Availl (Bury St Edmunds) remained in breach of Regulations 17 and 18 at this focused inspection, with persistent failures in governance, registered manager absence since February 2021, and staff induction and supervision. Some improvement was noted in risk assessment and care planning, but overall the service continued to present increased risk of harm to people.
Concerns (11)
criticalStaff training — “Staff were not routinely provided with shadow shifts prior to their working with people un-supervised as described in the provider's action plan.”
criticalSupervision / appraisal — “I do not know who the manager is. The communication is poor. There are no staff meetings and I've not ever had a supervision.”
critical
Governance
— “The lack of governance and oversight continued to place people at risk of harm. This was a continued breach of Regulation 17.”
criticalLeadership — “The service had been without a registered manager since February 2021. The provider's oversight and governance of the service continued to be ineffective.”
moderateIncident learning — “There was no system of management oversight in place to ensure analysis of themes and trends with actions taken to avoid a reoccurrence.”
moderateMissed or late visits — “There have been occasions when staff have not turned up. I call my family who have to come and help me.”
moderateStaffing levels — “People told us they experienced constant changes of care staff. Staff told us the constant change in management had impacted on morale.”
moderateComplaints handling — “Not all complaints raised with the provider had been recorded.”
moderateCommunication with families — “Several staff, people who used the service and their relatives told us they were not aware of who the manager was as they had not been kept informed.”
moderateRecord keeping — “No records had been maintained of staff inductions which should include evidence of shadowing opportunities and assessment of staff competency.”
minorCare planning — “We recommend the provider considers further work to ensure care plans in relation to people with a diagnosis of epilepsy describe the type, how this presents and intervention guidance.”
Strengths
· Risk assessments and care planning had improved since the last inspection; the provider was no longer in breach of Regulation 12.
· Relevant pre-employment checks including DBS, references and proof of identity were carried out, ensuring safe recruitment.
· Staff were supplied with PPE and had received infection control training; people confirmed PPE was used during personal care.
· Medication policies, procedures and training were in place; staff competency in medicine administration was checked for some staff.
· The provider worked positively with health care professionals, the local authority and social work professionals supporting people with complex needs.
This targeted KLOE inspection of Availl (Bury St Edmunds), a domiciliary care agency serving 35 people, identified concerns around medication record-keeping and the failure of staff to report safeguarding incidents in a timely manner. No ratings were assigned as the inspection covered only specific concerns within the Safe key question rather than the full key question.
Concerns (4)
criticalSafeguarding — “We found a potentially serious incident that had not been reported to the office by a carer. This coupled with a previous safeguarding incident that was not reported in a timely way.”
moderateMedication management — “MAR charts had been returned to the office and had been examined by the registered manager, but the above information was not found. The audit in place was not robust enough.”
moderateIncident learning — “Staff required further clarification to ensure escalation processes were clear to all staff.”
moderateRecord keeping — “MAR that was not completed in sufficient detail to understand how much medicine had been administered and when. Where MAR charts had been handwritten and altered...no information to show who had made this alteration.”
Strengths
· People felt safe with staff and trusted them in their homes
· Staff arrived on time and stayed the expected length of time
· Staff recruitment records were complete with all required regulatory checks in place
· Staff had access to adequate PPE throughout COVID-19 with monitored stock levels
· Communication between people using the service and the office was described as good
Quality-Statement breakdown (4)
safe: Using medicines safelyInsufficient evidence to rate
safe: Systems and processes to safeguard people from the risk of abuse and learning lessons when things go wrongInsufficient evidence to rate
safe: Staffing and recruitmentInsufficient evidence to rate
safe: Preventing and controlling infectionInsufficient evidence to rate
Availl (Bury St Edmunds) was rated Requires Improvement overall at its first comprehensive inspection in October 2021, with breaches of Regulations 12, 17 and 18 identified relating to unsafe medicines management, inadequate risk-assessment and care planning, and failure to provide staff with proper induction, supervision and training. The service was rated Good for caring, with people consistently reporting kind, dignified and respectful support from staff.
Concerns (10)
criticalMedication management — “Medicine administration records (MAR) did not always guide staff as to how these prescribed medicines should be administered.”
criticalCare planning — “All of the care plans we reviewed contained a lack of information to guide staff in managing the risks in relation to people at risk of choking, falls, prevention and treatment of pressure ulcers.”
criticalStaff training — “Systems were not in place to ensure staff received appropriate induction, support and training that is necessary for their role.”
criticalGovernance — “The provider failed to ensure adequate systems and processes were in place to assess, monitor and improve the quality and safety of the care provided.”
moderateSupervision / appraisal — “One member of staff told us, 'I have not had any supervision since I started work. As far as I know supervisions only take place if there are concerns with your work.'”
moderateStaff competency — “Staff competency to administer medicines safely had not always been assessed in line with the provider's medicines management policy.”
moderateEnd-of-life care — “We were not assured people had been consulted as to their wishes in relation to end of life care.”
moderateRecord keeping — “Other than on-line training no records had been maintained of staff inductions which would evidence shadowing opportunities and assessment of competency.”
moderatePerson-centred care — “Care plans did not always reflect how people's choice, wishes and preferences had been assessed. For example, in how they wished their care to be delivered.”
minorCultural competency — “Staff were not provided with training in equality and diversity.”
Strengths
· People told us staff were kind, caring and treated them with dignity.
· People told us they had not experienced any missed calls and if staff were running late the office kept them informed.
· Safeguarding training was mandatory for care staff and records showed it had been completed.
· Required recruitment safety checks had been carried out to ensure staff were suitable.
· Care staff had received training in infection control and people confirmed staff always wore PPE.
Quality-Statement breakdown (16)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidance
Good
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; End of life careRequires improvement
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
well-led: Promoting a positive culture; duty of candour; oversight and governanceRequires improvement
well-led: Managers and staff being clear about their roles and regulatory requirementsRequires improvement