Karia Care Services improved from Requires Improvement (with five regulatory breaches) to Good across all five key questions at this October 2023 inspection of a small domiciliary care agency supporting five people. All previous breaches of regulations 9, 12, 17, 18 and 19 were remedied, with robust risk assessments, recruitment, medicines management, staff supervision and governance systems now in place.
Strengths
· Detailed risk assessments in place for people with health conditions including diabetes, with evidence of regular health checks and liaison with GPs and other professionals.
· Robust staff recruitment processes including full pre-employment checks, references, DBS and right-to-work verification.
· Medicines Administration Records completed appropriately with no gaps; staff competency in medicines administration assessed and spot-checked.
· Staff received regular supervision and appraisal; training tracked via spreadsheet covering safeguarding, moving and handling, and infection control.
· Person-centred care plans with detailed daily routines, preferences, cultural and religious needs, accessible via password-protected app.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Learning lessons when things go wrongGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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
effective: Supporting people to eat and drink enough and 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 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: 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, understanding quality performance, risks and regulatory requirementsGood
well-led: Continuous learning and improving careGood
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, fully considering their equality characteristicsGood
First inspection of newly registered domiciliary care agency rated Requires Improvement overall with Well-led rated Inadequate, with breaches of Regulations 9, 12, 17 and 19 leading to Warning Notices for person-centred care, safe care and treatment, and good governance. Key concerns included generic risk assessments, weak recruitment checks, insufficient supervision/training (e.g. diabetes), poor care plan personalisation and ineffective governance oversight.
Concerns (15)
criticalGovernance: “The provider had failed to ensure systems and processes were established and operated effectively at all times to monitor and improve the quality and safety of the service.”
criticalCare planning: “Risk assessment were generic and was not personalised to each person.”
criticalPerson-centred care: “we found arrangements were not in place to ensure people received care that was person-centred. This was a breach of regulation 9 (Person centred care)”
criticalSafeguarding: “The systems and processes to safeguard people from the risk of abuse were not operated effectively.”
criticalLeadership: “There was a lack of provider and managerial oversight of the service.”
moderateStaff training: “staff had not received any training around diabetes care. This meant people were at risk of receiving care from staff who did not fully understand their health conditions.”
moderateSupervision / appraisal: “two staff working for more than 12 months did not have appraisals to support their development and they did not receive regular supervision”
moderateStaff competency: “There were no formal competency checks in place to ensure staff were competent in all aspects of their role.”
moderateIncident learning: “This meant there was no learning from incidents, or analysis to identify themes and trends and actions taken to prevent reoccurrence.”
moderateRecord keeping: “some records we requested were not easily accessible. Other records we had previously requested from the service had also not been provided”
moderateComplaints handling: “We were not assured that the provider was capturing and recording all the complaints that had been received.”
moderateOther: “only one employment references which was not in their job application had been requested, and the other reference had not been requested.”
minorCultural competency: “Care plans did not record people ethnicity and end of life preferences.”
minorEnd-of-life care: “Information about people's ethnicity and end of life was not recorded”
minorCommunication with families: “they could not get in contact with office staff over the weekend and the phone is not always answered.”
Strengths
· Medicines were managed safely with clear records and regular audits
· Staff followed infection control procedures and had ample PPE
· People felt safe with care workers and reported staff were kind and caring
· Privacy, dignity and independence were respected
· Staff understood and applied the Mental Capacity Act and sought consent
Quality-Statement breakdown (19)
safe: Systems and processes to safeguard people from the risk of abuse; Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to eat and drink enough; access healthcare; working with other agencies
Requires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Supporting people to express their views and be involved in making decisions about their careRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
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 preferencesRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: Meeting people's communication needsGood
responsive: End of Life care and supportNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
well-led: Engaging and involving people using the service, the public and staffInadequate
well-led: Working in partnership with othersRequires improvement