Kare Support Services Ltd received an overall rating of Requires Improvement at its first CQC inspection, with multiple regulatory breaches identified across safe, effective and well-led domains, including failures in recruitment, medicines management, safeguarding, staff training and governance. Caring and responsive practice were rated Good, with people feeling respected and involved in their care.
Concerns (10)
critical
Governance
: “The registered manager did not operate effective quality assurance systems to oversee the service. They had not identified the concerns we found through their own monitoring systems.”
criticalSafeguarding: “We were alerted to one incident where a safeguarding alert was not raised to ensure it was investigated properly. This incident was not reported to CQC.”
criticalMedication management: “We looked at the MAR sheet and the information about each medicine was noted. However, there were no signatures to indicate the medicine had been given.”
criticalStaff competency: “The registered manager did not have appropriate training to carry out these assessments. This meant the registered manager could not assure us staff were competent.”
criticalRecord keeping: “Records were not always completed accurately or updated when necessary. The registered manager did not always ensure people and staff were protected against the risks of unsafe or inappropriate support.”
criticalLeadership: “The registered manager did not demonstrate integrity and transparency when they failed to inform us about an incident they were responding to during our inspection.”
moderateStaff training: “The training matrix did not show the dates of the training so we could not judge if the staff were up to date with their necessary training.”
moderateCare planning: “One person had issues with mobility, balance and coordination...it was not explained what that position would be and how to achieve it.”
moderateIncident learning: “It was not very clear if themes and trends were identified and discussed with the staff team to ensure the quality of care could be improved.”
minorConsent / capacity: “Care and support records for one person were signed by the family members and it was not clear if they had a legal right to do that.”
Strengths
· Staffing levels were sufficient; people and staff confirmed there were enough staff and visits were completed on time.
· People and relatives felt safe and were treated with dignity, respect and compassion by familiar, consistent staff.
· Staff had PPE and infection control training; one person confirmed staff wore protective equipment.
· The service communicated proactively with families, GPs, community nurses and occupational therapists.
· Staff received regular supervision and appraisals and felt supported by the registered manager.
Quality-Statement breakdown (20)
safe: Recruitment and staffingRequires improvement
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Using medicines safelyRequires improvement
safe: Assessing risk, safety monitoring and management; Learning lessons when things go wrongRequires improvement
safe: Preventing and controlling infectionGood
effective: Staff support: induction, training, skills and experienceRequires improvement
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawRequires improvement
effective: Supporting people to eat and drink enough to maintain a balanced dietGood
effective: Staff working with other agencies to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceRequires improvement
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
caring: Respecting and promoting people's privacy, dignity and independenceGood
responsive: Planning personalised care to ensure people have choice and control and to meet their needs and preferencesGood
responsive: Meeting people's communication needsGood
responsive: Improving care quality in response to complaints or concernsGood
well-led: Managers and staff 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: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: Engaging and involving people using the service, the public and staff; Continuous learning and improving careGood