Careinmyhome West Essex was rated Requires Improvement overall following a focused inspection of Safe and Well-Led, with breaches of Regulation 17 (good governance) and Regulation 19 (fit and proper persons employed) identified. Key concerns included unsafe recruitment practices, lack of a registered manager, inconsistent oversight, and insufficiently detailed care plans and monitoring documentation.
Concerns (9)
critical
Governance
: “Breach of regulation 17 (good governance). Governance and performance management was not always reliable and effective. Some records contained conflicting or unclear information.”
criticalStaff competency: “Some staff had started work prior to receipt of sufficient references. There was no risk assessment for staff with an entry on their DBS.”
moderateStaffing levels: “Staff were concerned there was not enough staff to cover absence. One said "I worry if I can't cover who will. I try to help where I can."”
moderateRecord keeping: “One person's file said they had PRN medicines but it did not say what it was or where it was kept. Another person's file said they had no PRN medication, but there were two PRN medications on their MAR chart.”
moderateCare planning: “People's care plans were not always clear and detailed... assessments had been completed as prompted by the electronic system when not relevant.”
moderateMedication management: “Not all staff had received up to date training and competency assessments in medicines.”
moderateLeadership: “The registered manager had left in August 2022... the service continued to be managed on a temporary basis and there was no registered manager application yet in progress.”
minorSupervision / appraisal: “The list we saw to monitor these was not robust; it was unclear who was due what and when. The competency assessments included numerous prompts to check, but there was no space for narrative.”
minorMissed or late visits: “Another said, "I would like to be informed if they are going to be very late or cancel a visit." Another said, "They just need to sort their timing out then they'll be alright."”
Strengths
· Staff had good understanding of people's needs despite care plans lacking detail
· People felt safe and were happy with the care provided
· Staff were provided with appropriate PPE and had received infection prevention and control training
· Staff had received safeguarding training and could describe how to raise concerns
· People tended to have consistent, familiar carers
Careinmyhome West Essex received a Good rating across all five key questions at its first CQC inspection in June 2021, with 31 people using the service of whom 22 received personal care. Minor issues were identified around incomplete risk assessments and gaps in end-of-life care training, both of which were promptly addressed by the registered manager during the inspection.
Concerns (3)
minorCare planning: “We identified that some risks had not been assessed and raised this with the registered manager. They took immediate action to review people's care so staff would know how to support them safely.”
minorEnd-of-life care: “Not all staff had experience of caring for people at their end of their life. All staff members have been booked to complete training, so they are up to date with their knowledge.”
minorCommunication with families: “A recent survey by phone to people who used the service found that some people didn't know who to complain to. A new updated information pack was produced and provided to people.”
Strengths
· People felt safe with consistent staff providing continuity of care and all staff had completed safeguarding training.
· Safe recruitment practices were in place with necessary checks and references in all staff files.
· Medicines were administered safely by trained staff with electronic MAR monitoring and competency spot checks.
· Effective infection control and PPE practices were maintained throughout the COVID-19 pandemic.
· Staff received induction, ongoing training, regular supervision and observations of practice.
Quality-Statement breakdown (22)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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: Staff support: induction, training, skills and experienceGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
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 control and to meet their needs and preferencesGood
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: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Engaging and involving people using the service, the public and staff; continuous learning and improving careGood