Date of Assessment: 30 March to 13 June 2025. This assessment was prompted by a review of the information we held about the service. The service is a care at home service providing support to adults of all ages living in their own homes. CQC only inspects where people are receiving the regulated activity personal care. This is help with tasks related to personal hygiene and eating. At the time of the assessment 24 people were using the service. We assessed the service to check whether improvements had been made following our previous inspection. We assessed all of the quality statements from the safe and well-led key questions and 2 quality statements from caring and responsive. We have combined the scores for these areas with scores from our last inspection to give the rating for this assessment. There was a positive learning culture, where the provider was pro-active in seeking feedback and implanting learning to make improvements. People and relatives knew how to give feedback and were confident the provider took it seriously and acted on it. People were protected and kept safe. Staff were happy to raise any safety concerns and felt they would be dealt with properly. There were sufficient numbers of staff in place. Some improvement was needed to recruitment records. People’s care reflected their needs and people were consulted around how they wished their care to be carried out. Staff understood and managed risks related to people’s care, which helped keep them safe. Safe systems were in place to ensure medicines were administered appropriately where required, although some medicine records needed to be clearer in relation to dosage. Staff worked with stakeholders involved in people’s care to promote the best outcomes and safe transitions when people moved between services. Staff told us they were not always given adequate notice from the provider around their schedule of planned care calls. They said this made it difficult to plan ahead and negatively affected their wellbeing. The registered manager made sure staff received training to maintain high-quality care, although attendance at team meetings and frequency of supervisions needed to improve. The registered manager was aware of staff’s feedback and had put measures in place to address this. Staff cared for people with dignity and respect and promoted their independence. People were treated with kindness and compassion and had a good level of consistency in care staff. Leaders were visible, knowledgeable and supportive, helping staff develop in their roles. Staff felt able to give feedback and were treated equally. The provider had governance systems in place to monitor and improve the quality of care, although some areas could be improved to be more thorough. Managers worked with stakeholders in the local community to deliver the best possible care and were receptive to new ideas. The provider was previously in breach of the legal regulations in relation to safe care and treatment and good governance. Improvements were found at this assessment and the provider was no longer in breach of these regulations.
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Seremed Healthcare, a small domiciliary care agency, received an overall rating of Requires Improvement on its first inspection, with breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) identified due to incomplete risk assessments and ineffective governance systems. Caring, effective and responsive practice was generally good, with staff demonstrating compassion, strong relationships with people, and a positive working culture.
Concerns (10)
criticalCare planning: “one person lived with epilepsy but there was no care plan in place to guide staff on what to do should the person experience a seizure.”
criticalGovernance: “we were not assured, that these were being fully effective, or reliable, at driving improvements and ensuring that the fundamental standards were being met.”
moderateIncident learning: “there had been two missed visits. Whilst the root cause of these missed visits had been investigated, an incident form should have been completed.”
moderateSupervision / appraisal: “two staff who were employed in 2020, had no documented supervision in 2021.”
moderateStaff training: “Three of the four staff had last completed training in moving and handling, medicines management and safeguarding adults in November 2020.”
moderateStaff competency: “The registered manager was delivering training and undertaking competency assessments in moving and handling, but their qualification to do this had expired.”
moderateLeadership: “we were not assured that the registered manager was, in practice, in day to day management of the service, or that they had a sufficient oversight of the provision of care.”
moderateRecord keeping: “Electronic records completed staff at each of the care visits did not provide assurances that two workers had attended each care call, when this was required, or how long the visit had lasted.”
minorMedication management: “People's care plans lacked clarity about roles and responsibilities in relation to the administration of medicines as some of the information recorded was conflicting.”
minorEnd-of-life care: “this information and the person's priorities for their future care had not been incorporated, by the service, into an end of life or advanced care plan.”
Strengths
· People and relatives were positive about staffing, reporting a consistent and reliable service with no missed visits.
· Staff knew how to recognise signs of abuse and had received safeguarding training; people felt safe.
· Strong induction programme including shadowing, Care Certificate training and competency assessments before independent working.
· People were treated with kindness, compassion and respect; staff built strong relationships and promoted independence.
· Person-centred support delivered by staff who knew people well; staff went above and beyond, including an unscheduled 4am call.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionGood
safe: Systems and processes to safeguard people from the risk of abuseGood
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: Staff working with other agencies; supporting people to live healthier livesGood
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 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 needsRequires improvement
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportRequires improvement
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 empoweringGood
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improvementGood