Kare Plus Ipswich received a Requires Improvement rating following a focused inspection in July 2023, with a continued breach of Regulation 17 (Good Governance) due to inconsistent oversight, audit analysis, and absence of a registered manager. Improvements were noted in medication management, infection control, and risk assessment updates, but governance, incident learning, and person-centred care planning required further development.
Concerns (8)
criticalGovernance: “The provider did not have robust processes in place to monitor the safety and quality of the service. This demonstrated a continued breach of regulation 17 (Good governance)”
criticalLeadership: “The service did not have a manager registered with the Care Quality Commission. The management team were new and had been in post for 6 weeks.”
moderateIncident learning: “There was not a robust system in place for the provider to evidence how they learned lessons when things go wrong and to reduce the risk of reoccurrence.”
moderateCare planning: “Care plans and risk assessments had been updated and were accurate, they lacked detail in certain areas and were often generic.”
moderateSafeguarding: “Not all were confident in the processes for escalating concerns to relevant stakeholders externally.”
moderatePerson-centred care: “The provider did not have due regard to 'right support, right care right culture', despite being registered as a specialist service for people with a learning disability and autistic people.”
minorComplaints handling: “The provider's complaints policy and procedure needed updating to ensure information on how complaints were managed was correct to manage people's expectations.”
minorSupervision / appraisal: “There had been slippage with formal supervisions but the management team had identified this and supervisions were planned.”
Strengths
· Risk assessments had recently been reviewed and amended, and measures were put in place to guide staff on how to reduce risks.
· Staff were safely recruited with all relevant pre-employment checks completed including DBS checks.
· Medicines were managed safely with monitoring of administration records and processes to identify and address errors.
· Staff received training relevant to their role including Oliver McGowan Mandatory Training on Learning Disability and Autism.
· Staff received infection prevention and control training and were provided with adequate PPE.
Quality-Statement breakdown (9)
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
well-led: Managers and staff being clear about their roles, understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
First inspection of newly registered Kare Plus Ipswich domiciliary care agency, supporting one person, identified breaches of Regulation 12 (safe care and treatment) and Regulation 17 (good governance) due to absent risk assessments, unsafe medicines oversight, lack of competency checks and no registered manager. The service was rated Requires Improvement overall, though caring was rated Good with relatives describing staff as friendly and kind.
Concerns (12)
criticalCare planning: “Risk assessments were not in place and there were no managements plans in place to guide staff on how to reduce the risk of harm.”
criticalMedication management: “Medicines were not always managed in a safe way. Medicine administration records were not always accurately completed, and there were no medicine profiles or controls for overseeing the arrangements in place.”
criticalGovernance: “The management oversight of the service needed improvement and audits developed to monitor the quality of care.”
criticalLeadership: “The provider did not have a manager registered with the Care Quality Commission [CQC]. The previous registered manager left in June 2021 and had not been replaced.”
moderateIncident learning: “Incidents were not reviewed in a systematic way to reduce the likelihood of a reoccurrence.”
moderateStaff training: “While some training for staff was provided, it was not specific to the needs of the people they supported.”
moderateStaff competency: “There were no competency assessments to check staff's understanding of what they covered on training or spot checks to review care delivery.”
moderateSafeguarding: “Staff were clear about escalating safeguarding concerns to the management of the service but were not clear about the role of the Local Authority.”
moderateInfection control: “The system in place to ensure staff received regular COVID-19 swab testing was not effective and the provider was not able to demonstrate that testing was not being undertaken in line with government recommendations.”
moderateRecord keeping: “There was no record of a formal assessment being undertaken by the agency when care was commissioned with them.”
moderateConsent / capacity: “Staff were not clear whether the person they were supporting had capacity and the documentation was contradictory.”
moderateOther: “Recruitment processes were not robust and we identified shortfalls in referencing and risk assessments.”
Strengths
· People were supported by a consistent team of care staff who stayed for the allocated time.
· Relatives described the care staff as friendly and kind; staff demonstrated that they knew people well.
· Staff promoted people's privacy, dignity and independence.
· Staff received supervisions and were positive about the levels of support from management.
· An on-call system was in place outside office hours to support staff.
Quality-Statement breakdown (18)
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongNot rated
safe: Using medicines safelyNot rated
safe: Staffing and recruitmentNot rated
safe: Systems and processes to safeguard people from the risk of abuseNot rated
safe: Preventing and controlling infectionNot 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: Assessing people's needs and choices; delivering care in line with standards, guidance and the law
Not rated
effective: Staff working with other agencies; supporting people to live healthier lives, access healthcare servicesNot rated
effective: Ensuring consent to care and treatment in line with law and guidanceNot rated
caring: Ensuring people are well treated and supported; respecting equality and diversityNot rated
caring: Respecting and promoting people's privacy, dignity and independenceNot rated
responsive: Planning personalised care; End of life care and supportNot rated
responsive: Improving care quality in response to complaints or concernsNot rated
responsive: Supporting people to develop and maintain relationships; meeting communication needsNot rated
well-led: Managers and staff being clear about their roles; understanding quality, risks and regulatory requirementsNot rated
well-led: Promoting a positive culture and acting on the duty of candourNot rated
well-led: Engaging and involving people, public and staff; working in partnership with othersNot rated