This focused follow-up inspection of Richmond and Kingston DCA found that all previously identified breaches, including medication management, infection control, visit punctuality and governance, had been remedied and the service was no longer in breach of Regulation 17. Both Safe and Well-led were rated Good, reflecting sustained improvements in quality assurance, staffing and person-centred leadership.
Strengths
· Medicines safely administered, regularly audited and appropriately stored and disposed of following previous requires improvement rating
· Risk assessments covered all aspects of people's health, daily living and social activities and were regularly reviewed and updated
· Robust and thorough staff recruitment process including scenario-based interviews, DBS checks and 6-month probationary period
· Quality assurance systems now used effectively to monitor care quality, with KPIs including care plan reviews and satisfaction surveys
· Accidents, incidents and safeguarding concerns fully investigated with emerging themes identified and shared with staff
Richmond and Kingston DCA was rated Requires Improvement overall, with a breach of Regulation 17 (good governance) due to inadequate management oversight, weak medicines management, inconsistent infection control and ineffective partnership working. Care delivery was rated Good for effective, caring and responsive, with people reporting positive caring relationships and person-centred support.
Concerns (9)
criticalGovernance: “These issues are a breach of regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.”
criticalMedication management: “People's medicines were not always managed safely. Some Medicine Administration Records (MAR) were not correctly signed and did not have complete information.”
criticalMedication management: “Another person was short of medicines during the monthly cycle... The arrangements to monitor and reorder stock were not adhered to which placed the people at risk of not receiving their medicines.”
moderateInfection control: “There were poor hygiene practices. There was a lack of oversight or inaction by the registered manager to ensure people received the support they required to minimise the risk.”
moderateIncident learning: “Learning from incidents and accidents was not always done in a timely manner. This meant missed opportunities for minimising a repeat.”
moderateLeadership: “The registered manager did not always provide adequate oversight to the care provided at the service. They relied heavily on managers and senior staff on site to oversee the operations.”
moderateRecord keeping: “Record keeping was not consistently completed in the service and audit documentation required improvement.”
moderateMissed or late visits: “Some people did not always receive care in a timely manner... 'I have experienced delays'; 'The office telephone sometimes goes unanswered when I want to check the whereabouts of my carer'.”
minorCommunication with families: “Relatives of people using the service and some staff were not always clear about the management structure and the roles of the different managers involved at the services.”
Strengths
· People and relatives reported feeling safe with the care provided
· Staff were recruited safely with DBS checks and people took part in recruitment
· Staff received thorough induction and training, with supervision opportunities
· People had developed meaningful caring relationships with a consistent staff team
· Person-centred care promoting dignity, privacy and independence
Quality-Statement breakdown (26)
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
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 to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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 meet people's needs, preferences, interests and give them choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
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: Working in partnership with othersRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffRequires 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