Skyline Home Care Services improved from Requires Improvement to Good overall following a focused inspection of Safe, Responsive and Well-led, with all prior regulatory breaches remediated. Well-led remains Requires Improvement as governance audit systems, including medicines audits, require further embedding and greater specificity.
Concerns (3)
moderateGovernance: “medicines audits did not always clarify whose medicines records had been reviewed.”
moderateRecord keeping: “none of these contained references that were signed for or had the company stamp of the previous employer and referee.”
minorStaffing levels: “scheduled rosters did not always allow enough travel time for staff to get between calls; and accommodate traffic.”
Strengths
· Risk assessments fully transferred onto electronic case management system with clear risk management plans for falls, catheter care, UTIs and personal care neglect.
· Medicines administered safely with PRN protocols in place and incident reporting used to learn from errors.
· Care plans were personalised, reflecting people's histories, likes, dislikes and communication needs.
· Complaints robustly investigated with witness statements, findings and responses documented.
· Management visible and accessible; people, relatives and staff gave positive feedback about the registered manager.
Skyline Home Care Services deteriorated from Good to Requires Improvement overall, with breaches of Regulations 9, 12, 17 and 19 due to missing risk assessments, weak recruitment checks, lack of person-centred and end-of-life planning, and ineffective governance audits. Caring and effective domains remained Good, with positive feedback on staff kindness, training, medicines management and the registered manager's approachability.
Concerns (9)
criticalCare planning: “Three of the four care plans reviewed were for people that were at risk of falls. There were no falls risk assessments in place to advise staff on how to minimise this risk.”
criticalCare planning: “Two care plans reviewed were for people that were at risk of pressure ulcers. There were no risks assessments for staff to know how to identify a new pressure area”
criticalOther: “recruitment checks were not robust enough to demonstrate thorough consideration prior to being employed. This placed people at risk of harm.”
criticalPerson-centred care: “The new care planning system had very little personalised detail for staff to understand people's individual needs. There were no life histories or details of people's hobbies and interests.”
criticalGovernance: “systems were either not in place or robust enough to demonstrate safety was effectively managed or that there was consistent oversight of the service.”
moderateCare planning: “A person who was receiving support with personal care had a catheter. Although staff had received training, there was no catheter risk assessment or guidance for staff”
moderateEnd-of-life care: “People's care files lacked end of life support plans. The registered manager confirmed that this is something that she has not yet addressed”
moderateRecord keeping: “Daily notes were not personalised and there were often entries such as 'tasks completed, service user comfortable'.”
moderateCare planning: “For people that were wholly dependent on staff for support with personal care, there were no oral health care plans.”
Strengths
· Staff were up to date with safeguarding training and knew what process to follow
· Regular medicine competency checks and medicine audits completed; new online system generated alerts for missed medicines
· Infection control audits completed regularly; provider using PPE effectively and safely
· Clear induction programme with shadowing and a training matrix ensuring staff were up to date
· Staff were kind, caring, respectful of privacy and dignity, and treated people as individuals
Quality-Statement breakdown (19)
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 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
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effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to access healthcare servicesGood
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 care; respecting privacy, dignity and independenceGood
responsive: End of life care and support; planning personalised care to meet needs and preferencesRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture; managers and staff understanding roles, quality, risks and regulatory requirementsRequires improvement
well-led: Duty of candour; engaging people, public and staff; continuous learning and improving careGood