Your Choice 4 Care was rated Inadequate and placed in special measures following a focused inspection that found breaches relating to safe care and treatment, safeguarding, staffing, good governance and failure to notify CQC of notifiable incidents. Significant failings were identified in infection control, medicines management, recruitment, staffing levels, missed/late calls and leadership.
Concerns (15)
criticalInfection control: “The providers policy for COVID-19 had not been updated to reflect government guidance or best practice guidance.”
criticalStaff training: “Staff had not received any training in relation to the donning and doffing of PPE.”
critical
Medication management
: “Staff were administering medication without appropriate training or checks of their competency.”
criticalMissed or late visits: “The providers call monitoring system identified multiple missed and late visits. This meant that people were at risk of harm by not having their care and support needs met.”
criticalSafeguarding: “we identified two concerns of potential financial abuse and three concerns of neglect. We raised safeguarding alerts in respect of our findings with the local authority safeguarding team.”
criticalStaffing levels: “The provider had failed to ensure that there were sufficient numbers of staff deployed to meet the needs of people using the service.”
criticalStaff competency: “one member of staff had worked without supervision before the recruitment process had been completed.”
criticalCare planning: “Risks to people were not assessed, recorded, managed and reviewed regularly.”
criticalRecord keeping: “people's daily records were not always completed. This lack of review meant concerns about people's care and support needs were not always known and responded to.”
criticalIncident learning: “The provider had no systems in place for recording of incidents or accidents. Accidents and incidents were not monitored.”
criticalGovernance: “The provider had failed to implement and operate effective systems to monitor the quality and safety of the service.”
criticalLeadership: “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care”
moderateCommunication with families: “They're always late. We get a phone call much later than the call time saying they are going to be late. I just expect it now.”
moderateSupervision / appraisal: “There were no records of staff meetings and records relating of supervision did not demonstrate how the provider had engaged with staff to seek feedback and drive improvement.”
moderateConsent / capacity: “People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests”
Quality-Statement breakdown (9)
safe: Preventing and controlling infectionNot rated
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Staffing and recruitmentNot 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
The service improved from Inadequate to Requires Improvement and exited Special Measures, with progress on infection control, recruitment, safeguarding and risk assessment. However, continued breaches of Regulations 12 and 17 were found relating to inaccurate medicines records, late calls, lack of accident/incident analysis and incomplete competency and recruitment records.
Concerns (9)
criticalMedication management: “Handwritten medicine records were not always checked by another member of staff to ensure they were correct and included all required information.”
criticalMedication management: “one person's medicine protocol referred to two different medicines and it was unclear how much medicine should be administered.”
criticalGovernance: “Quality assurance systems had not identified or addressed the shortfalls identified during the inspection.”
moderateMissed or late visits: “People continued to receive late care calls and monitoring systems had not resolved this shortfall.”
moderateIncident learning: “An appropriate system to monitor and learn from accidents and incidents was not in place. There was no evidence of analysis or learning from accidents and incidents.”
moderateRecord keeping: “Competency and spot checks had been implemented... Though records were not always dated or signed by the staff member which meant it was unclear when they were last assessed.”
moderateStaff competency: “Records were in place but were not always fully completed with the assessment date or staff signatures.”
moderateOther: “We identified one incident that had not been notified to CQC.”
minorSafeguarding: “records did not always show when this was completed, or the advice received. Monitoring systems required improving to ensure records demonstrated action taken.”
Strengths
· Risks to people's safety and wellbeing were identified, assessed and strategies put in place to manage the risks.
· Improvements made to infection prevention and control; staff trained in PPE and part of regular COVID-19 testing programme.
· Recruitment processes had improved with appropriate checks completed.
· Staff were trained in safeguarding and understood who to report concerns to.
· People and relatives were positive about the caring approach of staff.
Quality-Statement breakdown (9)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff