Ruby24hr Care and Revive Supported Living received an overall rating of Requires Improvement at its first inspection, with a breach of Regulation 17 (Good Governance) identified due to inconsistent oversight of safety and quality, including gaps in risk assessment, care plan review, staff supervision, recruitment records, and COVID-19 testing. Mitigating factors included a knowledgeable consistent staff team, no missed calls, good safeguarding awareness, and recent steps taken to strengthen governance through the recruitment of an experienced compliance administrator.
Concerns (8)
criticalGovernance: “The provider had not consistently maintained effective oversight of the safety and quality of the service.”
moderateInfection control: “The provider had not ensured staff were routinely polymerase chain reaction (PCR) tested as per government guidance for homecare providers.”
moderateCare planning: “The care plan was overdue a review, with some information out of date such as dispensing medication which staff no longer supported the person with.”
moderateSupervision / appraisal: “Staff supervision had not been completed in line with the provider's policy and procedure and spot checks were not regularly completed.”
moderateRecord keeping: “Risks to the person were not consistently assessed and mitigated. There were no risk assessments in place for staff guidance in these areas.”
minorStaff training: “Not all staff had completed training in MCA. However, they had been prompted by the provider to complete this.”
minorEnd-of-life care: “End of life wishes in the case of a sudden decline in health had not been discussed as part of the care planning process.”
minorPerson-centred care: “The person told us they did not consistently feel well supported, and stated some staff were not completing the domestic tasks required.”
Strengths
· Staff had received safeguarding training and understood how to identify and report abuse; the person felt safe with staff.
· Staff had access to adequate PPE stock and were using it appropriately; they were trained in infection control including handwashing.
· No missed or late calls; the person received a consistent small staffing team that knew them well.
· Care plans included person-centred information written with the person and their family's involvement.
· The provider demonstrated good understanding of duty of candour and had a policy and procedure in place.
Quality-Statement breakdown (22)
safe: Preventing and controlling infectionRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choicesRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Supporting people to live healthier lives and access healthcare servicesRequires improvement
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 guidanceRequires improvement
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and controlRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsRequires improvement
well-led: Managers and staff being clear about their roles and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; working in partnership with othersGood
Ruby24hr Care and Revive Supported Living improved from Requires Improvement to Good across all three inspected key questions (safe, effective, well-led), having remediated prior breaches of Regulations 12 and 17. The service demonstrates strengthened governance, safe medicines management, robust recruitment and a person-centred culture, with only a minor concern noted around staff working consecutive long shifts.
Concerns (1)
minorStaffing levels: “Rotas showed, and staff told us they worked long shifts and consecutive days which included overnight support. This meant staff may not have rested enough to support the person the next day.”
Strengths
· Improved incident recording, investigation and monitoring systems in place; lessons learnt shared with staff transparently.
· Strengthened staff recruitment processes including DBS checks, right to work checks and employment gap exploration.
· No missed visits reported; consistent, reliable staffing with very low staff turnover.
· Medicines safely prompted by trained and competency-assessed staff with audit systems in place.
· Staff trained in sign language to support effective communication with people with a learning disability and autism.
Quality-Statement breakdown (16)
safe: Learning lessons when things go wrong; Assessing risk, safety monitoring and managementGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceGood
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 diet
Ruby24hr Care and Revive Supported Living received an overall rating of Requires Improvement, with breaches of Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance), including failure to notify CQC of serious incidents and ineffective oversight of staff records. Strengths included consistent staffing, good infection control, person-centred matching of staff, and positive family feedback, but governance and incident management failings persisted from the previous inspection.
Concerns (8)
criticalIncident learning: “Incident reports were not effectively monitored or analysed, to check staff followed personalised risk assessments when responding to incidents of physical violence.”
criticalSafeguarding: “We found 2 incidents of a person self-harming that required hospital treatment. The incidents were not notified to CQC and no records were available of the provider consulting with the safeguarding authority.”
criticalGovernance: “The provider had failed to ensure the governance systems were effective in continually monitoring and driving improvement of the service. This was a breach of regulation 17.”
moderateRecord keeping: “The systems to review and monitor staff records were not fully robust. We found gaps in staff recruitment, training and supervision records, that had not been identified in the providers own audits.”
moderateSupervision / appraisal: “One staff member that started at the service in December 2021, had no supervision records available. Another that started in September 2022 had no records of having supervision during their induction period.”
moderateStaff training: “During the inspection site visit we found records were unavailable of the dates when staff had received training on safeguarding adults and Prevention and Management of Violence and Aggression (PMVA) training.”
moderateConsent / capacity: “Incident reports did not always record how staff supported people in the least restrictive way possible and in their best interests.”
moderateStaff competency: “One staff file had a gap of 11 years with no employment history recorded, which had not been identified or explored further at the interview stage.”
Strengths
· DBS checks were completed for all staff prior to them working alone with people.
· There were enough staff deployed to meet people's needs; people received care from a consistent team.
· Staff followed infection control practices including appropriate use of PPE.
· People's needs were assessed with involvement of the person and their family, including healthcare specialists.
· A relative described a staff member as 'absolutely brilliant' with a great rapport with their family member.
Quality-Statement breakdown (13)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires 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 diet
Good
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
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
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
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving careGood
well-led: Working in partnership with othersGood
Good
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement