Home Care & Support Limited received an overall rating of Requires Improvement, with breaches of Regulations 12, 17, 18 and 19 identified in relation to risk assessment, medicines management, staff deployment, recruitment, and governance. The service has remained at this rating since its previous inspection in April 2022, with no sufficient improvements made.
Concerns (9)
criticalCare planning: “Risk assessments and risk management plans were not always in place. Risks to people such as those associated with falls, and medicines had either not been assessed adequately.”
criticalMedication management: “People who were prescribed PRN medicines did not have a PRN protocol in place with clear guidance for staff on how or when to administer medicines to them.”
critical
Governance
: “The provider had failed to carry out regular audits to identify issues. There were no audits carried out for care plans, the ECM system or for staff files.”
criticalRecord keeping: “Application forms were not always completed fully, and the provider had failed to obtain each applicant's complete and accurate employment and education histories.”
criticalLeadership: “The registered manager did not have an adequate understanding of their role, regulatory requirements and lacked oversight of the service.”
moderateStaff competency: “Regular medicine competency assessments were not carried out to ensure staff had the skills to administer medicines safely.”
moderateStaffing levels: “Only 73 per cent of calls were on time and 9 per cent of calls were more 45 minutes late. 18 per cent of calls were short and staff did not stay for the duration of the call.”
moderateIncident learning: “Where medicine audits did identify shortfalls, records showed that follow up actions were not documented.”
moderateCommunication with families: “Some people and relatives also said that they did not know who the registered manager was. A relative said, 'I don't know the manager. I tried to speak to the office... They don't answer the phone.'”
Strengths
· People told us they felt safe using the service and appropriate safeguarding systems were in place.
· Staff had received safeguarding training and knew how to report allegations of abuse.
· Infection control was appropriately managed and staff had sufficient PPE available.
· A system was in place to record, investigate and monitor accidents and incidents.
· Staff felt well supported by the registered manager, describing an open-door policy.
Quality-Statement breakdown (8)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires 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, quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture; engaging and involving people and staffRequires improvement
Home Care & Support Limited remained Requires Improvement for a third consecutive inspection, with continuing breaches of Regulations 12 and 17 and a new breach of Regulation 19 around medicines management, recruitment checks, call scheduling and governance oversight. The Effective domain improved to Good, with positive findings on assessment, training, consent and access to healthcare.
Concerns (11)
criticalMedication management: “Medicines were not always safely managed. Medicines risk assessments did not always fully detail or assess the possible risks to people.”
criticalRecord keeping: “Medicines administration records (MAR) were not always legible and did not include the specific dose to be administered.”
criticalOther: “Recruitment records did not always show the provider had completed the required recruitment checks on staff. The provider did not record full employment histories”
criticalGovernance: “The provider's systems to oversee quality and the safety of the service were not always effectively operated. Medicines audits had not identified the concerns we found”
moderateStaff competency: “most staff had not completed medicines competency record to assure the provider of their competence to administer medicines.”
moderateCare planning: “Where people had a diagnosis of epilepsy there were no risk assessments to guide staff on possible signs and triggers to reduce risk”
moderateMissed or late visits: “two people and two relatives told us that staff did not always stay the full length of their calls... 'They have been 90 minutes late four or five times in the last few months.'”
moderateStaffing levels: “We checked the rotas and found enough time was not always planned between calls... they don't take into account travelling time when booking visits.”
moderateIncident learning: “Staff were reporting accidents and incidents to the office by phone but not completing a full written record of their actions when they involved a person using the service.”
moderateLeadership: “six people or their relatives thought the service was not managed well because of the issues with call scheduling and care workers not always completing tasks.”
minorSupervision / appraisal: “Staff said they received regular supervision to support them in their roles. However, this was not always evidenced from records.”
Strengths
· People told us they felt safe using the service and that regular staff knew them and understood their needs.
· Staff were familiar with safeguarding procedures and knew where to raise any concerns.
· Staff had received training on infection control and people told us they wore PPE and observed infection control practice.
· Staff sought consent from people before they provided care in line with MCA principles.
· People's needs were assessed before they started using the service and they had a personalised plan for their care.
Quality-Statement breakdown (14)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Preventing and controlling infectionGood
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 diet
Home Care & Support Limited remained Requires Improvement at this focused inspection, with previous breaches in recruitment, medicines and governance now met. However, an ineffective call monitoring system and inconsistent staff deployment meant calls were sometimes late, rushed or shortened.
Concerns (5)
moderateMissed or late visits: “People told us they did not always receive their calls at the right times and they could be rushed and not always for the planned duration.”
moderateGovernance: “The call monitoring system, introduced following the last inspection, did not provide accurate oversight of people's call times and durations.”
moderateStaffing levels: “There were enough staff to meet people's needs but they were not always deployed effectively.”
moderatePerson-centred care: “some calls were cut short, some people experienced a lack of consistency of care workers and care workers rushing when delivering support.”
minorRecord keeping: “Where paper medicines records had been used due to problems with the electronic system these were not always audited to ensure any issues were addressed.”
Strengths
· Improvements made to recruitment checks; provider now meeting Regulation 19.
· Medicines administered safely with risk assessments, training and competency checks in place.
· Robust safeguarding systems; staff trained and alerts raised appropriately.
· Comprehensive business continuity plan and reliable out-of-hours on-call service.
· Strong infection prevention and control with good PPE supply during COVID-19.
Quality-Statement breakdown (9)
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuse; learning lessons when things go wrongGood
safe: Preventing and controlling infectionGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff being clear about their roles; duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staff; promoting a positive person-centred culture