Crisis North, a short-term domiciliary crisis support service in Lancaster, received an overall Good rating at its first CQC inspection, with staff praised for their caring, respectful and independence-promoting approach. However, Well-Led was rated Requires Improvement due to immature quality assurance systems that failed to identify issues with medicines oversight, consent recording, incident reporting, and staff training gaps.
Concerns (8)
moderate
Medication management
: “Medicines audits were not always robust. For example, they did not always sample enough MARs for the size of the service and had not always identified issues with MARs.”
moderateRecord keeping: “People's care needs were not always recorded in detail in their care plans. People did not have access to these records.”
moderateStaff training: “Staff had not always received training in learning disabilities and autism, which the service specialised in.”
moderateConsent / capacity: “Although staff sought consent from people prior to providing their care, people's consent was not being recorded.”
moderateGovernance: “The provider's quality assurance systems had not always identified issues we found during this inspection, including with medicines, consent and staff training.”
moderateIncident learning: “We were not assured all relevant incidents were being identified and reported to CQC. The provider told us they had identified this shortfall.”
minorCare planning: “People's care records did not always show how people were involved in their assessments or designing their care.”
minorSupervision / appraisal: “The provider had identified improvements were needed to staff appraisals. They had started to take action to ensure staff received appraisals routinely.”
Strengths
· People felt safe with staff and safeguarding training was in place; staff understood how to identify and escalate concerns.
· Staff demonstrated a consistently kind and caring approach; people and relatives praised dignity, respect, and encouragement of independence.
· The service was flexible and responsive, rapidly adapting care to meet people's changing needs and goals.
· Strong collaborative working relationships with local authority, health organisations and social care professionals.
· Staff completed a range of training and induction support; spot checks and regular supervision were carried out.
Quality-Statement breakdown (24)
safe: Systems and processes to safeguard people from the risk of abuseGood
safe: Preventing and controlling infectionGood
safe: Assessing risk, safety monitoring and managementGood
safe: Staffing and recruitmentGood
safe: Using medicines safelyGood
safe: Learning lessons when things go wrongGood
effective: Assessing people's needs and choices; delivering care in line with standards, guidance and the lawGood
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: Ensuring consent to care and treatment in line with law and guidanceGood
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
responsive: End of life care and supportGood
well-led: Continuous learning and improving careRequires improvement
well-led: Managers and staff being clear about their roles, and understanding quality performance, risks and regulatory requirementsRequires improvement
well-led: Engaging and involving people using the service, the public and staff, fully considering their equality characteristicsRequires 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