First rating inspection of a newly registered domiciliary care agency identified breaches of Regulations 12, 17 and 19 relating to safe care and treatment, governance and recruitment. While caring and responsive domains were rated Good, weaknesses in risk assessment, infection control, MCA/DoLS understanding, induction and quality monitoring resulted in an overall rating of Requires Improvement.
Concerns (9)
critical
Infection control
: “The provider had failed to ensure that risks relating to infection control and the transmission of COVID 19 were being effectively managed.”
criticalCare planning: “This information did not form part of this person's care plan and there was no risk assessment in place to guide staff as to any actions they should take to keep this person, themselves and others safe.”
criticalGovernance: “The provider did not have effective systems in place to assess, monitor and improve the safety and quality of the service.”
criticalOther: “The provider had failed to ensure that recruitment procedures are established and operated effectively.”
moderateIncident learning: “Systems were not fully embedded or robust enough to demonstrate accidents and incidents were effectively monitored, reviewed or used as a learning opportunity.”
moderateConsent / capacity: “the management team did not have a good understanding of the Mental Capacity Act and DoLS process within community settings. This lack of understanding had led to one person having various restrictions placed upon them without a legal basis”
moderateStaff training: “we found staff had not completed an induction in line with Care Certificate Standards.”
moderateLeadership: “service management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.”
minorRecord keeping: “The language used within one person's daily notes / incident records did not always demonstrate a person-centred approach and was not in keeping with best practice guidance.”
Strengths
· People received their medicines as prescribed and medicines were managed safely and stored securely
· Staff knew people well, communicated effectively and spoke about people in a dignified and respectful way
· Support plans contained detailed information on people's likes, dislikes, preferences, care needs and medical history
· People were encouraged and supported to lead full and active lives, follow their interests and take part in activities
· Staff had opportunities for regular supervision and appraisal and felt supported by the management team
Quality-Statement breakdown (23)
safe: Assessing risk, safety monitoring and management; Preventing and controlling infectionRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
effective: Ensuring consent to care and treatment in line with law and guidance (MCA/DoLS)Requires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to live healthier lives and access healthcare servicesGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
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: Supporting people to develop and maintain relationships and follow interestsGood
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 requirementsRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
well-led: 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