Johnston's Homecare Ltd received an overall Requires Improvement rating at its first inspection, with breaches of Regulation 19 (unsafe recruitment practices) and Regulation 17 (inadequate governance and audit systems). Strengths included safe medicines management, caring and culturally responsive staff, and person-centred care planning, with a newly appointed manager already implementing improvements.
Concerns (7)
critical
Staff competency
: “Recruitment files did not always contain appropriate references... references for 2 staff members were from organisations which were not listed on their application forms.”
criticalGovernance: “Management audits had not been completed effectively... did not reveal shortfalls we found in relation to recruitment, staff deployment and assessing people's risks.”
moderateStaffing levels: “Staff rosters were not in place to show how staff were allocated to people... instances where staff were scheduled to have attended more than 1 call at the same time”
moderateRecord keeping: “Management records were not always securely stored. The nominated individual told us that a former manager had deleted staff supervision and induction records.”
moderateCare planning: “Some of the risk assessments lacked detail... for one person who used a hoist to transfer, guidance was brief and did not contain enough instructions on how to safely operate this equipment.”
moderateStaff training: “Where a person had a specific health condition which required specialised care, such as dysphagia or pressure sores, staff had not received training in these specialist areas.”
minorSupervision / appraisal: “Most staff had not received a supervision due to their short term of employment, but a supervision and appraisal matrix was in place.”
Strengths
· People were protected from the risk of abuse and staff were fully aware of their duties to report concerns.
· Medicines were managed safely; staff received training and were assessed as competent to administer medicines.
· Infection prevention and control measures were in place including appropriate use of PPE.
· Staff treated people with dignity, kindness and respect; described as 'like a family' by people using the service.
· Care plans were person-centred and contained detailed information on individual needs, preferences and life histories.
Quality-Statement breakdown (19)
safe: Staffing and recruitmentRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
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: Supporting people to live healthier lives, access healthcare services and supportGood
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
responsive: Planning personalised care to ensure people have choice and controlGood
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: Managers and staff being clear about their roles, 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