First inspection of a small domiciliary care service supporting one person, rated Requires Improvement overall with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to unsafe medicines management and inadequate risk assessment. Caring and responsive domains were rated Good, with the person using the service reporting they felt safe and well supported by a consistent staff team.
Concerns (9)
criticalMedication management — “Medicines were not safely managed. Medicines profiles were not accurate and did not include all prescribed medicines”
criticalMedication management — “Staff were administering over the counter medicines without seeking the advice of the GP.”
criticalCare planning — “Risks to people had not always been assessed and staff did not always have access to information about how to manage possible risks”
criticalGovernance — “Effective systems were not always operated to monitor the quality and safety of the service.”
moderateCare planning — “Falls risk assessments contained some contradictory information about how to support people following a fall and referred to the use of equipment which was not available”
moderateCare planning — “assessments of need... had not always fully identified people's health conditions, or provide information on the steps staff might need to take”
moderateCommunication with families — “the service communicated in a timely way with health professionals... changes in a health condition had not been reported to or discussed with health professionals”
minorComplaints handling — “the complaints policy in the service user guide did not advise people that if their care was funded by the local authority they could complain to the local authority”
minorRecord keeping — “We identified gaps in one staff members employment history. This was addressed during the inspection.”
Strengths
· Person using the service felt safe and was happy with the support provided
· Consistent small staff team who knew the person well
· Staff treated people with care, dignity and respect
· Person-centred care that met people's wishes
· Staff received regular training, induction and supervision
Quality-Statement breakdown (21)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
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 experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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 supportNot rated
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staffGood