First inspection of newly registered domiciliary care agency supporting 4 people with personal care identified two breaches of regulations (Regulations 12 and 17) covering unsafe risk management, inadequate medicines protocols, ineffective governance audits and poor record keeping. Caring and responsive domains were rated Good with positive feedback on staff kindness, but safe, effective and well-led required improvement.
Concerns (12)
criticalCare planning: “Known risks associated with people's care and support were not always assessed. One person had epilepsy, but an epilepsy risk assessment had not been completed”
criticalCare planning: “One person's accessing the community risk assessment instructed staff to 'take reasonable actions' to keep the person safe if they ran out into the road.”
criticalMedication management: “Protocols for those medicines were not in place for staff to follow to ensure people received their medicines when they needed them in line with national medicines guidance.”
criticalGovernance: “Systems were not established or operated effectively to assess, monitor and improve the quality and safety of the service.”
criticalRecord keeping: “accurate, complete records in respect of each person were not maintained. This was a breach of Regulation 17 (Good Governance)”
criticalSafeguarding: “we had not been notified of an allegation of abuse that had occurred in September 2021. The statutory notification was submitted retrospectively following our request.”
moderateMedication management: “a check of medicines during January 2022 had not identified a staff signature was missing to confirm administration of a medicine”
moderateInfection control: “The individual characteristics of staff including staff from Black, Asian and Ethnic Minority groups (BAME) had not been assessed to ensure staff were kept as safe as possible at work during the COVID-19 pandemic”
moderateConsent / capacity: “further information needed to be added to care records to ensure people's care and support was consistently provided in line with the requirements of the Act.”
moderateLeadership: “managerial oversight of the care and support provided needed to be strengthened to demonstrate good quality safe care was always provided.”
minorCommunication with families: “Whilst the AIS standards to support people's needs had not been fully considered during care planning”
minorCultural competency: “The registered manager was in the process of adding further information to people's care records in relation to their cultural needs and preferences”
Strengths
· Staff recruited safely with sufficient staffing levels to meet people's needs
· Staff completed safeguarding training and understood how to protect people from abuse
· Relatives and people felt safe and gave positive feedback about caring, kind staff
· People received care from a small number of consistent staff, supporting continuity
· Privacy, dignity and independence were promoted and respected
Quality-Statement breakdown (21)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff support: induction, training, skills and experienceGood
effective: Supporting people to live healthier lives, access healthcare services and supportGood
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 needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
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 requirementsRequires improvement
well-led: Continuous learning and improving care; duty of candour; partnership workingGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood