This domiciliary care agency was rated Inadequate overall and placed in special measures, with breaches identified in person-centred care, safe care and treatment, governance, staffing/training and recruitment. Widespread failings included unsafe recruitment, missing risk assessments and care plans, poor medicines management, inadequate MCA compliance and a fourth consecutive rating of requires improvement or inadequate with no registered manager since February 2021.
Concerns (15)
criticalStaff competency: “The provider had not adhered to safe recruitment practices. This placed people at risk of being supported by unsuitable staff.”
critical
Care planning
: “No risk assessments or care plans had been completed for one person using the service, which meant staff had no written guidance on how to safely meet their needs.”
criticalMedication management: “People's medicines were not always managed and administered safely to ensure they were not placed at risk.”
criticalInfection control: “The provider had failed to follow current government advice regarding COVID testing of staff. This placed people and staff at increased risk of increased transmission of COVID-19.”
criticalSafeguarding: “Following the inspection, we raised a safeguarding concern to the local authority for a person regarding the care they received. The provider had failed to identify or report these concerns”
criticalIncident learning: “We were not assured the provider had consistently recorded, analysed or acted on incident and accidents to reduce harm to people.”
criticalStaff training: “We found multiple staff had gaps in their training record, including safeguarding, first aid, mental health awareness and medicines training.”
criticalConsent / capacity: “The provider was not working in line with the principles of the MCA. They were unable to evidence that people's rights under the MCA were being protected.”
criticalGovernance: “The provider had failed to implement effective systems to assess, monitor and improve the service... This was the provider's fourth consecutive rating of requires improvement or inadequate”
criticalLeadership: “There was no registered manager in post at the time of the inspection and no registered manager had been in place since February 2021.”
moderateSupervision / appraisal: “Staff did not always receive regular supervision to monitor and reflect on their practice... There were no records of supervision in staff files.”
moderatePerson-centred care: “Assessments completed for people were very basic and did not incorporate key information, such as their life history, wishes, preferences or protected characteristics”
moderateCommunication with families: “We received mixed views from relatives about the effectiveness of their communication with staff and management.”
moderateComplaints handling: “I told [the provider] that I was not happy [with the care their relative was receiving]. [The provider] just said. 'If you want to complain then complain.'”
moderateRecord keeping: “Some staff we spoke with were not aware how to access people's care plans and lacked understanding of what these contained.”
Strengths
· Staff reported feeling supported by the provider and management team
· People and relatives told inspectors they felt safe and that staff wore correct PPE
· One healthcare professional said the provider was responsive and acted on guidance given
· Some relatives reported timely referrals to health services were made
Quality-Statement breakdown (15)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Using medicines safelyNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Learning lessons when things go wrongNot rated
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawNot rated
effective: Staff support: induction, training, skills and experienceNot rated
effective: Supporting people to eat and drink enough to maintain a balanced dietNot rated
effective: Staff working with other agencies; supporting people to access healthcareNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
well-led: Managers and staff understanding roles, quality, risks and regulatory requirements; continuous learningNot rated
well-led: Promoting a positive, person-centred culture and duty of candourNot rated
well-led: Engaging and involving people, public and staffNot rated
well-led: Working in partnership with othersNot rated
Following improvements since the previous Inadequate rating, the service exited Special Measures but remains Requires Improvement overall, with continued concerns about medicines records, risk assessments and inconsistent partnership working. A continued breach of Regulation 17 (Good Governance) was identified due to ineffective audits, unreviewed incidents, and the absence of a registered manager since February 2021.
Concerns (7)
criticalMedication management: “the provider had failed to ensure accurate and up to date information regarding people's medicines was made available to staff”
criticalGovernance: “The provider had failed to implement robust audits and monitoring systems. This was a continued breach of regulation 17 (Good Governance)”
criticalIncident learning: “we identified 84 such incidents which had not been reviewed by the provider for over one week. In addition, the provider had failed to analyse patterns and trends”
moderateCare planning: “some risk assessments lacked sufficient detail to guide staff how to safely support people”
moderateRecord keeping: “Two people's care records also contained contradictory information about their risk of choking and how staff were to support them to eat safely”
moderateLeadership: “no registered manager had been in place since February 2021”
moderateOther: “Care records did not evidence the provider had liaised with external healthcare professionals to support treatment of the skin condition”
Strengths
· Safe recruitment practices including DBS checks and references now consistently completed
· Staff received up to date safeguarding training and people felt safe
· Regular staff supervision implemented and staff felt supported
· Improved induction programme for new staff
· Provider working within principles of the Mental Capacity Act 2005
Quality-Statement breakdown (15)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentGood
safe: Learning lessons when things go wrongGood
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
effective: Assessing people's needs and choicesRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
Following a focused inspection, the service improved from Inadequate to Requires Improvement and exited Special Measures, with progress in recruitment, risk management and medicines. However, a continued breach of Regulation 17 (Good Governance) remained as audits and monitoring systems were not sufficiently embedded to drive consistent improvement.
Concerns (8)
criticalGovernance: “The provider had failed to implement robust audits and monitoring systems. This was a continued breach of regulation 17 (Good Governance)”
moderateIncident learning: “systems needed to be developed to ensure the provider was able to review safeguarding, accidents and incidents... to identify any patterns and maximise opportunities for taking learning from these”
moderateCare planning: “further improvements in the consistency of guidance across risk assessments and care planning was required, in order to further reduce risks to people”
moderateMedication management: “further action was required to ensure staff were consistently provided with the information needed to support individual people... guidance to advise staff how they would know if people wanted 'as and when required' medicines”
moderateConsent / capacity: “systems for confirming who had legal rights to make some decisions on people's behalves required further development, to ensure people's rights were fully promoted”
moderateLeadership: “There was no registered manager in post at the time of the inspection.”
minorStaff training: “we found some staff still had not had the opportunity to access some specific training, such as Parkinson's disease”
minorRecord keeping: “We found not all the initial DBS checks undertaken by the provider with staff had been recorded.”
Strengths
· Improvements made to safe recruitment practices including references and DBS checks before lone working
· Improved risk assessments and care plans with clearer guidance for staff on moving safely, bedrails and catheter care
· Effective medication checks ensuring people received medicines as prescribed and on time
· Staff used PPE consistently and infection control measures (temperature checks, COVID-19 testing) were in place
· Provider and senior staff covered calls in emergencies, ensuring no missed calls
Quality-Statement breakdown (10)
safe: Staffing and recruitmentNot rated
safe: Assessing risk, safety monitoring and managementNot rated
safe: Learning lessons when things go wrongNot rated
safe: Using medicines safelyNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirements; Continuous learning and improving careNot rated
well-led: Promoting a positive culture that is person-centred, open, inclusive and empowering
Care Is Where The Heart Is Ltd remained rated Inadequate following a focused inspection prompted by safeguarding, recruitment, medication and governance concerns, with continued breaches of Regulations 12, 17 and 19. The service stays in special measures due to insufficient improvement in care planning, risk assessment, medicines management and provider oversight.
Concerns (10)
criticalGovernance: “There continued to be a lack of provider oversight which meant risks to people's safety had not been identified and responded to appropriately.”
criticalCare planning: “Care plans were not in place for known health conditions to provide staff with the information they needed to mitigate risk and meet or respond to people's needs.”
criticalMedication management: “MAR... did not include all medications prescribed for people using the service. This meant care staff did not have accurate records to refer to, ensuring they were giving the correct medication”
criticalStaff competency: “Two suitable references had not been obtained prior to care staff members commencing work... did not follow their own recruitment policy or adhere to regulations”
criticalRecord keeping: “failed to identify there was a lack of information in care records, such as the support people needed especially with known health conditions.”
criticalLeadership: “there were widespread and significant shortfalls in service leadership. Leaders and the culture they created did not assure the delivery of high-quality care.”
moderateStaff training: “Moving and handling training for staff was identified as needed at the last inspection. However, this had still not been provided”
moderateInfection control: “these did not always refer to the individual's known health conditions to assess the risk to each person... They also did not refer to care staff wearing Personal Protective Equipment (PPE).”
moderateComplaints handling: “The provider told us they had not received any complaints... they had received calls from people using the service to raise concerns... did not want to record these as a formal complaint.”
moderateMissed or late visits: “We requested call records... These records had not been provided within the set timeframe, so we were unable to review if calls were the length they were commissioned for”
Strengths
· People and relatives reported feeling safe and said care staff knew them and their needs
· Staff had a good understanding of safeguarding and whistleblowing procedures
· Staff felt supported by the management team
· Provider arranged weekly COVID tests for staff and had up-to-date guidance available
· Engagement with health professionals to support people with changing needs
Quality-Statement breakdown (11)
safe: Staffing and recruitmentInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Learning lessons when things go wrongNot rated
safe: Preventing and controlling infectionNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsInadequate
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effective: Staff support: induction, training, skills and experienceGood
effective: Staff working with other agencies to provide consistent, effective, timely careRequires improvement
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 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 staffGood
well-led: Working in partnership with othersRequires improvement
Not rated
well-led: How the provider understands and acts on the duty of candourNot rated
well-led: Working in partnership with othersNot rated
Inadequate
well-led: Engaging and involving people using the service, the public and staffNot rated
well-led: Duty of candour and promoting a positive person-centred cultureNot rated
well-led: Working in partnership with othersNot rated