First inspection of this domiciliary care agency found a breach of Regulation 17 (Good Governance) due to ineffective systems for keeping care plans and risk assessments accurate and up to date, with staff unaware of risk assessments. Despite this, staff knew people well, medicines were managed safely and people and relatives reported caring, reliable, person-centred support.
Concerns (7)
critical
Governance
: “The provider had failed to have effective systems to monitor the quality and safety of the service and mitigate the risks relating to people. Records were not all accurate and up to date.”
moderateCare planning: “People's care plans were not always up to date and some lacked information about the person from their initial assessment. For example, people who had been identified as at risk of falling, did not have a falls risk assessment in place.”
moderateRecord keeping: “Paper copies of the care plans were available if there was an emergency, however the paper care plans did not always reflect the electronic system.”
moderateStaff competency: “Staff told us they did not always feel confident using the equipment on their own.”
moderateInfection control: “where it had been identified staff could come into contact with body fluids, there was no guidance or risk assessment to inform staff of how to reduce the risk spreading infection or cross contamination.”
minorStaff training: “one staff member felt they needed more shadowing. They felt they needed more support and shadowing when using mobility equipment”
minorLeadership: “some staff felt the registered manager was not always available for them to contact due to the registered manager supporting people in care calls.”
Strengths
· Staff knew people well and understood their health concerns and preferences
· People and relatives reported staff were caring, kind and reliable
· Medicines were administered safely using an electronic MAR system with prompts and competency checks
· Effective electronic call monitoring meant calls were rarely missed and people were notified of lateness
· Staff worked well in partnership with GPs, district nurses and other healthcare professionals
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
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 dietGood
effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies; supporting people to access healthcareGood
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 controlGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers and staff being clear about their roles; understanding quality performance, risks and regulatory requirements; continuous learning and improving careRequires 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