Date of assessment: 20 February 2025. This was a responsive assessment to follow up on warning notices served for Regulations 12 (Safe care and treatment), 17 (Good governance), 18 (Staffing) and 19 (Fit and proper persons employed) following our last inspection. We found the provider had made the improvements required and was no longer in breach of regulation. People were kept safe from abuse and harm by staff who were aware of their responsibility to safeguard people. People’s care needs and risks associated with them were appropriately assessed and managed. Staff practiced safe infection prevention and control and medicine management processes. There was a positive and inclusive ethos within the service, which built an environment of honesty and trust between people and staff. Staff felt the management of the service were hands on and approachable. Regular audits were completed to ensure the quality of the care being delivered was of a good standard. People, their relatives and staff were regularly asked for their feedback on the service. The provider worked closely with external partners and stakeholders to ensure people received a smooth transition between care services.
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Radiant Care Services Ltd received an overall rating of Requires Improvement at this focused inspection, with Warning Notices issued for breaches of Regulations 12, 17, 18 and 19 relating to unsafe medicines management, poor risk assessments and care planning, inadequate staffing oversight, and unsafe recruitment practices. Despite a positive and caring culture reported by people and staff, the provider failed to make sufficient improvements since the previous inspection in February 2022, remaining in breach of good governance requirements.
Concerns (15)
criticalMedication management: “gaps in signatures in medicines administration records (MAR), had not always recognised as a potential medicines error nor acted on”
criticalMedication management: “Another person had not received some of their medicines for 5 days as they run out of stock. Although some action was taken to minimise the risk to them, the action was delayed”
criticalMissed or late visits: “system report we reviewed stating staff attendance was only 53% compliant with planned timings in April 2023”
criticalMissed or late visits: “one person's visit was planned for 60 minutes on the morning of the inspection and we saw staff recorded a visit which lasted only 19 minutes”
criticalCare planning: “electronic records for all people we reviewed did not provide any detail around specific risks to people, such as personal care, health needs, moving and handling”
criticalCare planning: “one person had been supported for over 5 months at the time of the inspection and they had no risk assessments in place”
criticalStaffing levels: “provider had failed to ensure sufficient numbers of suitably qualified, competent, skilled and experienced persons were adequately deployed to attend care visits as planned”
criticalGovernance: “provider had poor oversight of the overall safety and quality of the service...management team could not clarify how staff recruitment checks were monitored and audited”
criticalRecord keeping: “provider had failed to ensure their governance systems were used effectively and failed to maintain accurate and complete records”
criticalSafeguarding: “local authority looked into other concerns of staff unauthorised presence in people's homes...additional staff visiting their homes did not record their attendance on the staff monitoring system”
moderateStaff training: “Multiple staff had out of date training, for example, in safeguarding, health and safety or medicines management. This was not clearly addressed in the provider's action plan.”
moderateStaff competency: “Not all staff had received appropriate training in safe management of medicines and competency assessments”
moderateGovernance: “incidents, accidents, complaints and feedback was recorded but not analysed to identify any patterns and lessons learnt”
moderateIncident learning: “The provider did not always learn from adverse events in the service and people's feedback. The incidents, accidents, complaints and feedback was recorded but not analysed”
moderateLeadership: “registered manager provided assurances to CQC prior to the inspection stating all improvements had been completed. However, we identified multiple people did not have an up to date care plan”
Strengths
· People felt safe with staff and described them as caring, kind, respectful and considerate
· Staff knew how to recognise and report safeguarding concerns and changes in people's needs
· Good infection prevention and control practice; staff had access to PPE and relevant training
· Service operated within the principles of the Mental Capacity Act 2005
· Positive, open culture reported by people, relatives and staff; management responsive to concerns raised
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirements; Continuous learning and improving careRequires 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; Working in partnership with othersGood
Radiant Care Services Ltd was rated Requires Improvement after rapid growth outpaced its governance systems, leading to inconsistent care and medicines records and a breach of Regulation 17. Despite a hands-on registered manager, positive culture and people feeling safe, record-keeping and recruitment oversight needed strengthening.
Concerns (5)
criticalGovernance: “The provider had failed to ensure their governance systems were used effectively and failed to maintain accurate and complete records.”
moderateRecord keeping: “people's care records did not always reflect their up to date needs clearly”
moderateCare planning: “one person had a range of equipment and guidance in place on how to prevent them falling but this was not recorded in their risk assessments”
moderateMedication management: “Another person's medicines records showed discrepancies which were not clearly addressed in spot check audits.”
minorStaff training: “there was limited evidence on how the provider assured themselves of staff's employment history and their conduct in previous employment in social care”
Strengths
· Registered manager had a hands-on approach and was approachable to staff and families
· Enough staff to provide timely care with consistent allocation and adequate travel time
· People and relatives reported feeling safe and described staff as caring, kind and competent
· Staff trained in safe medicines management and infection prevention with ongoing PPE access
· Positive culture with feedback sought via spot checks and satisfaction surveys
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and management; Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
safe: Learning lessons when things go wrongNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated