This focused KLOE inspection of Zander Mackenzie Care UK Ltd found the service had remediated all four prior regulatory breaches (Regulations 12, 13, 17 and 18), improving its overall rating from Requires Improvement to Good. Safe and Well-led key questions were both rated Good, with strong evidence of effective safeguarding, risk management, medicines safety, governance and person-centred culture.
Strengths
· People were protected from risk of harm and abuse; safeguarding concerns were shared with local authority and investigated appropriately.
· Risks were individually assessed, regularly monitored and reviewed, with up-to-date task lists and external guidance for staff.
· Medicines were managed safely with staff training, competency assessments and documented refusals or missed administrations.
· Infection control procedures were embedded in care plans with PPE compliance monitored visit-by-visit by management.
· Incidents and accidents were recorded, investigated and lessons shared with staff via team meetings or direct communication.
Quality-Statement breakdown (11)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Assessing risk, safety monitoring and managementGood
safe: Using medicines safelyGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
safe: Staffing and recruitmentGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsGood
well-led: Continuous learning and improving care; Working in partnership with othersGood
First inspection of this newly registered domiciliary care service rated Requires Improvement overall, with breaches identified in safeguarding, safe care and treatment (medicines, risk and infection control), good governance and CQC notifications. While care was caring and effective with consistent staff and personalised support, leadership oversight, complaints handling and record keeping were inadequate.
Concerns (11)
criticalSafeguarding: “The registered manager failed to report a safeguarding concern to the local authority.”
criticalMedication management: “There were not effective systems in place for recording medicines and ensuring the safe administration of them to people.”
criticalInfection control: “Systems had not been established to assess, monitor and mitigate risks of infections being caught or spread by staff to people.”
criticalCare planning: “Risk assessments and care plans were not up to date, complete or accurate.”
criticalRecord keeping: “Systems or processes were not established and operating effectively to maintain securely an accurate, complete and contemporaneous record of a persons care and treatment.”
criticalComplaints handling: “Systems and processes were not established and consistently operating effectively to ensure the accurate recording, investigation and response to complaints.”
criticalGovernance: “The registered manager had not ensured systems or processes were established and operating effectively to assess, monitor and improve the quality and safety of the service.”
moderateLeadership: “There was a lack of managerial oversight of the service to ensure the timely and thorough documenting, assessing and mitigations of risks within peoples care plans.”
moderateIncident learning: “Systems and processes were not established and effective to ensure the recording, investigation and learning from incidents.”
moderateStaff training: “The registered manager had not ensured staff had been trained in food hygiene to ensure the safe and appropriate preparation and storage of food.”
moderateConsent / capacity: “Systems and processes were not established and operating effectively to ensure the requirements of Deprivation of Liberty orders were understood and adhered to by staff.”
Strengths
· Care was consistently provided by the same staff, valued by people and relatives.
· Staff supported people's communication needs using Makaton and picture exchange systems.
· Safe recruitment checks including DBS were carried out for staff.
· People reported staff were polite, friendly, reliable and arrived on time.
· Staff felt valued, supported and described the team as a 'family'.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseRequires improvement
safe: Assessing risk, safety monitoring and managementRequires improvement
safe: Using medicines safelyRequires improvement
safe: Preventing and controlling infectionRequires improvement
safe: Learning lessons when things go wrongRequires improvement
safe: Staffing and recruitmentGood
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 law
Good
effective: Staff support: induction, training, skills and experienceGood
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: Supporting people to live healthier lives, access healthcare services and supportGood
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: Improving care quality in response to complaints or concernsRequires improvement
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: End of life care and supportGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Continuous learning and improving careRequires improvement
well-led: Engaging and involving people using the service, the public and staffGood
well-led: Promoting a positive culture that is person-centred, open, inclusive and empoweringGood
well-led: How the provider understands and acts on the duty of candourGood