Alina Homecare Devizes improved from Requires Improvement to Good following a focused inspection of Safe and Well-led domains, having remediated a prior breach of Regulation 17 around clinical competency monitoring. The service demonstrated safe medicines management, robust governance, positive staff culture, and no missed visits across its 21 service users.
Strengths
· Medicines managed safely with electronic system enabling real-time alerts for missed administrations and guidance for 'as required' medicines.
· No missed visits reported; staffing levels sufficient for commissioned care packages with office staff available to cover.
· Staff recruited safely with all pre-employment checks including DBS completed.
· Clinical competency monitoring improved since last inspection; staff trained and assessed for complex clinical needs.
· Robust quality monitoring at branch and provider level including unannounced home checks and telephone quality calls.
Quality-Statement breakdown (11)
safe: Using medicines safely
Good
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
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 staffGood
well-led: Continuous learning and improving careGood
Alina Homecare Devizes received an overall rating of Requires Improvement at its first inspection in January 2020, with Safe and Well-led rated Requires Improvement due to unsafe medicine administration records and a breach of Regulation 17 for failing to monitor staff clinical competency through effective governance audits. Effective, Caring, and Responsive were all rated Good, reflecting strong person-centred practice, staff relationships, and community inclusion.
Concerns (6)
criticalStaff competency: “records did not always evidence the clinical care training staff had completed or whether their competency had been assessed. This included areas such as tracheostomy care.”
criticalGovernance: “Quality auditing was not fully effective, as management had not identified the competency assessments for staff, were incomplete.”
criticalRecord keeping: “Many of the assessments were incomplete and did not give a conclusion of the staff member's competence. This did not demonstrate all staff were sufficiently knowledgeable.”
moderateMedication management: “Some medicine administration records (MARs) were handwritten. There was no evidence that the hand written MARs were checked to ensure that they were accurate.”
moderateMedication management: “There was a policy in place regarding the administration of "as required" medicines. However, information specific to each person, was not in place.”
minorCare planning: “Other areas were less comprehensive, with phrases such as, "Check vulnerable areas." Whilst the information lacked detail, staff told us they were aware of people's needs.”
Strengths
· People felt safe and were consistently supported by the same small team of staff who knew them well.
· Safe recruitment practices were followed including DBS checks and conduct references.
· The service had its own training department with a detailed induction programme including mentoring and shadowing.
· People were supported to eat and drink adequately and to access healthcare services.
· Staff supported people in the least restrictive way possible in line with MCA principles.
Quality-Statement breakdown (25)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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
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: Supporting people to develop and maintain relationships to avoid social isolationGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
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: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood