The Care Bureau Ltd – Domiciliary Care – Northampton was rated Requires Improvement overall following a focused inspection in November–December 2022, down from Good at the previous inspection in 2019. Key failures included ineffective governance and audit systems (a breach of Regulation 17), inconsistent medication management, inadequate risk record detail, poor weekend scheduling consistency, and insufficient communication with people and families.
Concerns (8)
criticalMedication management: “Issues raised in relation to medicine administration or found in medicine administration audits were not consistently addressed.”
criticalGovernance: “Systems to monitor the quality and performance of the service were not operated effectively to identify and maintain improvements.”
moderateCare planning: “some plans lacked the detail to fully mitigate the risk and give guidance to staff”
moderateStaffing levels: “I can have up to 9 calls in a morning with no travel time, it's too much.”
moderateMissed or late visits: “Weekends vary, I have an evening call and the staff rarely stay for the half an hour.”
moderateRecord keeping: “we found gaps in information and some records not updated which had not been identified through the provider's audits.”
moderatePerson-centred care: “The weekend call time changed without any consultation, weekends are not good.”
moderateCommunication with families: “I have raised concerns with the office and been told the manager would get back to me, but they haven't.”
Strengths
· Staff received training in medicine administration with competencies tested
· Effective infection prevention and control measures including appropriate PPE use
· Safe recruitment practices with DBS checks and employment references obtained before staff started
· Good relationships established with community health professionals and local hospital
· People's needs assessed prior to service commencement with consent obtained
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyRequires improvement
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 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
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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 staffRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Working in partnership with others; Continuous learning and improving careGood
The Care Bureau Ltd - Domiciliary Care - Northampton received an overall Good rating across all five key questions at its first inspection in May 2019, with 98 older adults receiving personal care. Minor issues were identified around incomplete capacity assessments, overdue care plan reviews for transferred service users, a missing DBS record, and occasional weekend late visits, all of which the provider had already begun to address.
Concerns (5)
moderateRecord keeping: “one file for a staff member that had transferred to the service under TUPE conditions did not have on file proof of a DBS check”
minorConsent / capacity: “we found some of the capacity assessments had not been fully completed. This was an area the provider had identified in their own internal audits.”
minorCare planning: “some support plans for people that had transferred to the service from other providers were overdue formal care reviews.”
minorMissed or late visits: “One person said staff arrived late (mainly at weekends), which caused a problem for them attending a physiotherapy appointment.”
minorGovernance: “The service did not have a manager registered with the Care Quality Commission (CQC). The previous registered manager had de-registered with CQC on 15 May 2019.”
Strengths
· People felt safe and staff demonstrated clear understanding of safeguarding responsibilities.
· Sufficient staffing levels with a call monitoring system to track arrivals and alert the service when staff were running late.
· Thorough recruitment process including DBS checks, employment history and proof of identity.
· Staff received induction training, supervision and one-to-one meetings to support their development.
· Medicines managed safely with accurate MAR records and regular audits.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
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 lawGood
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff worked with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Ensuring people are well treated and supported; respecting equality and diversity; privacy, dignity and independenceGood
caring: Supporting people to express their views and be involved in making decisions about their careGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
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: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and 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 careGood