Care Staffing Limited improved from Requires Improvement to Good overall, having remedied previous breaches around call management, staff preferences and governance, with people reporting safe, personalised and consistent care. Well-led remains Requires Improvement due to audit processes that failed to identify medicines recording gaps and lacked sufficient evidence of what was checked and actions taken.
Concerns (3)
moderate
Medication management
: “the audit had not identified that your electronic system had not generated a medicine administration record.”
moderateGovernance: “some audits were a tick box exercise rather than demonstrating exactly what was checked.”
moderateRecord keeping: “there was no record of whose care plan and what had been checked, to ensure actions were taken when required.”
Strengths
· People received care calls at agreed times with effective electronic call management system ensuring missed or late calls were acted upon immediately.
· Staff were kind, caring and attentive, matched with people they got on well with, providing a consistent staff team.
· People's privacy, dignity, gender preferences and cultural wishes were respected and promoted.
· Effective complaints handling with the registered manager responsive and approachable.
· Safe recruitment processes including DBS checks and references were in place.
Quality-Statement breakdown (22)
safe: Assessing risk, safety monitoring and management; Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Systems and processes to safeguard people from the risk of abuse and avoidable harmGood
safe: Preventing and controlling infectionGood
safe: Learning lessons when things go wrongGood
effective: Staff support: induction, training, skills and experienceGood
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 to provide consistent, effective, timely careGood
effective: Ensuring consent to care and treatment in line with law and guidanceGood
caring: Respecting and promoting people's privacy, dignity and independenceGood
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: Improving care quality in response to complaints or concernsGood
responsive: Planning personalised care to ensure people have choice and controlGood
responsive: Meeting people's communication needsGood
responsive: Supporting people to develop and maintain relationships to avoid social isolationGood
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
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: Continuous learning and improving careGood
First inspection of Care Staffing Limited rated Requires Improvement overall and across all five key questions, with breaches of Regulations 10, 12 and 17. Key concerns included missed and late care calls, medication errors, ineffective call monitoring, failure to submit statutory notifications for neglect incidents, and dignity/gender-preference failings.
Concerns (12)
criticalMissed or late visits: “People had experienced missed care calls... This included a missed mealtime call to a person who could not access their own food and drink. Another person had a missed care call when medication was due”
criticalMedication management: “Due to a missed care call, one person did not receive their medication as prescribed. Another person did not receive their medication because this was 'forgotten' by a staff member.”
criticalGovernance: “The provider did not have an effective care call monitoring system and people had experienced missed calls... their current system did not create an alert when staff failed to arrive at a care call.”
criticalSafeguarding: “they had not recognised neglect as a potential form of abuse or a safeguarding concern... seven incidents that should have been reported to us. These included five incidents of neglect”
moderatePerson-centred care: “We stated a gender preference for staff, but this is not met and my relation has no dignity or modesty, it is heart-breaking.”
moderateStaff training: “I did an online theory session on moving and handling but nothing on using equipment... I would have felt more confident and safer using it if I had been showed and trained before using it”
moderateComplaints handling: “some relatives made us aware of issues they had verbally complained to the compliance manager about, but we found no written record of the concern or complaint”
moderateIncident learning: “for two incidents, there was no written staff record of the actions proposed for improvement having been followed through.”
moderateRecord keeping: “the medication audit showed no evidence of people's medication administration record being checked. The audit focused on what would be relevant in a care home.”
moderateStaffing levels: “I have three care jobs and work 60 hours a week... the registered manager had not asked staff to inform them when they had multiple jobs”
moderateLeadership: “Leaders and the culture they created did not always promote high-quality, person-centred care.”
minorInfection control: “part of the infection control policy referred to 'the home' (care home)... This policy had not been adapted by the registered manager to the needs of their staff.”
Strengths
· People and their relatives felt safe with staff in their homes and protected from the risks of abuse
· Pre-employment checks (DBS, identity, references) were undertaken on staff to ensure they were suitable
· Staff understood the importance of gaining consent and supported people in the least restrictive way
· Collaborative working took place with district nurse team to support positive outcomes (e.g. skin damage)
· Adequate supplies of personal protective equipment (PPE) were available for staff use