Continuity Healthcare Services Private Limited improved from Inadequate to Requires Improvement following a focused inspection of Safe, Effective, and Well-led domains, exiting Special Measures, but remained in breach of Regulation 17 (Good Governance) due to ineffective oversight systems failing to identify gaps in medicines management, MCA compliance, and recruitment. Key concerns included incomplete 'as required' medicines protocols, lack of recorded best-interests decisions, late care visits without communication to people, and governance processes not yet sufficiently embedded to sustain improvements.
Concerns (11)
criticalGovernance: “governance systems were not established and did not always identify areas where improvements were required.”
criticalConsent / capacity: “one person's family member had been asked to sign consent for their care and treatment on the person's behalf. This is not in accordance with the principles of the MCA.”
moderateMedication management: “further improvements were required to ensure each 'as required' medicine had a protocol in place.”
moderateMedication management: “further improvements were still required to ensure staff were given clear instructions on how to record and rotate the application of patches.”
moderateConsent / capacity: “where decisions needed to be made about people's care and welfare in their best interests, these decisions were not always recorded.”
moderateMissed or late visits: “"I am fed up with the poor timing of visits" and, "Staff just appear, the call times have not been followed."”
moderateIncident learning: “staff did not always raise incidents with the registered manager when they occurred, so that incidents could be effectively investigated.”
moderateRecord keeping: “new governance processes had not identified there were improvements required in the areas of medicines management, safe recruitment practices, and the adherence to the MCA.”
moderateCommunication with families: “some care staff did not have English as their first language. Where people had a hearing impairment or a cognitive impairment, this lack of communication caused anxiety.”
moderateComplaints handling: “the majority of people told us they found it difficult to make contact with office staff if they had a concern about their care. One person told us it was, "Impossible to get through to the office."”
minorCommunication with families: “"If they [staff] are late we are not informed." People also told us they would like to have a copy of the call rota.”
Strengths
· Safeguarding systems and procedures had been improved; safeguarding concerns were identified, investigated, and referred to appropriate authorities, resolving the previous breach of Regulation 13.
· Staff training had improved, including Care Certificate onboarding, safeguarding, infection prevention, MCA, and learning disability/autism training.
· Medicines administration records (MAR) were held electronically with a backup paper process, and time-critical medicines calls were scheduled appropriately.
· Safe recruitment procedures had been improved with an up-to-date policy and identity/right-to-work checks in place.
· The provider worked closely with local authority commissioners and external organisations such as the Alzheimer's Society to improve outcomes.
Quality-Statement breakdown (15)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Staffing and recruitmentRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies; supporting people to live healthier livesGood
well-led: Managers and staff being clear about their roles; continuous learning; engaging people and staffRequires improvement
well-led: How the provider understands and acts on the duty of candourRequires improvement
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringRequires improvement
Continuity Healthcare Services was rated Inadequate overall and placed in special measures, with breaches of Regulations 12, 13, 17 and 19 and Warning Notices served for safe care and good governance. Significant failings included missed care calls (one person without care for 7 days), unsafe medicines management, untrained staff, unmanaged safeguarding allegations, and a provider with no oversight of the service since April 2021.
Concerns (18)
criticalSafeguarding: “We identified two allegations of abuse which had not been managed appropriately and had not been referred to the local authority safeguarding team or CQC.”
criticalMissed or late visits: “One person received no care calls for 7 days, leaving them at serious risk of harm.”
criticalMedication management: “Medicines were not always managed safely. The provider did not have a system in place to ensure staff always recorded when people received their medicines.”
criticalStaff training: “There were significant gaps in training for all staff and senior staff told us they had not received essential training required for their role when they started work.”
criticalStaff competency: “The provider's records confirmed 24 staff had never received a medicine competency check, which placed people at risk.”
criticalGovernance: “The provider failed to have oversight and governance systems were not established or effective. This placed people at risk of harm.”
criticalLeadership: “The provider demonstrated no oversight of the service and told us they had carried out no quality assurance checks on the service since April 2021.”
criticalCare planning: “people's care plans did not always include risk mitigation plans for people with specific health conditions, or guidance for staff about how to care for people safely.”
criticalIncident learning: “The provider failed to maintain accurate records of events which called into question people's safety, so that a review and analysis of these events could take place and lessons could be learnt.”
criticalRecord keeping: “Records were not accurate or complete. For example, care records did not contain management plans and risk assessments relating to some people's specific needs”
moderateStaffing levels: “the provider was unable to demonstrate whether there were sufficient numbers of staff to meet each person's scheduled care calls.”
moderateComplaints handling: “Complaints had not been managed in accordance with the provider's policy, because people had not received a record of the outcome of their complaint.”
moderateConsent / capacity: “one person's family members had been asked to sign consent for their care and treatment on the person's behalf. This is not in accordance with the principles of the MCA.”
moderateInfection control: “Over 40 staff had not received training in safe infection prevention and control for over two years or had not received it at all.”
moderateEnd-of-life care: “Records showed 167 staff had not received awareness training in end of life care. This included all senior staff apart from one.”
moderateCommunication with families: “The provider was not aware of their legal responsibilities under the NHS's Accessible Information Standards.”
moderateSupervision / appraisal: “The manager told us they had not received a one to one meeting with their manager to discuss their progress and development since they began their current role.”
moderatePerson-centred care: “there was no communication plan or assessment of risk in the person's care records, which meant staff were not provided with guidance about how to consistently meet the person's specific communication needs.”
Strengths
· Protected characteristics under the Equality Act 2010 were considered in assessments, including accommodating requests such as female-only carers for religious reasons
· Staff prepared meals in line with people's choices and supported people to eat and drink enough
· People had been referred to other healthcare professionals such as occupational therapists and district nurses
· Most relatives were satisfied with the service and spoke positively about the manager
· Some people praised carers as 'a really lovely team with a caring attitude' and reported dignity being maintained during personal care
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseInadequate
safe: Assessing risk, safety monitoring and managementInadequate
safe: Using medicines safelyInadequate
safe: Staffing and recruitmentInadequate
safe: Learning lessons when things go wrongInadequate
safe: Preventing and controlling infectionRequires improvement
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standardsGood
effective: Supporting people to eat and drink enoughGood
effective: Working with other agencies and supporting access to healthcareGood
caring: Ensuring people are well treated and supported; respecting equality and diversityRequires improvement
caring: Respecting and promoting people's privacy, dignity and independenceRequires improvement
caring: Supporting people to express their views and be involved in making decisionsGood
responsive: Meeting people's communication needsRequires improvement
responsive: Improving care quality in response to complaints or concernsRequires improvement
responsive: End of life care and supportRequires improvement
responsive: Planning personalised care to meet needs and preferencesGood
well-led: How the provider understands and acts on the duty of candourInadequate
well-led: Managers and staff being clear about their roles and understanding quality, risks and regulatory requirementsInadequate
well-led: Continuous learning and improving careInadequate
well-led: Working in partnership with othersInadequate
well-led: Engaging and involving people using the service, the public and staffRequires improvement
well-led: Promoting a positive, person-centred, open, inclusive cultureRequires improvement