Rapid Improvement Care Agency Central London Branch was rated Good across all five key questions at its February 2020 inspection, having remedied the previous breach of Regulation 12 relating to medicines management. Two recommendations were made regarding clearer Mental Capacity Act assessment processes and more robust auditing of personnel files.
Concerns (3)
minor
Consent / capacity
: “the policy stated that the provider should abide by the MCA, but there were not always clear instructions on how they might assess capacity or how to demonstrate they were working in line with the person's best interests.”
minorGovernance: “Personnel files contained a checklist of information that needed to be held, which was not fully in line with legal requirements. These checklists had not always been completed and there was no overall audit of personnel files.”
minorRecord keeping: “People were given information on how to contact CQC but this contained out of date contact information.”
Strengths
· Medicines management had improved since the previous inspection, resolving the prior breach of Regulation 12.
· People received consistent care from the same care worker who knew them well, with one person stating their carer is 'amazing' and '[s/he] knows me better than myself'.
· Robust recruitment processes including DBS checks, right-to-work verification, and evidence of satisfactory conduct in previous employment.
· Staff received quarterly supervisions, regular competency checks via bi-monthly observations, and training across a range of key areas.
· Care plans were culturally sensitive and personalised, addressing language, religious, dietary, and psychological needs.
Quality-Statement breakdown (21)
safe: Using medicines safelyGood
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
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: Supporting people to live healthier lives, access healthcare services and supportGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
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 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: How the provider understands and acts on the duty of candour; Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsGood
safe:Insufficient evidence to rateeffective:Insufficient evidence to ratecaring:Insufficient evidence to rateresponsive:Insufficient evidence to ratewell-led:Insufficient evidence to rate
This first inspection of Rapid Improvement Care Agency Central London Branch found the service could not be rated due to insufficient evidence, with only one person using the service at the time. A breach of Regulation 17 was identified regarding inaccurate medicines records and care plans, though broader aspects of care, staffing, and management were found to be broadly appropriate.
Concerns (5)
criticalMedication management: “The person's plan inaccurately stated they were self-administering their medicines but care workers recorded on daily logs that they were giving medicines.”
criticalRecord keeping: “The provider was not keeping medicines administration records of the support people received for each individual medicine. This constituted a breach of regulation 17.”
minorGovernance: “The provider did not have a suitable system for displaying the ratings of their services on their website, although this location is yet to be rated.”
minorComplaints handling: “The provider's process did not detail any follow up with people to ensure they were happy with the response to the complaint.”
minorConsent / capacity: “The person using the service had capacity to make decisions about their care and had signed some records such as assessments; not all care plans had been signed by the person.”
Strengths
· The person using the service expressed satisfaction with their care worker and reported regular management check-ins.
· Care plans were reviewed regularly and updated when needs changed, including following hospital discharge.
· Staff were recruited using safer recruitment processes including DBS checks and right-to-work verification.
· Care workers received appropriate induction training covering safeguarding, moving and handling, medicines, first aid, and infection control.
· Care workers received regular supervision and quarterly team meetings were held.
Quality-Statement breakdown (19)
safe: Using medicines safelyInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuseInsufficient evidence to rate
safe: Assessing risk, safety monitoring and managementInsufficient evidence to rate
safe: Staffing and recruitmentInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate
safe: Learning lessons when things go wrongInsufficient evidence to rate
effective: Assessing people's needs and choicesInsufficient evidence to rate
effective: Staff support: induction, training, skills and experience
Insufficient evidence to rate
effective: Supporting people to eat and drink enough to maintain a balanced dietInsufficient evidence to rate
effective: Staff working with other agencies and supporting people to live healthier livesInsufficient evidence to rate
effective: Ensuring consent to care and treatment in line with law and guidanceInsufficient evidence to rate
caring: Ensuring people are well treated and supported; respecting equality and diversityInsufficient evidence to rate
caring: Respecting and promoting people's privacy, dignity and independenceInsufficient evidence to rate
responsive: Planning personalised care to meet people's needs, preferences and choicesInsufficient evidence to rate
responsive: Improving care quality in response to complaints or concernsInsufficient evidence to rate
well-led: Planning and promoting person-centred, high-quality care with opennessInsufficient evidence to rate
well-led: Managers and staff being clear about their roles and understanding quality performanceInsufficient evidence to rate
well-led: Engaging and involving people using the service and continuous learningInsufficient evidence to rate
well-led: Working in partnership with othersInsufficient evidence to rate