Community Support Services received an overall Good rating in July 2017, with a Requires Improvement rating for Safe following a serious series of medication errors that led the provider to suspend the service for six weeks and undertake a comprehensive review. Newly introduced medicines governance measures, robust recruitment, adequate staffing, and positive person-centred care across the other four domains supported the overall Good rating, though medicines reforms remained in the process of being fully embedded.
Concerns (6)
criticalMedication management: “a series of errors when community support workers were assisting people with their medicines...staff not understanding or following the policies and procedures in place”
moderateIncident learning: “there had previously been a lack of analysis of accidents and incidents, and consequently a lack of evidence of any learning”
moderateSafeguarding: “the services threshold for submitting safeguarding alerts was previously too high...not all medicines errors were referred to the safeguarding adult's team”
moderateGovernance: “The provider had recognised that previous quality audits had not been robust. This, along with the number of medicines errors, led to a full review of the service.”
minorRecord keeping: “There was no system to record occasions when staff failed to turn up at someone's home”
minorStaff training: “staff who had not completed the required training were already booked on a training course, with the exception of food hygiene”
Strengths
· Staff were recruited safely with appropriate DBS checks and references obtained
· Sufficient staffing levels ensured people received the correct level and duration of support
· People expressed satisfaction with kind, compassionate and caring staff who respected privacy and dignity
· Staff received thorough induction training including the Care Certificate and were well supported through supervision
· Provider demonstrated transparency and learning following service suspension, introducing robust medicines governance measures
Community Support Services was rated Good across all five key questions at its February/March 2015 inspection, with staff demonstrating strong safeguarding knowledge, person-centred care and effective re-ablement outcomes. The only notable issue was a historic pattern of ten medication errors over twelve months, which had already been addressed through extended visit times prior to inspection.
Concerns (1)
moderateMedication management: “ten medication errors being identified over a twelve month period...introduction of half hour visits in place of 15 minute visits”
Strengths
· Staff appropriately trained in safeguarding adults and knowledgeable in recognising signs of abuse with clear referral procedures
· Sufficient staffing levels adjusted dynamically to meet people's needs with very rarely any missed appointments
· Staff received regular supervision, appraisal and ongoing mandatory training including QCF qualifications
· Safe recruitment procedures including DBS checks and references followed consistently
· People involved in planning their care packages and given Service User Guide including complaints procedure
Community Support Services is an Outstanding-rated domiciliary reablement provider serving 64 people in East Riding of Yorkshire, with exceptional responsiveness and leadership driving highly personalised, goal-focused care. The service improved from Requires Improvement to Good in Safe since the last inspection, with no current failure themes identified.
Strengths
· Exceptionally person-centred reablement care with bespoke enablement plans tailored to individual goals, preferences and diverse needs.
· Medication errors reduced since last inspection through implementation of ongoing weekly medication workshops for all staff.
· Strong governance framework with regular audits, surveys and quality monitoring by registered manager and provider.
· Highly motivated, well-supported staff team with regular supervisions, competency assessments and biannual appraisals.
· Innovative communication methods used, including staff learning key words in a person's first language to support reablement goals.
Quality-Statement breakdown (19)
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuse; Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
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 care; Supporting people to live healthier lives
Good
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; supporting people to maintain relationships and interestsOutstanding
responsive: Meeting people's communication needsOutstanding
responsive: Improving care quality in response to complaints or concernsOutstanding
responsive: End of life care and supportGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringOutstanding
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsOutstanding
well-led: Engaging and involving people, the public and staff; continuous learning and improving care; working in partnershipOutstanding