
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferences
Not rated
responsive: Meeting people's communication needsNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: End of life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Continuous learning and improving care; Working in partnership with othersNot rated