Date of assessment 26 February 2025 to 12 March 2025. Covenant Healthcare Ltd is a domiciliary care service providing personal care to people who live in their own homes, including older people and younger adults, some of whom live with dementia, sensory impairments or physical disabilities. Not everyone who used the service received personal care. CQC only inspects where people receive personal care which is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided. At the time of the inspection there were 11 people receiving personal care. Some people receiving care have learning disabilities or autism. We have therefore assessed the service against ‘Right support, right care, right culture’ guidance to make judgements about whether the provider guaranteed people with a learning disability and autistic people respect, equality, dignity, choices, independence and good access to local communities that most people take for granted. This assessment was carried out to follow up on action we told the provider to take at the last assessment of this service. We found improvements had been made and the provider was no longer in breach of the regulations. There had been improvements in the way people were supported, the management of people’s safety, how people were individually referred to in their care records and the management of the service. However, further development of some governance systems was required to provide the registered manager with assurance people’s care was consistently and accurately recorded and staff were always given the guidance they needed to support people, including in relation to advanced decisions. Staff supported people in their best interests and promoted their rights. Staff were confident any concerns and their feedback would be acted on. Processes were in place to safely recruit and induct new staff.
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First inspection of this newly registered domiciliary care agency identified breaches of Regulations 12 and 17 due to contradictory medication and care plan information, ineffective governance audits, and failure to submit statutory notifications. People and relatives gave positive feedback about caring, responsive staff, but improvements were needed in safe medicines management, risk assessment, and well-led oversight.
Concerns (13)
criticalMedication management: “one person had a medication listed in their plan of care which told staff to give 1ml but immediately below this instruction was a different instruction to give 2mls”
criticalMedication management: “This person's body map showed the registered manager had directed staff to use two alternating skin sites every seven days. This was not in line with the manufacturer's instructions”
criticalCare planning: “Information in people's plans of care was sometimes contradictory and this posed potential risks of harm to people.”
criticalGovernance: “Governance systems failed to identify concerns with medicine administration information. Governance systems for care plan information were insufficient.”
criticalLeadership: “Since registration with CQC in February 2021, no statutory notifications had been sent to us... "There are at least ten I know I should have sent."”
moderateMedication management: “Where medicine was prescribed 'when required' we found no protocol with the medication administration information to guide staff when the medicine should be administered.”
moderateCare planning: “one person's plan of care stated in one section they were incontinent and would ask staff for support to use the toilet and another section stated the person was continent.”
moderateGovernance: “Quality checks were undertaken but were not always effective in identifying where improvements were needed.”
moderateIncident learning: “a staff member had crushed a person's tablets without first seeking guidance... there was no evidence this had been reported by staff to the registered manager as an incident.”
moderateConsent / capacity: “the outcome of each assessment was generic and not person centred and stated, "where the individual lacks capacity then a best interest decision document would be completed".”
moderateRecord keeping: “their care plan section 'where is the DNACPR located' had not been completed.”
minorRecord keeping: “some language in care plans referred to 'the service users' or 'the patient' where generic terminology or cut and pasted information had not been changed to the person's name.”
minorLeadership: “The registered manager had not yet started their Level 5 Care Leadership and Management Diploma.”
Strengths
· People and their relatives were satisfied with the care and described staff as kind and caring
· No missed care calls and people felt safe with staff in their homes
· Staff were recruited safely with references and DBS checks
· Staff received induction and training including for complex healthcare tasks (PEG, tracheostomy)
· Registered manager (a registered nurse) carried out three-monthly competency assessments
Quality-Statement breakdown (20)
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Staffing and recruitmentGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietRequires improvement
effective: Staff work with other agencies to provide consistent, effective, timely careGood
effective: Staff support: induction, training, skills and experienceGood
caring: Ensuring people are well treated and supported; respecting equality and diversityGood
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 needsGood
responsive: Improving care quality in response to complaints or concernsGood
responsive: End of life care and supportGood
well-led: Managers being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Continuous learning and improving care; Working in partnership with othersRequires improvement