Date of Assessment: 2 December to 17 December 2024. The service is a Domiciliary Care Agency (DCA). This assessment was prompted by a review of information we held about the service. At the time of the assessment the service supported 61 people with personal care. At our last assessment, the service was in breach of regulations regarding staffing, medication, risk management and governance. The service had made improvements and is no longer in breach of regulations. Staff knew how to safely support people. Staff understood, assessed and mitigated risks and followed individualised care plans. The provider had improved their quality monitoring systems, however, these processes needed to be fully embedded and built upon to ensure any quality improvements were identified in future. Whilst overall people received their medicines as prescribed, further work was required to ensure people’s records were always fully detailed and up to date. Staff were safely recruited; however, we noted one issue in relation to safety checks which the provider had not identified, they addressed this straight away. People were treated with kindness and compassion. The provider had focused on improving the quality and consistency information within people’s care plans. People knew how to give feedback and were confident the provider took it seriously and acted on it. The provider gave information to people; however, they needed to ensure everyone understood how they could access or have a copy of their care plan. Managers were visible, knowledgeable and supportive, helping staff develop in their roles and staff felt valued by the management team. The provider promoted a culture of openness and learning. However, they needed to ensure they fully understood all the regulatory requirements in relation to notifying CQC of certain incidents as required.
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Focused inspection of a domiciliary care agency supporting 78 people found recent improvements but continued breaches of Regulations 12, 17 and 18 around risk, medicines, staffing and governance. The service moved out of Inadequate overall to Requires Improvement but remained in special measures with Well-led still Inadequate.
Concerns (7)
criticalMedication management: “The provider could not always be assured that people were receiving their medication in a timely manner. We saw that some staff did not arrive to calls at the scheduled time.”
criticalMissed or late visits: “I haven't seen the carer for three days. They're no use to me if they don't come on time.”
criticalStaffing levels: “The provider could not be assured that staff were attending calls for the agreed times. We saw that some staff had calls added at short notice to their daily rota without being informed.”
criticalGovernance: “Although the provider had a range of new audits, they could not always be assured that some scheduled calls were being met at the agreed time.”
moderateCare planning: “some risk assessments did not contain relevant information for some individuals and were not always person centred...some information was generic and personal information was inaccurate including date of birth”
moderateRecord keeping: “some daily care notes were not updated accurately with tasks marked as complete in the electronic recording system when these had been completed by relatives or completed with unrealistic time frames”
moderateMedication management: “We saw that PRN (as and when needed) protocols were generic and needed to be more person specific.”
Strengths
· Improvements in oversight of risks and steps to mitigate them since the previous inspection
· Safe recruitment practices including DBS, right to work and identification checks now fully followed
· PPE used effectively and safely; monthly infection control audits in place
· Staff trained in safeguarding and knowledgeable about action to take if abuse suspected
· Induction and competency checks completed before staff support people on their own
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: StaffingRequires improvement
safe: Preventing and controlling infectionGood
safe: RecruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
well-led: Continuous learning and improvingInadequate
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Working in partnership with othersNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringNot rated
Focused re-inspection found the service remained Inadequate in Safe and Well-led, with continued breaches of Regulations 12, 17, 18 and 19 covering risk, medicines, staffing, recruitment, infection control and governance. The service stays in special measures, with insufficient improvement since the previous inspection despite a new action plan.
Concerns (18)
criticalMedication management: “There were multiple gaps in the recording of administration of medicines, allergies were not always recorded”
criticalMedication management: “a carer had chosen not to give their relative pain medication... The person was in pain and has since been admitted to hospital.”
criticalMissed or late visits: “people received multiple calls more than thirty minutes later than the planned time and many lasted less than half of the planned duration.”
criticalMissed or late visits: “their family members evening call had recently been missed completely. This meant they did not receive prescribed pain relief and was left in pain.”
criticalStaffing levels: “There was not always enough staff to ensure calls were undertaken at the planned times, or for the full duration.”
criticalCare planning: “Care plans viewed did not always provide clear and accurate information regarding people's needs and how staff should safely support them.”
criticalStaff competency: “Not all staff had had their competency assessed to ensure they could administer medicines safely.”
criticalInfection control: “not all staff wore masks in the office and people told us care staff did not always follow current guidance regarding the use of personal protective equipment.”
criticalGovernance: “New governance systems had been implemented since the last inspection, to monitor the quality and safety of the service, but they were not effective.”
criticalGovernance: “Records showed that audits completed were inaccurate and contradictory.”
criticalLeadership: “widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
criticalOther: “appropriate professional references were not always sought, or verbal references verified.”
moderateCare planning: “one person's moving and handling assessment had risks recorded within it, but no risk was identified on the form.”
moderateStaff training: “Not all staff had completed infection control training since the COVID-19 pandemic began.”
moderateInfection control: “There was no evidence of staff COVID-19 testing recorded.”
moderatePerson-centred care: “When [new carers] come, they come blind; no clue what I need so I don't feel so good about them.”
moderateRecord keeping: “Correct codes were not always used to indicate when and why medications were not administered.”
moderateComplaints handling: “I no longer bother complaining as I only get empty promises.”
Strengths
· Staff had undertaken safeguarding training and were clear about their responsibilities in reporting and recording concerns
· Accidents and incidents were recorded and reviewed, with appropriate actions taken to reduce risk (e.g. skin integrity training arranged)
· Duty of candour policy in place; family members informed when incidents occurred
· CQC notified of reportable incidents as required
· Staff meetings and quality assurance surveys used to gather feedback
Quality-Statement breakdown (11)
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Preventing and controlling infectionInadequate
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Learning lessons when things go wrongGood
well-led: Continuous learning and improving careInadequate
well-led: Promoting a positive, person-centred, open cultureInadequate